Question 1

A patient is experiencing an anaphylactic reaction.Which action by the nurse takes priority?

Accepted Answer

Anaphylaxis is a medical emergency.Airway comes first.The patient may need oxygen,but if the airway is not patent,the oxygen will not help.Listening to the lungs and determining the allergen come later.

Question 2

An HIV-positive mother wants to return to work because she is feeling well after starting therapy for her disease.She has a 10-month-old infant.What does the nurse advise her when selecting a day care or care provider for her child,who also is HIV-positive?

Accepted Answer

An important concept when caring for babies who are HIV-positive is that diaper changes must include using standard precautions and proper disposal of soiled diapers in biohazard bags and hazardous waste containers.To protect public safety,any day care or care provider the mother chooses must be educated on these procedures.Wearing gloves is not enough.The mother should disclose the baby's illness to protect the day-care workers.Keeping ill children away from her baby is important,too,and most day-care centers have specific guidelines about when sick children can attend.The mother should know these policies and advise the staff to keep her child away from other ill children.But the priority is proper disposal of waste.

Question 3

A 4-month old baby was recently hospitalized with septicemia and now has a severe diaper rash.Which primary immunodeficiency disorder does the nurse suspect?

Accepted Answer

Combined deficiency: T- and B-cell disorder usually manifests before 6 months of age and includes severe infections such as meningitis and septicemia,diaper dermatitis,and opportunistic infections.Antibody deficiencies are usually seen after 6 months of age.Complement defect disorder is often accompanied by autoimmune diseases.Phagocyte defect disorders include impetigo,mouth ulcers,suppurative adenitis,osteomyelitis,and poor wound healing.

Question 4

A faculty member is discussing systemic lupus erythematosus (SLE)with a group of nursing students.Which pathophysiological process does the nurse describe as the major problem in this disorder?

Accepted Answer

SLE is an autoimmune disorder in which antigen-antibody complexes are formed and deposited widely throughout the body,damaging many organs and tissues.It is tied to a genetic disposition but is not solely genetic in origin; it affects females more than males.The destruction is widespread,not limited to a few target organs.The disease is characterized by exacerbations and remissions.

Question 5

A nurse is caring for an infant with an HIV-positive mother.Which statement made by the nursing during teaching is the most appropriate?

Accepted Answer

Vertical (mother-to-infant)transmission can occur via breast milk,so the mother should be taught to bottle feed her baby.The other statements are inaccurate.

Question 6

An adolescent patient is taking combination retroviral therapy for HIV infection.He is not responding as expected.Which action by the nurse is most appropriate?

Accepted Answer

Adolescents are notorious for wanting to fit in with their peers,even at the cost of their health,and are frequently noncompliant with medication regimens.This is compounded by the very complex nature of multi-drug therapy for HIV.The nurse needs to assess for noncompliance first.Asking "why" questions often puts people on the defensive and may not lead to a truthful response.Consulting a social worker may be needed,but not as the first step.Unfortunately,simple drug regimens for HIV do not exist.

Question 7

A child with a primary immunodeficiency disorder had postimmunization titers drawn.The titers came back low.Which explanation does the nurse give the parents?

Accepted Answer

The most correct answer is that the low titers indicate that the child's immune system did not respond adequately to the vaccinations.It cannot be determined if they had no effect at all on the child.Although vaccinations did not produce the desired response,that does not mean they are not needed; they just did not work as planned.This child had a hypoactive,not hyperactive,response.

Question 8

A patient is experiencing an anaphylactic reaction.Which IV solution does the nurse anticipate will be ordered for this patient?

Accepted Answer

The fluid of choice in any emergency is an isotonic crystalloid; 0.9% normal saline is isotonic,0.45% normal saline and 5% dextrose in water are both hypotonic,and 3% saline is hypertonic.

Question 9

A nurse is providing anticipatory guidance to new parents.Which instruction by the nurse will assist the parents in maintaining physical barriers to prevent infection in their newborn?

Accepted Answer

All options are sound advice for helping to keep a newborn well.However,the only option specific to physical barriers available to protect against infection (skin,mucous membranes)is to wash the baby's skin with gentle soap and dry it well,helping to keep it intact.

Question 10

A nurse is caring for an HIV-positive child diagnosed with Pneumocystis jiroveci pneumonia who is receiving trimethoprim-sulfamethoxazole.Which finding indicates a possible complication of using this drug?

Accepted Answer

P.jiroveci is usually treated with trimethoprim-sulfamethoxazole (TMP-SMZ),a sulfa drug.A potential complication of this drug is Stevens-Johnson syndrome,characterized by a rash that turns into hemorrhagic blistering,fever,cough,sore throat,nausea,and vomiting.Polyuria,headache,and seizures are not typical findings in this condition.

Question 11

A child is receiving vaccinations at a well-baby clinic.The nurse explains to the mother that the vaccinations provide which type of immunity?

Accepted Answer

Vaccinations provide one type of active immunity.Passive immunity is brought about through immunoglobulins,either passed via the mother or given to the child through another means.Innate protection is provided by physical barriers,such as the skin or mucous membranes.Man-made immunity is not a classification of immunity.

Question 12

A 10-month-old-child is in the pediatric clinic for his eighth ear infection.Which assessment is most important for the nurse to perform on this child?

Accepted Answer

Children with primary immunodeficiencies can often be identified using Modell's 10 Warning Signs,which include failure to gain weight or grow properly.The nurse should assess the child's height and weight and graph it on the growth chart,comparing it to normal values for the child's age.Persistent oral or skin thrush is another sign if it persists past 1 year of age.Assessing for parental views on allergy testing is not related.Because these deficiencies are congenital,asking about the health of the entire family is too vague; it would be important to ask specifically about a history of primary immunodeficiencies,however.

Question 13

A nursing student is learning about the immune system.Which statement about immunoglobulins is correct?

Accepted Answer

IgM is the first antibody made in response to an infection.Adult levels of IgG are reached by 1 year of age.Children attain an adult level of IgA by 5 years of age.IgE is important in the response against fungus spores,animal dander,and pollen.

Question 14

A parent calls a pediatric information line worried about muscular dystrophy because her daughter has new onset of muscle weakness.Which question by the nurse would elicit the most useful information?

Accepted Answer

Dermatomyositis is an autoimmune disorder characterized by proximal muscle weakness,a red-purple facial rash,possibly a rash similar to that seen in systemic lupus erythematosus,tender and stiff muscles,voice changes,and dysphagia.The muscle weakness combined with the facial rash would provide the nurse a basis to suspect this disorder.This is not contagious nor is it inherited,so asking about others' symptoms would not be helpful.It is not characterized by exacerbations and remissions,and although stiffness is a common manifestation,that could be indicative of many other conditions.

Question 15

A parent of a child suspected of having systemic lupus erythematosus (SLE)asks why so many blood tests are being done.Which response by the nurse is the most appropriate?

Accepted Answer

The diagnostic workup for SLE is indeed complex,but many of the tests are done to determine if organ damage has already occurred and to obtain a baseline to which future tests can be compared.The other options are vague and do not really answer the parent's questions.

Question 16

A nurse is caring for a 5-year-old child diagnosed with Wiskott-Aldrich syndrome.When reviewing today's laboratory results,which finding does the nurse correlate with this condition?

Accepted Answer

Wiskott-Aldrich syndrome is characterized by thrombocytopenia,so the low platelet count of 6,000 correlates with this condition.The low hemoglobin could be found if the child has significant bleeding,but is not a specific finding.The low PaO₂ is also not directly related,and neither is the high white blood cell count.

Question 17

A teenage girl is diagnosed with systemic lupus erythematosus (SLE).Which health promotion guidance is important for the nurse to provide?

Accepted Answer

Sun exposure is a frequent cause of SLE exacerbations,so patients with SLE must use sunscreen and avoid prolonged time in the sun.This decreases vitamin D synthesis,which is required to metabolize and utilize calcium,leading to increased risk of osteoporosis.A side effect of steroid use is also osteoporosis,so patients with SLE (women especially)need to guard against this occurrence by adding supplemental vitamin D.NSAIDs are best for the pain and inflammation that accompany SLE.The patient does not have to be sedentary; a balance of rest and activity is needed.Pregnancy is not absolutely contraindicated in the patient with SLE; however,it must be considered cautiously in consultation with the health-care provider.

Question 18

A nursing faculty member is explaining the pediatric immune system to students.Which statement is correct?

Accepted Answer

Children are born with an intact immune system.There immune system,however,is immature.Infants do retain some immunity from their mothers from birth until about 6 months.The other statements are incorrect.

Question 19

A nurse volunteers for a disaster relief program and has traveled to an area devastated by a natural disaster.All basic services have been disrupted.When counseling an HIV-positive mother,what is the priority for her 8-month-old infant?

Accepted Answer

If the mother must mix dry powered formula to feed her baby,it is imperative that the water used be sanitary to avoid further compromising the infant and causing infection.The other information is important,but feeding is an immediate need.

Question 20

An HIV-positive child has low titers after a measles vaccination.She has now been exposed to the disease.Which action by the nurse is most appropriate?

Accepted Answer

When the immune-compromised child does not show an appropriate response to a vaccination,she should be treated with immunoglobulin if exposed.Repeating the vaccination will not help if the child's immune system cannot mount a response.Antibiotics are not used to treat measles.Protective isolation is not warranted.

Quiz 25: Caring for the Child With an Immunological or Infectious Condition