Question 1

A nurse in a well-child clinic is teaching parents about their child's immune system.Which statement by the nurse is correct?
A) The immune system distinguishes and actively protects the body's own cells from foreign substances.
B) The immune system is fully developed by 1 year of age.
C) The immune system protects the child against communicable diseases in the first 6 years of life.
D) The immune system responds to an offending agent by producing antigens.

Accepted Answer

The immune system responds to foreign substances,or antigens,by producing antibodies and storing information.Intact skin,mucous membranes,and processes such as coughing,sneezing,and tearing help maintain internal homeostasis.Children up to age 6 or 7 years have limited antibodies against common bacteria.The immunoglobulins reach adult levels at different ages.Immunization is the basis from which the immune system activates protection against some communicable diseases.Antibodies are produced by the immune system against invading agents,or antigens.

Question 2

A young child with HIV is receiving several antiretroviral drugs.What is the purpose of these drugs?
A) Cure the disease.
B) Delay disease progression.
C) Prevent the spread of disease.
D) Treat Pneumocystis jiroveci pneumonia.

Accepted Answer

Although not a cure,these antiviral drugs can suppress viral replication,preventing further deterioration of the immune system,and delay disease progression.At this time,cure is not possible.These drugs do not prevent the spread of the disease.Pneumocystis jiroveci prophylaxis is accomplished with antibiotics.

Question 3

Which is the Centers for Disease Control and Prevention (CDC,2009)recommendation for immunizing infants who are HIV positive?
A) Follow the routine immunization schedule.
B) Routine immunizations are administered; assess CD4+ counts before administering the MMR and varicella vaccinations.
C) Do not give immunizations because of the infant's altered immune status.
D) Eliminate the pertussis vaccination because of the risk of convulsions.

Accepted Answer

Routine immunizations are appropriate.CD4⁺ cells are monitored when deciding whether to provide live virus vaccines.If the child is severely immunocompromised,the MMR vaccine is not given.The varicella vaccine can be considered on the basis of the child's CD4⁺ counts.Only inactivated polio virus (IPV)should be used for HIV-infected children.The pertussis vaccination is not eliminated for an infant who is HIV positive.

Question 4

What is the primary nursing concern for a child having an anaphylactic reaction?
A) Identifying the offending allergen
B) Ineffective breathing pattern
C) Increased cardiac output
D) Positioning to facilitate comfort

Accepted Answer

Laryngospasms resulting in ineffective breathing patterns is a life-threatening manifestation of anaphylaxis.The primary action is to assess airway patency,respiratory rate and effort,level of consciousness,oxygen saturation,and urine output.Determining the cause of an anaphylactic reaction is important to implement the appropriate treatment,but the primary concern is the airway.During anaphylaxis,the cardiac output is decreased.Positioning for comfort is not a primary concern during a crisis.

Question 5

Which intervention is appropriate for a child receiving high doses of steroids?
A) Limit activity and receive home schooling.
B) Increase the amount of carbohydrates in the diet.
C) Substitute a killed virus vaccine for live virus vaccines.
D) Monitor for seizure activity.

Accepted Answer

The child on high doses of steroids should not receive live virus vaccines because of immunosuppression.Limiting activity and home schooling are not routine for a child receiving high doses of steroids.Children on high doses of steroids sometimes get carbohydrate intolerance; the diet should not contain high levels of carbohydrates.Children on steroids are not typically at risk for seizures.

Question 6

The nursing student learns how infants acquire immunity.Which statement about this process is correct?
A) The infant acquires humoral and cell-mediated immunity in response to infections and immunizations.
B) The infant acquires maternal antibodies that ensure immunity up to 12 months age.
C) Active immunity is acquired from the mother and lasts 6 to 7 months.
D) Passive immunity develops in response to immunizations.

Accepted Answer

Infants acquire long-term active immunity from exposure to antigens and vaccines.Immunity is acquired actively and passively.The term infant's passive immunity is acquired from the mother and begins to dissipate during the first 6 to 8 months of life.Passive immunity is acquired from the mother.Active immunity develops in response to immunizations.

Question 7

A nurse is teaching parents about the importance of immunizations for infants because of immaturity of the immune system.The parents demonstrate that they understand the teaching if they make which statement?
A) "We plan to opt out of most childhood vaccinations."
B) "There are only a few diseases that have effective immunizations."
C) "Babies are born with a sophisticated immune system so they need few, if any, immunizations."
D) "Newborns have a hard time fighting infection so they need vaccinations."

Accepted Answer

Immaturity of the immune system places an infant and young child a greater risk of infection,so they need protection through a scheduled series of immunizations.Parents can opt out of many vaccinations,but the nurse should investigate why they plan to do so.Most communicable disease of childhood have immunizations.

Question 8

The nurse is planning care for an adolescent with AIDS.The priority nursing goal is to
A) prevent infection.
B) prevent secondary cancers.
C) restore immunologic defenses.
D) identify sources of infection.

Accepted Answer

As a result of the immunocompromise that is associated with HIV infection,the prevention of infection is paramount.Preventing secondary cancers is not currently possible.Current drug therapy is affecting the disease progression; although not a cure,these drugs can suppress viral replication and prevent further deterioration.Case finding is not a priority nursing goal.

Question 9

A 5-year-old child has acquired immunodeficiency syndrome (AIDS).What statement by the mother indicates good understanding of medications used for this condition?
A) "When my child's pain increases, I double the recommended dosage of antiretroviral medication."
B) "Addiction is a risk, so I only use the medication as ordered."
C) "Doses of the antiretroviral medication are selected on the basis of my child's age and growth."
D) "By the time my child is an adolescent she will not need her antiretroviral medications any longer."

Accepted Answer

Doses of antiretroviral medication to treat HIV infection for infants and children are based on individualized age and growth considerations.Antiretroviral medications are not administered for pain relief.Addiction is not a realistic concern with antiretroviral medications.Antiretroviral medications are still needed during adolescence.

Question 10

What is the drug of choice the nurse should administer in the acute treatment of anaphylaxis?
A) Diphenhydramine
B) Histamine inhibitor (cimetidine)
C) Epinephrine
D) Albuterol

Accepted Answer

Epinephrine is the first drug of choice in immediate treatment of anaphylaxis.Treatment must be initiated immediately because it may only be a matter of minutes before shock occurs.Diphenhydramine and cimetidine may be used,but the drug of choice is epinephrine.Albuterol is not usually indicated.

Question 11

What is the primary nursing concern for a hospitalized child with HIV infection?
A) Maintaining growth and development
B) Eating foods that the family brings to the child
C) Consideration of parental limitations and weaknesses
D) Resting for 2 to 3 hours twice a day

Accepted Answer

Maintaining growth and development is a major concern for the child with HIV infection.Frequent monitoring for failure to thrive,neurologic deterioration,or developmental delay is important for HIV-infected infants and children.Nutrition,which contributes to a child's growth,is a nursing concern; however,it is not necessary for family members to bring food to the child.Although an assessment of parental strengths and weaknesses is important,it will be imperative for health care providers to focus on the parental strengths,not weaknesses.This is not as important as the frequent assessment of the child's growth and development.Rest is a nursing concern,but it is not as high a priority as maintaining growth and development.Rest periods twice a day for 2 to 3 hours may or may not be appropriate.

Question 12

Which suggestion is appropriate to teach a mother who has a preschool child who refuses to take the medications for HIV infection?
A) Mix medications with chocolate syrup or pudding
B) Mix the medications with milk or an essential food.
C) Skip the dose of medication if the child protests too much.
D) Mix the medication in a syringe, hold the child down firmly, and administer the medication.

Accepted Answer

Adding medication to a small amount of nonessential food the child finds tasty may be helpful in gaining the child's cooperation.Doses of medication should never be skipped.Fighting with the child or using force should be avoided.A nonessential food that will make the taste of the medication more palatable for the child should be the correct action.The administration of medications for the child with HIV becomes part of the family's everyday routine for years.

Question 13

A nurse is working in an allergy clinic and has performed skin testing on an adolescent.Seventeen minutes after the procedure,the nurse note the presence of a wheal at one of the sites.What conclusion does the nurse make about this response?
A) The child is allergic to that substance.
B) This result is indeterminate.
C) The testing should be redone in another location.
D) Anaphylaxis is imminent.

Accepted Answer

The presence of a wheal within 30 minutes of skin testing is indicative of an allergy to the substance used.The test does not need to be repeated,and anaphylaxis is not imminent.

Question 14

Which organs and tissues control the two types of specific immune functions?
A) The spleen and mucous membranes
B) Upper and lower intestinal lymphoid tissue
C) The skin and lymph nodes
D) The thymus and bone marrow

Accepted Answer

The thymus controls cell-mediated immunity (cells that mature into T lymphocytes).The bone marrow controls humoral immunity (stem cells for B lymphocytes).Both the spleen and mucous membranes are secondary orgAnswer of the immune system that act as filters to remove debris and antigens and foster contact with T lymphocytes.Gut-associated lymphoid tissue is a secondary organ of the immune system.This tissue filters antigens entering the gastrointestinal tract.The skin and lymph nodes are secondary orgAnswer of the immune system.

Question 15

The mother of an HIV-positive infant who is 2 months old questions the nurse about which childhood immunizations her child will be able to receive.Which immunizations should an HIV-positive child be able to receive? (Select all that apply.)
A) Hepatitis B
B) DTaP
C) MMR
D) IPV
E) HIB

Accepted Answer

Routine immunizations are appropriate.The MMR vaccination is not given at 2 months of age.If it were indicated,CD4⁺ counts are monitored when deciding whether to provide live virus vaccines.If the child is severely immunocompromised,the MMR vaccine is not given.The varicella vaccine can be considered on the basis of the child's CD4⁺ counts.Only IPV should be used for HIV-infected children.

Question 16

What disorder is caused by a virus that primarily infects a specific subset of T lymphocytes,the CD4⁺ T cells? A) Raynaud phenomenon B) Idiopathic thrombocytopenic purpura C) Acquired immunodeficiency syndrome (AIDS) D) Severe combined immunodeficiency disease

Accepted Answer

Acquired immunodeficiency is caused by the human immunodeficiency virus (HIV),which primarily attacks the CD4⁺ T cells.The other disorders are not viral in nature.

Question 17

What should the nurse include in a teaching plan for the mother of a toddler who will be taking prednisone for several months?
A) The medication should be taken between meals.
B) The medication needs to be discontinued if side effects appear.
C) The medication should not be stopped abruptly.
D) The medication may lower blood glucose.

Accepted Answer

The dosage must be tapered before the drug is discontinued to allow the gradual return of function in the pituitary-adrenal axis.Prednisone should be taken with food to minimize or prevent gastrointestinal bleeding.Although there are adverse effects from long-term steroid use,the medication must not be discontinued without consulting a physician.Acute adrenal insufficiency can occur if the medication is withdrawn abruptly.The dosage needs to be tapered.The medication puts the child at risk for hyperglycemia.

Question 18

Children receiving long-term systemic corticosteroid therapy are most at risk for which condition?
A) Hypotension
B) Dilation of blood vessels in the cheeks
C) Growth delays
D) Decreased appetite and weight loss

Accepted Answer

Growth delay is associated with long-term steroid use.Hypertension is a clinical manifestation of long-term systemic steroid administration.Dilation of blood vessels in the cheeks is associated with an excess of topically administered steroids.Increased appetite and weight gain are clinical manifestations of excess systemic corticosteroid therapy.

Question 19

What is the most common mode of transmission of human immunodeficiency virus (HIV)in the pediatric population?
A) Perinatal transmission
B) Sexual abuse
C) Blood transfusions
D) Poor handwashing

Accepted Answer

Perinatal trAnswermission accounts for the highest percentage (91%)of HIV infections in children.Infected women can trAnswermit the virus to their infants across the placenta during pregnancy,at delivery,and through breastfeeding.Cases of HIV infection from sexual abuse have been reported; however,perinatal trAnswermission accounts for most pediatric HIV infections.Although in the past some children became infected with HIV through blood trAnswerfusions,improved laboratory screening has significantly reduced the probability of contracting HIV from blood products.Poor handwashing is not an etiology of HIV infection.

Question 20

The nurse observes a rash on a teen's face which is characteristic of systemic lupus erythematosus (SLE).What action by the nurse is most appropriate?
A) Teach the teen about using sunscreen.
B) Prepare the teen for a bone marrow biopsy.
C) Educate the teen on proper use of antibiotics.
D) Demonstrate how to use an Epi-pen.

Accepted Answer

The nurse needs to provide education on managing the disease; one facet includes minimizing sun exposure so the nurse teaches the teen about the correct use of sunscreen.The teen will not have a bone marrow biopsy,need antibiotics,or have to use an Epi-pen.

Quiz 42: The Child with an Immunologic Alteration

A nurse in a well-child clinic is teaching parents about their child's immune system.Which statement by the nurse is correct?

A young child with HIV is receiving several antiretroviral drugs.What is the purpose of these drugs?

Which is the Centers for Disease Control and Prevention (CDC,2009) recommendation for immunizing infants who are HIV positive?

What is the primary nursing concern for a child having an anaphylactic reaction?

Which intervention is appropriate for a child receiving high doses of steroids?

The nursing student learns how infants acquire immunity.Which statement about this process is correct?

A nurse is teaching parents about the importance of immunizations for infants because of immaturity of the immune system.The parents demonstrate that they understand the teaching if they make which statement?

The nurse is planning care for an adolescent with AIDS.The priority nursing goal is to

A 5-year-old child has acquired immunodeficiency syndrome (AIDS) .What statement by the mother indicates good understanding of medications used for this condition?

What is the drug of choice the nurse should administer in the acute treatment of anaphylaxis?

What is the primary nursing concern for a hospitalized child with HIV infection?

Which suggestion is appropriate to teach a mother who has a preschool child who refuses to take the medications for HIV infection?

A nurse is working in an allergy clinic and has performed skin testing on an adolescent.Seventeen minutes after the procedure,the nurse note the presence of a wheal at one of the sites.What conclusion does the nurse make about this response?

Which organs and tissues control the two types of specific immune functions?

The mother of an HIV-positive infant who is 2 months old questions the nurse about which childhood immunizations her child will be able to receive.Which immunizations should an HIV-positive child be able to receive? (Select all that apply.)

What disorder is caused by a virus that primarily infects a specific subset of T lymphocytes,the CD4⁺ T cells?

What should the nurse include in a teaching plan for the mother of a toddler who will be taking prednisone for several months?

Children receiving long-term systemic corticosteroid therapy are most at risk for which condition?

What is the most common mode of transmission of human immunodeficiency virus (HIV) in the pediatric population?

The nurse observes a rash on a teen's face which is characteristic of systemic lupus erythematosus (SLE) .What action by the nurse is most appropriate?