Chapter 42: The Child with an Immunologic Alteration My Nursing Test Banks

Chapter 42: The Child with an Immunologic Alteration

Test Bank

MULTIPLE CHOICE

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

a.

The immune system distinguishes and actively protects the bodys 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.

ANS: A

Feedback

A

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.

B

Children up to age 6 or 7 years have limited antibodies against common bacteria. The immunoglobulins reach adult levels at different ages.

C

Immunization is the basis from which the immune system activates protection against some communicable diseases.

D

Antibodies are produced by the immune system against invading agents, or antigens.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1039

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

2. 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.

The spleen reaches full size by 1 year of age.

b.

IgM, IgE, and IgD levels are high at birth.

c.

IgG levels in the newborn infant are low at birth.

d.

Absolute lymphocyte counts reach a peak during the first year.

ANS: D

Feedback

A

The spleen reaches its full size during adulthood.

B

IgM, IgE, and IgD are normally in low concentration at birth. IgM, IgE, IgA, and IgD do not cross the placenta.

C

The term newborn infant receives an adult level of IgG as a result of transplacental transfer from the mother.

D

Absolute lymphocyte counts reach a peak during the first year.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1040

OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

3. 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

ANS: D

Feedback

A

Both the spleen and mucous membranes are secondary organs of the immune system that act as filters to remove debris and antigens and foster contact with T lymphocytes.

B

Gut-associated lymphoid tissue is a secondary organ of the immune system. This tissue filters antigens entering the gastrointestinal tract.

C

The skin and lymph nodes are secondary organs of the immune system.

D

The thymus controls cell-mediated immunity (cells that mature into T lymphocytes). The bone marrow controls humoral immunity (stem cells for B lymphocytes).

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1039

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

4. Which statement is true regarding how infants acquire immunity?

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.

ANS: A

Feedback

A

Infants acquire long-term active immunity from exposure to antigens and vaccines. Immunity is acquired actively and passively.

B

The term infants passive immunity is acquired from the mother and begins to dissipate during the first 6 to 8 months of life.

C

Passive immunity is acquired from the mother.

D

Active immunity develops in response to immunizations.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1042

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

5. 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

ANS: A

Feedback

A

Perinatal transmission accounts for the highest percentage (91%) of HIV infections in children. Infected women can transmit the virus to their infants across the placenta during pregnancy, at delivery, and through breastfeeding.

B

Cases of HIV infection from sexual abuse have been reported; however, perinatal transmission accounts for most pediatric HIV infections.

C

Although in the past some children became infected with HIV through blood transfusions, improved laboratory screening has significantly reduced the probability of contracting HIV from blood products.

D

Poor handwashing is not an etiology of HIV infection.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1045

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

6. The Center for Disease Control (CDC, 2009) recommendation for immunizing infants who are HIV positive is

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 infants altered immune status.

d.

Eliminate the pertussis vaccination because of the risk of convulsions.

ANS: B

Feedback

A

Routine immunizations are appropriate; however, CD4+ cell counts should be assessed before administering the MMR and varicella vaccines to establish adequate immune system function.

B

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 childs CD4+ counts. Only inactivated polio virus (IPV) should be used for HIV-infected children.

C

Immunizations are given to infants who are HIV positive.

D

The pertussis vaccination is not eliminated for an infant who is HIV positive.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1052 | Table 42-2

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

7. 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 follow with chocolate candy.

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.

ANS: A

Feedback

A

Liquid forms of HIV medications may be foul tasting or have a gritty texture. Chocolate will help to make these foods more palatable and is liked by most children.

B

Medications should be mixed with nonessential foods.

C

Doses of medication should never be skipped.

D

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 familys everyday routine for years.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1051

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

8. 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

ANS: A

Feedback

A

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.

B

Nutrition, which contributes to a childs growth, is a nursing concern; however, it is not necessary for family members to bring food to the child.

C

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 childs growth and development.

D

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 not be appropriate.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1047

OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

9. 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 because of the risks associated with long-term usage.

c.

The medication should not be stopped abruptly.

d.

The medication may lower blood glucose, so the mother needs to observe for signs of hypoglycemia.

ANS: C

Feedback

A

Prednisone should be taken with food to minimize or prevent gastrointestinal bleeding.

B

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.

C

The dosage must be tapered before the drug is discontinued to allow the gradual return of function in the pituitary-adrenal axis.

D

The medication puts the child at risk for hyperglycemia.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1056

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

10. Children receiving long-term systemic corticosteroid therapy are most at risk for

a.

Hypotension

b.

Dilation of blood vessels in the cheeks

c.

Growth delays

d.

Decreased appetite and weight loss

ANS: C

Feedback

A

Hypertension is a clinical manifestation of long-term systemic steroid administration.

B

Dilation of blood vessels in the cheeks is associated with an excess of topically administered steroids.

C

Growth delay is associated with long-term steroid use.

D

Increased appetite and weight gain are clinical manifestations of excess systemic corticosteroid therapy.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1055

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

11. Which statement by a mother about antiretroviral agents for the management for her 5-year-old child with acquired immunodeficiency syndrome (AIDS) indicates that she has a good understanding?

a.

When my childs 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 childs age and growth.

d.

By the time my child is an adolescent she will not need her antiretroviral medications any longer.

ANS: C

Feedback

A

Antiretroviral medications are not administered for pain relief. Doubling the recommended dosage of any medication is not appropriate without an order from the physician.

B

Addiction is not a realistic concern with antiretroviral medications.

C

Doses of antiretroviral medication to treat HIV infection for infants and children are based on individualized age and growth considerations.

D

Antiretroviral medications are still needed during adolescence. Doses for adolescents are based on pubertal status by Tanner staging.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1048

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

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

a.

Limit activity and receive home schooling.

b.

Decrease the amount of potassium in the diet.

c.

Substitute a killed virus vaccine for live virus vaccines.

d.

Monitor for seizure activity.

ANS: C

Feedback

A

Limiting activity and home schooling are not routine for a child receiving high doses of steroids.

B

The child receiving steroids is at risk for hypokalemia and needs potassium in the diet.

C

The child on high doses of steroids should not receive live virus vaccines because of immunosuppression.

D

Children on steroids are not typically at risk for seizures.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1055

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

13. The nurse observes a red butterfly-shaped rash that spreads across the childs cheeks and nose. This assessment finding is characteristic of which condition?

a.

Systemic lupus erythematosus (SLE)

b.

Rheumatic fever

c.

Kawasaki disease

d.

Anaphylactic reaction

ANS: A

Feedback

A

A red, flat or raised malar butterfly rash over the cheeks and bridge of the nose is a clinical manifestation of SLE.

B

A major manifestation of rheumatic fever is erythema marginatum, which appears as red skin lesions spread peripherally over the trunk.

C

An erythematous rash, induration of the hands and feet, and erythema of the palms and soles are manifestations of Kawasaki disease.

D

Initial symptoms of anaphylaxis include severe itching and rapid development of erythema.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1057

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

14. 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

ANS: B

Feedback

A

Determining the cause of an anaphylactic reaction is important to implement the appropriate treatment, but the primary concern is the airway.

B

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.

C

During anaphylaxis, the cardiac output is decreased.

D

During the acute period of anaphylaxis, the nurses primary concern is the childs breathing. Positioning for comfort is not a primary concern during a crisis.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1060

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

15. 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

ANS: C

Feedback

A

Although diphenhydramine may be indicated, epinephrine is the first drug of choice in the immediate treatment of anaphylaxis.

B

Although a histamine inhibitor such as cimetidine may be indicated, epinephrine is the first drug of choice in immediate treatment of anaphylaxis.

C

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.

D

Albuterol is not usually indicated for treatment of anaphylaxis.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1064

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

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

a.

Wiskott-Aldrich syndrome

b.

Idiopathic thrombocytopenic purpura

c.

Acquired immunodeficiency syndrome (AIDS)

d.

Severe combined immunodeficiency disease

ANS: C

Feedback

A

Wiskott-Aldrich syndrome is not a viral illness.

B

Idiopathic thrombocytopenic purpura is not a viral illness.

C

Acquired immune deficiency is caused by the human immunodeficiency virus (HIV), which primarily attacks the CD4+ T cells.

D

Severe combined immunodeficiency disease is not a viral illness.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1045

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

17. A young child with HIV is receiving several antiretroviral drugs. The purpose of these drugs is to

a.

Cure the disease.

b.

Delay disease progression.

c.

Prevent the spread of disease.

d.

Treat Pneumocystis carinii pneumonia.

ANS: B

Feedback

A

At this time, cure is not possible.

B

Although not a cure, these antiviral drugs can suppress viral replication, preventing further deterioration of the immune system, and delay disease progression.

C

These drugs do not prevent the spread of the disease.

D

Pneumocystis carinii prophylaxis is accomplished with antibiotics.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1047

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

18. 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 source of infection.

ANS: A

Feedback

A

As a result of the immunocompromise that is associated with HIV infection, the prevention of infection is paramount. Although certain precautions are justified in limiting exposure to infection, these must be balanced with the concern for the childs normal developmental needs.

B

Preventing secondary cancers is not currently possible.

C

Current drug therapy is affecting the disease progression; although not a cure, these drugs can suppress viral replication preventing further deterioration.

D

Case finding is not a priority nursing goal.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1054

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

MULTIPLE RESPONSE

1. 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 according to the American Academy of Pediatrics recommendation for immunizing infants who are HIV positive? Select all that apply.

a.

Hepatitis B

b.

DTaP

c.

MMR

d.

IPV

e.

HIB

ANS: A, B, D, E

Feedback

Correct

Routine immunizations are appropriate.

Incorrect

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 childs CD4+counts. Only IPV should be used for HIV-infected children.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1052

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

2. Which home care instructions should the nurse provide to the parents of a child with acquired immunodeficiency syndrome (AIDS)? Select all that apply.

a.

Give supplemental vitamins as prescribed.

b.

Yearly influenza vaccination should be avoided.

c.

Administer trimethoprim-sulfamethoxazole (Bactrim) as prescribed.

d.

Notify the physician if the child develops a cough or congestion.

e.

Missed doses of antiretroviral medication do not need to be recorded.

ANS: A, C, D

Feedback

Correct

The parents should be taught that supplemental vitamins will be prescribed to aid in nutritional status. Bactrim is administered to prevent the opportunistic infection of Pneumocystis pneumonia. The physician should be notified if the child with AIDS develops a cough and congestion.

Incorrect

The yearly influenza vaccination is recommended and any missed doses of antiretroviral medication need to be recorded and reported.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1051

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

COMPLETION

1. It is important for the parents of a child who has had a severe allergic reaction to either peanuts or tree nuts to talk to their health care provider about whether the child should have medication available at school in case of an unanticipated exposure to nuts. Epinephrine is now available and easy to use in a device known as the ____________.

ANS:

EpiPen

The EpiPen is an auto-inject that can be given through the childs clothing. After the injection is given, the pen should be held in place for 10 seconds so that all medication can be delivered.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1061

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

2. _________________________ is a chronic, multisystem, autoimmune disease characterized by inflammation of the connective tissue.

ANS:

Systemic lupus erythematosus

SLE

SLE varies in severity and is marked by remission and exacerbations. Although the etiology is unknown, genetic, hormonal, environmental, and immune response factors are likely to be responsible.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 1057

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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