Archer Child Health - Infectious Disease

The nurse is educating a new nurse working on the pediatric unit about the causes of bacterial tonsillitis in children. Which of the following is the most common cause of bacterial tonsillitis? A. Group A beta hemolytic streptococcus B. Streptococcus pneumoniae C. Group B Streptococcus D. Neisseria meningitidis Submit Answer

Explanation Choice A is correct. Group A beta hemolytic streptococcus is the most common cause of bacterial tonsillitis. Choice B is incorrect. Streptococcus pneumoniae is a gram-positive bacterium that causes pneumonia; this bacterium does not cause tonsillitis. Choice C is incorrect. Group B Streptococcus is a type of bacteria sometimes found in a pregnant woman's vagina or rectum; this bacterium does not cause tonsillitis. Choice D is incorrect. Neisseria meningitidis is a gram-negative bacterium that causes meningococcal diseases such as meningitis; this bacterium does not cause tonsillitis. NCSBN Client Need Topic: Effective, safe care environment, Subtopic: Infection control and safety, Pediatric - HEENT Last Updated - 04, Feb 2022

You are reinforcing education to a group of parents after an outbreak of pediculosis capitis at the local elementary school. Which of the following points should you include? Select all that apply. A. Teach your children not to share hats or combs to prevent the spread of lice. B. It is important to apply the permethrin cream once as soon as you can. C. Parents will need to manually remove the lice with a fine-tooth comb 2-3 times/day until there are no visible lice. D. Anyone can get lice, it is not indicative of a dirty house. Submit Answer

Explanation Choices A and D are correct. You must educate parents to teach their children not to share hats or combs to prevent the spread of lice. Pediculosis capitis, or mites, is transmitted from person to person either through direct contact with the scalp or through personal items. Children may not understand why sharing hats or combs is terrible, so parents must talk with them about it (Choice A). Anyone can get lice; it is not indicative of a dirty house or child. Parents and children often feel embarrassed over having insects in their home and fear the reaction of their peers, friends, and family. The nurse should educate the community that anyone can contract lice and that it is not a reflection of how clean their home environment is (Choice D). Choice B is incorrect. While it is essential to apply permethrin cream to the scalp to kill the lice, it will be necessary to apply twice, not once. The first application will be immediately and then the second will be in 7-10 days. This is to prevent the recurrence of any lice. Choice C is incorrect. It is essential to teach the parents to remove the lice and mites with a fine-tooth comb manually, but only once per day is necessary, not 2-3 times/day. NCSBN Client Need Topic: Effective, safe care environment, Subtopic: Infection control and safety; Integumentary Last Updated - 16, Nov 2021

An 8-year-old client is admitted with rheumatic fever. Which clinical finding indicates to the nurse that the client needs to continue taking the salicylates he had received at home? A. Chorea B. Polyarthritis C. Subcutaneous nodules D. Erythema marginatum Submit Answer

Explanation Choice B is correct. Polyarthritis is characterized by swollen, painful, hot joints that respond to salicylates. Rheumatic fever is an inflammatory disease that can develop when strep throat or scarlet fever, which are caused by streptococcus bacteria, isn't adequately treated. It most often affects children who are between 5 and 15 years old, though it can develop in younger children and adults. Although strep throat is frequent, rheumatic fever is rare in the United States and other developed countries. However, rheumatic fever remains common in many developing nations. Rheumatic fever can cause permanent damage to the heart, including damaged heart valves and heart failure. Treatments can reduce inflammation, lessen pain, and prevent the recurrence of rheumatic fever. Choice A is incorrect. Chorea is restless, sudden aimless, and irregular movements of the extremities suddenly seen in persons with rheumatic fever, especially girls. Choice C is incorrect. Subcutaneous nodules are non-tender swellings over bony prominences sometimes seen in people with rheumatic fever. Choice D is incorrect. Erythema marginatum is a skin condition characterized by a nonpruritic rash, affecting the trunk and proximal extremities, seen in people with rheumatic fever. NCSBN Client Need Topic: Physiological Integrity, Subtopic: Pharmacological Therapies Last Updated - 09, Feb 2022

The nurse is explaining immunizations to the parent of a pediatric patient. What type of acquired specific immunity would the Varicella vaccine fall under? A. Natural active immunity B. Artificial active immunity C. Passive natural immunity D. Passive artificial immunity Submit Answer

Explanation Choice B is correct. The Varicella vaccine contains a live chicken-pox virus. Artificial active immunity refers to the immunization of the specific antigen known to cause illness. This includes live and attenuated vaccines. Choice A is incorrect. Natural active immunity is achieved when there is contact with the infecting antigen through clinical infections. Choice C is incorrect. Passive natural immunity is when the benefits are passed down from the mother via transplacental and colostrum transfer. Choice D is incorrect. Passive artificial immunity refers to the short-term freedom that occurs upon the injection of serum antibodies from an individual who is immune to the body of someone who was not making these antibodies. NCSBN Client Need: Topic: Immune, Subtopic: Health promotion/disease prevention, pathophysiology Last Updated - 16, Feb 2022

The nurse is administering palivizumab to a 3 month old infant being discharged from the Neonatal Intensive Care Unit. Which of the following images correctly demonstrates the appropriate site for the injection? A . B . C . D . Submit Answer

Explanation Choice B is correct. This image shows an injection being given in the vastus lateralis. This is the preferred injection site for IM injections in infants less than 12 months of age. The injection should be administered into the bulkiest part of the vastus lateralis muscle. Choice A is incorrect. This image shows an injection being given in the dorsogluteal site. This is not recommended in infants less than 12 months of age, but can be used in adult patients. The dorsogluteal site is above an imaginary line between the greater trochanter and the posterior superior iliac crest. The injection is administered laterally and superior to this imaginary line. Choice C is incorrect. This image shows an injection being given in the deltoid. This is not recommended in infants less than 12 months of age, but can be used in adult patients. The injection site is in the middle of the deltoid muscle, about 2.5 to 5 cm (1 to 2 inches) below the acromion process. Choice D is incorrect. This image shows an injection being given in the ventrogluteal site. This is not recommended in infants less than 12 months of age, but can be used in adult patients. To administer an injection in the ventrogluteal muscle, first, find the trochanter and then find the anterior iliac crest. Place the palm of your hand over the trochanter with your fingers extending towards the anterior iliac crest and give the injection between the knuckles on your index and middle fingers. NCSBN Client Need: Topic: Physiological Integrity, Subtopic: Pharmacological therapies, Pediatric - Respiratory Last Updated - 16, Nov 2021

A toddler has just been diagnosed with Reye syndrome. Upon assessment of the child's medical history, which condition should the nurse expect? A. Cellulitis B. Influenza C. Meningitis D. Mumps Submit Answer

Explanation Choice B is correct. Upon assessment of the child's medical history, the nurse should anticipate a finding of a viral infection -- specifically influenza (A or B) or varicella -- within the preceding two-week period. Choice A is incorrect. Cellulitis is a bacterial infection not typically associated with Reye syndrome. Choice C is incorrect. Meningitis, including viral meningitis, is not commonly associated with Reye syndrome. Choice D is incorrect. Mumps, although viral, is not generally associated with Reye syndrome. Learning Objective Correlate Reye Syndrome (also commonly referred to as Reye's Syndrome) with the finding of a diagnosis of influenza or varicella within the preceding two weeks. Additional Info Reye syndrome is a rare form of acute encephalopathy and fatty infiltration of the liver that tends to occur after some acute viral infections, particularly when salicylates are used. In June 1982, the Secretary of Health and Human Services began a public campaign to educate against the use of salicylates in pediatric patients. The New York Times ran a front-page article that included the following first line: "The Government announced plans today to advise doctors and parents against using aspirin to treat children's chicken pox or flu-like symptoms because studies have linked aspirin to Reye's Syndrome, a rare but often fatal children's disease."

The parent of an 11-year-old client who is receiving chemotherapy for leukemia is concerned because the client's sibling has chickenpox. Which of these actions will you anticipate taking next in caring for this client? A. Teach the parents regarding contact and airborne precautions. B. Administer varicella-zoster immune globulin to the client. C. Prepare the client for admission to a private room in the hospital. D. Educate the parent about the correct use of acyclovir. Submit Answer

Explanation Choice B is correct. Varicella-zoster immune globulin (VZIG) administration may prevent or reduce the severity of chickenpox in high-risk clients and will typically be prescribed by the provider in this setting. The Centers for Disease Control (CDC) recommends the administration of VZIG to prevent or reduce the severity of infection in high-risk people exposed to varicella or herpes zoster. Such high-risk clients include immunocompromised patients, pregnant women with no evidence of immunity to varicella, or newborn clients with exposure to varicella. VZIG should be administered as soon as the following possible exposure; however, it may be beneficial to administer it up to 96 hours after exposure. VZIG may offer protection up to 3 weeks following administration. Do not confuse Varicella Zoster Immunoglobulin with varicella vaccine. Varicella zoster vaccine is a live vaccine approved for the use in children aged 12 months and older to prevent chickenpox. Live attenuated Varicella vaccines (example: Zostavax; Varivax) are contraindicated in this client with chemotherapy-induced immunocompromise. Live vaccines are also contraindicated in pregnant women as they may cause congenital varicella. Additionally, there is not enough time for a vaccine to elicit an immune response to produce enough antibodies in the host following an exposure. On the other hand, an immunoglobulin (example: Varicella-Zoster Immunoglobulin) refers to a passive immunity where a readymade antibody is administered. It is, therefore, useful in post-exposure prophylaxis. Choice A is incorrect. Contact and airborne precautions will be implemented to prevent the spread of infection to other children if the child develops varicella. The client's sibling is at home and exposure has already occurred. Implementation of isolation precautions now is not going to help this client who already had a vulnerability. Avoid the distractor - focus on the client who has been exposed, NOT the sibling. Choices C and D are incorrect. Hospitalization and acyclovir therapy may be required if the child develops a varicella-zoster virus (chickenpox) infection. The child just had exposure, so VZIG should be administered to reduce his chances of getting chickenpox. NCSBN Client Need Topic: Safe and Effective Care Environment; Subtopic: Safety and Infection Control Last Updated - 11, Feb 2022

The nurse is interviewing the parents of a child diagnosed with rheumatic fever. Which previous infection is linked to the development of this condition? A. Cystitis B. Influenza C. Streptococcal infection D. Whooping cough Submit Answer

Explanation Choice C is correct. An untreated streptococcal infection, specifically Group A streptococcus, may lead to rheumatic fever, a severe condition with cardiac implications. Choices A, B, and D are incorrect. Cystitis, which is a bladder infection, is commonly caused by E. coli not linked to rheumatic fever. Influenza is not associated with rheumatic fever. Influenza is a contagious virus. Pertussis (whooping cough, Bordetella Pertussis) infection may affect the patient's skin, throat, urinary tract, and many other sites. Weight loss, urinary incontinence, syncope, and rib fractures from severe coughing may be seen, but not rheumatic fever. Additional Info Rheumatic fever (RF) has a strong relationship with group A streptococci (GAS) infection, usually pharyngitis. Manifestations of this illness include carditis, murmur, cardiomegaly, polyarthritis, and chorea. Severe cases may cause heart failure. Treatment for RF includes antibiotics, anti-inflammatory agents (aspirin), and supportive care. Last Updated - 01, Sep 2022

The parents of a 2-month-old infant brought their child to the outpatient clinic due to fever, telling the nurse that the child had a Diphtheria, Tetanus, and Pertussis (DTaP) vaccination injection one week prior. The parents ask the nurse if the fever is related to the DTaP vaccination. What would be the nurse's most appropriate response? A. "The fever after a DTaP injection usually occurs within the first 2 hours of immunization." B. "Fever is rare in a child after a DTaP immunization." C. "Fever after the DTaP injection is usually low-grade and appears within the first two days." D. "The child's fever should be treated." Submit Answer

Explanation Choice C is correct. Fever after a DTaP injection is low-grade and is expected within 24-48 hours of the vaccination. Choice A is incorrect. Fever after a DTaP injection is usually low-grade and typically occurs within 24-48 hours following the vaccination. Generally, most side effects are mild to moderate and only last between 1 to 3 days. Choice B is incorrect. Fever following a DTaP vaccination is usually low-grade and, if present, typically occurs within 24-48 hours of the vaccination. Studies have shown that 7% to 26% of pediatric clients experience fever symptoms following DTaP administration. Choice D is incorrect. The fever should be reported to the health care provider (HCP) so an antipyretic may be prescribed. Learning Objective In a pediatric client with a fever one-week post-DTaP administration whose parents ask whether the fever is related to the vaccination, identify the most appropriate nurse response as "[f]ever after the DTaP injection is usually low-grade and appears within the first two days." Additional Info The DTaP vaccine is given as five primary and one booster (all intramuscular injections) during childhood as follows: at age two months, four months, six months, 15 to 18 months, and 4 to 6 years (before school entry). The fifth dose is not necessary if the fourth dose was given at age ≥ 4 years and at least six months after the third dose. If the pertussis vaccine is contraindicated, a combined diphtheria and tetanus vaccination is available without the pertussis component. Last Updated - 25, Nov 2022

The 6-year-old immigrant child has been diagnosed with Hepatitis A. He was brought from Mexico by his grandparents a few days ago. You would expect that treatment for this child will include: A. Acyclovir B. Interferon C. Supportive care D. Ribavirin Submit Answer

Explanation Choice C is correct. Hepatitis A is typically an infection that is self-limiting if the child receives the appropriate supportive care. The disease is usually transmitted by drinking water and food that is contaminated with fecal matter. Removing the source of the infection and providing a healthy diet will often help resolve the infection. A hepatitis A vaccine is available that should be given to all children and high-risk adults. This vaccine should be given in two doses. Choice A is incorrect. Acyclovir is an antiviral that is given to slow the growth of the herpes virus. Choice B is incorrect. Interferon is a protein-based medication used in many immune system diseases such as multiple sclerosis (MS). Choice D is incorrect. Ribavirin is an antiviral medication used to treat hepatitis C, not hepatitis A. Last Updated - 26, Nov 2021

The nurse is admitting a child diagnosed with epiglottitis. Which vaccination would be most important for the nurse to ask the mother about? A. Tdap B. Influenza C. Hib D. MMR Submit Answer

Explanation Choice C is correct. Hib (Haemophilus influenzae type B) is the most common cause of the bacterial infection that causes epiglottitis. Incidence has been significantly decreased by the Hib vaccination. That is why the nurse should ask the mother about this vaccination during the admission questions. Choice A is incorrect. Tdap stands for Tetanus, Diphtheria, and Pertussis. While this vaccination is very important, it is not related to epiglottitis. There is no indication to ask specifically about this vaccination. Choice B is incorrect. The seasonal influenza vaccination is very important and all children over 6 months of age should receive it every year. While it is important to check on all vaccinations, the flu shot is not specifically related to epiglottitis so there is no indication to ask specifically about this vaccination. Choice D is incorrect. MMR stands for Measles, Mumps & Rubella. This is a very important childhood vaccination that all children should receive, but there is no relation between this specific vaccine and epiglottitis. Therefore, there is no indication to ask specifically about this vaccination. NCSBN Client Need: Topic: Health promotion and maintenance; Subtopic: Pediatric - Respiratory Additional Info Source : Archer Review Last Updated - 22, Nov 2021

Which of the following over-the-counter (OTC) medications is Reye's syndrome associated with? A. Acetaminophen B. Ibuprofen C. Aspirin D. Brompheniramine/pseudoephedrine Submit Answer

Explanation Choice C is correct. Reye's syndrome is a potentially fatal illness that can lead to liver failure and encephalopathy. Virus-infected children who are given aspirin to manage pain, fever, and inflammation are at an increased risk of developing Reye's syndrome. Choice A is incorrect. The use of acetaminophen has not been associated with Reye's syndrome and can be safely given to patients with fever due to viral illnesses. Choice B is incorrect. Ibuprofen's adverse effects include GI irritation and bleeding; in toxic doses, both renal and hepatic failure are reported. However, ibuprofen has not been associated with the onset of Reye's disease. Choice D is incorrect. Brompheniramine/pseudoephedrine contains a first-generation OTC antihistamine and a decongestant. Neither agent has been associated with the development of Reye's syndrome. NCSBN Client Need Topic: Physiological Integrity, Subtopic: Pharmacological Therapies Last Updated - 03, Feb 2022

The nurse is educating a group of students on the measles, mumps, and rubella (MMR) vaccine. Which statement, if made by the student, would indicate effective teaching? A. "Egg allergy is a contraindication to giving this vaccine." B. "This is a three-series vaccine that should be started at birth." C. "It is safe for breastfeeding women to receive MMR vaccination." D. "This vaccine is safe if the client is pregnant." Submit Answer

Explanation Choice C is correct. The MMR vaccine is safe to administer to a client who is breastfeeding. No evidence exists of this vaccine being weakened by breastfeeding. Further, breastfeeding does not interfere with the response to the MMR vaccine. Choices A, B, and D are incorrect. The MMR vaccine does not contain egg proteins and is not contraindicated in individuals with an egg allergy. The CDC does not recommend restricting MMR or Influenza vaccines to those with egg allergies. The yellow fever vaccine is the only vaccine that is contraindicated in severe egg allergy. This vaccine is not three series nor is it started at birth. The ideal immunization schedule is two doses of the MMR vaccination. The first dose should be between 12 and 15 months, and the second should be between 4 and 6 years. Current studies support the idea that it is possible that a pregnant woman could pass the virus to the fetus; therefore, use during pregnancy is not recommended. Additional Info The MMR vaccine is a live attenuated vaccine. In general, live vaccines are contraindicated in: Severely immunocompromised individuals: Prolonged courses of high-dose corticosteroids may cause immunosuppression and predispose the child to infections. Other conditions that can lead to immunocompromised status include hematological malignancies (lymphoma, leukemia), use of chemotherapy, and immunodeficiency disorders. In severely immunocompromised adults, the vaccine virus by itself may lead to the illness. Pregnant women: Current studies support the idea that it is possible that a pregnant woman could pass the virus to the fetus; therefore, use during pregnancy is not recommended. The ideal immunization schedule is two doses of the MMR vaccination. The first dose should be between 12 and 15 months, and the second should be between 4 and 6 years. Last Updated - 08, Sep 2022

A pediatric client has rubeola. What kind of infection control measure should the nurse initiate? A. Contact transmission precautions B. Droplet transmission precautions C. Airborne transmission precautions D. Rubella transmission precautions Submit Answer

Explanation Choice C is correct. The infection control measure that must be initiated is airborne transmission precautions because the mode of transmission for rubeola, or measles, is airborne. This type of transfer occurs when the pathogen is carried in dust or droplets in the air and that remains in place for a sufficient enough time to infect a person exposed to this air. Do not confuse rubeola with rubella. Rubeola (measles) requires airborne precautions, whereas rubella requires droplet precautions. Choice A is incorrect. Contact transmission precautions are used for infectious diseases that are spread with contact with the client or the client's environment. Contact transmission precautions prevent infections such as C. difficile and shigella. Choice B is incorrect. Droplet transmission precautions are used to prevent infections that are spread with particle drops larger in size than 5 microns. Droplet transmission precautions prevent diseases such as rubella, pneumonia, and scarlet fever. Choice D is incorrect. There are no transmission-based precautions referred to as rubella transmission precautions. The three types of transmission-based precautions are airborne transmission precautions, droplet transmission-based precautions, and contact transmission-based precautions. Additional Info Last Updated - 28, Oct 2022

While working in the emergency department, the nurse is assigned a 5-year-old client with a chief complaint of sore throat. The father states that the client has been complaining of throat pain for 2 days and when he looks in the child's throat it appears red with white patches. The nurse confirms the red throat with white patches during the throat assessment. Based on these findings, the nurse expects which of the following diagnostic tests to be ordered? A. Basic metabolic panel B. Extended respiratory virus panel C. Throat culture D. Complete blood count Submit Answer

Explanation Choice C is correct. The nurse expects that a throat culture will be ordered to confirm a diagnosis of bacterial tonsillitis. A throat culture will assess for the presence of bacteria on the pharynx and guide the team in making decisions about treatment/antibiotics for this patient. If the suspected diagnosis of bacterial tonsillitis is not confirmed, other tests may be necessary. Choice A is incorrect. A basic metabolic panel (BMP) is a very common laboratory test that evaluates a client's electrolyte levels, kidney function, blood glucose level, metabolism, and acid/base balance. This test is ordered for many different reasons, but it would not be helpful in the client suspected of having tonsillitis. There is another test that the nurse expects to be ordered. Choice B is incorrect. The extended respiratory virus panel is a test sent to evaluate for the presence of some of the most common respiratory viruses, including influenza, RSV, adenovirus, parainfluenza, and rhinovirus. While it is possible that this client has a virus, the nurse suspects bacterial tonsillitis based upon his symptoms and expects another diagnostic test to be ordered first. Choice D is incorrect. A complete blood count (CBC) is a test done to evaluate the different components present in a patient's blood such as their red blood cells, white blood cells, and platelets. It can show if a patient is anemic, has markers of infection, and much more. While this test could be ordered for many different reasons, it is not the test that will help confirm the suspected diagnosis of bacterial tonsillitis. The nurse expects another diagnostic test to be ordered first. NCSBN Client Need Topic: Effective, safe care environment, Subtopic: Coordinated care, Pediatric - HEENT Last Updated - 21, Oct 2021

While on day seven of antibiotic therapy, a 7-month-old infant develops oral thrush. Nystatin drops, 2 mL (200,000 units) four times daily, is prescribed by the infant's health care provider (HCP) for the thrush. Which nursing consideration should be implemented when administering this medication? A. Administer the medication with water B. Administer this medication through a nipple C. Give the medication with food D. Place 1 mL of the medication in each side of the infant's mouth Submit Answer

Explanation Choice D is correct. For nystatin to be effective, the medication should come into contact with the infected area. Nystatin drops are dispensed with a calibrated dropper to allow easier administration in young children. Administering half of the dose into each side of the mouth increases the likelihood the infected area has come into contact with the medication. Specifically, when administering this medication, use the calibrated dropper to place one-half of the dose (i.e., 1 mL (100,000 units)) in each side of the infant's mouth. Additionally, avoid providing oral intake to the infant for a minimum of 5 to 10 minutes following the administration of nystatin. Choice A is incorrect. Administering this medication with water would decrease the efficacy of the medication. The drug requires sustained contact with the infected area for nystatin to be effective.Administering the medication with water would either dilute the medicine or hinder the ability for sustained contact between the drug and the infected area. Choice B is incorrect. Administering this medication through a nipple would decrease the efficacy of the nystatin. Nystatin requires sustained contact with the infected area(s) for the medication to be effective. Administering the drug through a nipple would hinder the ability for sustained contact between the drug and the infected regions. Choice C is incorrect. Nystatin should not be given with food or water. Following the administration of nystatin, avoid providing oral intake to the infant for a minimum of 5 to 10 minutes. The drug requires sustained contact with the infected area for nystatin to be effective. Providing food and/or water during or immediately after nystatin is administered would hinder the therapeutic effects of the medication and decrease the efficacy. Learning Objective Recognize the need to place one-half of the ordered dose in each side of the mouth when administering nystatin to an infant client. Additional Info Source : Archer Review Last Updated - 10, Sep 2022

Your pediatric client has just begun an intravenous course of antibiotic therapy with a cephalosporin TID rather than penicillin because this child has a known allergy to penicillin but not to cephalosporins. When you enter the child's room during his first treatment with the cephalosporin, you see that the client is short of breath. What is the first thing that you should do? A. Call the doctor. B. Elevate the client's head of the bed to ease the shortness of breath. C. Slow the IV rate down because of possible fluid overload. D. Discontinue the IV and the cephalosporin administration. Submit Answer

Explanation Choice D is correct. The first thing that you should do is discontinue the IV and the cephalosporin administration because it is possible that this client is experiencing anaphylactic shock. Anaphylactic shock is a life-threatening emergency and is a high priority when considering airway, breathing, and cardiovascular status. Many people who have an allergy to penicillin also have a sensitivity and allergy to cephalosporins. Once the life-saving intervention is done, the nurse would fully assess the client, raise the head of the bed, and call the doctor for the possible administration of epinephrine. Choice A is incorrect. Although you would notify and call the child's doctor, this is not the first thing that you would do. There is another higher priority action that you would do before calling the doctor. Choice B is incorrect. Although you would elevate the client's head of the bed to ease the shortness of breath, this is not the first thing that you would do. There is another higher priority action that you would do before this. Choice C is incorrect. You would not slow the IV rate because of possible fluid overload since there is another possible life-threatening event that could be occurring. Last Updated - 26, Aug 2021

The nurse is reinforcing discharge instructions to the parents of a 6-year-old child with chickenpox. The nurse knows that the parents understand the discharge instructions when they make which of the following statements? A. "Once she has been without a fever for a day, she can go back to school." B. "She will still be infectious for 14 days, so we should let the school know she will be out for 2 weeks." C. "After antibiotics have been started, she can go back to school in 48 hours." D. "Once all of her sores are crusted over, it will be safe for her to go back to school." Submit Answer

Explanation Choice D is correct. This statement demonstrates understanding by the parents. Chickenpox is considered infectious until all of the lesions have crusted over. For most children, this occurs 6-7 days after the last of the rash presents but can be up to 10 days. Choice A is incorrect. The child could still be infectious after 24 hours of being afebrile, so she should not return to school until all the lesions are crusted over. Choice B is incorrect. The child will not necessarily be infectious for 14 days after going home. With chickenpox, children remain infectious until all of the lesions have crusted over. Typically, all the lesions crust over within 6-7 days. Therefore, staying home for 2 weeks is unnecessary. Choice C is incorrect. Chickenpox (or varicella) is a viral infection for which antibiotics will not be prescribed. This statement by the parents would indicate that they do not understand the treatment plan for their child, nor do they understand when she can go back to school. NCSBN Client Need: Topic: Effective, safe care environment; Subtopic: Infection control and safety Last Updated - 11, Jan 2022

A 3-year old presents to the emergency department with signs of respiratory distress. The child has epiglottitis associated with a high fever; he is apprehensive and drooling. The nurse must avoid which of the following? A. Listening to the child's lungs B. Assessing the child's vital signs C. Weighing the child D. Inspecting the child's mouth and throat with a tongue blade Submit Answer

Explanation Choice D is correct. When there are symptoms of epiglottitis, a tongue blade should not be used to assess the throat visually. The use of a tongue blade on the infected tissue might result in further swelling and inflammation, potentially closing off the child's airway completely. The symptoms of epiglottitis may resemble the signs of upper airway infection. These may include sudden onset of a severe sore throat, fever, loud voice, and a cough. Worsening symptoms may also involve drooling and leaning forward in a sitting position. Choices A, B, and C are incorrect. The nursing assessment should include listening to the lungs, assessing vital signs, and obtaining a weight. NCSBN Client Need: Topic: Physiological Integrity, Subtopic: Common Respiratory Disorders Last Updated - 25, Jul 2021

The nurse is performing a physical assessment on a child admitted with erythema infectiosum (Fifth disease). Which of the following would be an expected finding? Select all that apply. A. Erythema on face B. Headache C. Nuchal rigidity D. Hepatosplenomegaly E. Photophobia Submit Answer

Explanation Choices A and B are correct. Erythema infectiosum (Fifth disease) characteristically causes a child to develop erythema on the face (slapped face appearance). It also causes the appearance of maculopapular red spots distributed on the upper and lower extremities. Finally, the client will have mild flu-like symptoms such as a fever, headache, and malaise. Choices C, D, and E are incorrect. Nuchal rigidity and photophobia are characteristic of bacterial meningitis. Hepatosplenomegaly is an assessment found in mononucleosis. Additional Info Erythema infectiosum (Fifth disease) The causative agent is Parvovirus B19 Mode of transmission for this pathogen is respiratory secretions and blood, blood products Isolation is not necessary unless the child is immunosuppressed (standard/droplet will then be used) Manifestations include erythema on the face (slapped face appearance). It also causes the appearance of maculopapular red spots distributed on the upper and lower extremities. Finally, the client will have mild flu-like symptoms such as a fever, headache, and malaise Treatment is primarily supportive (antipyretics and analgesics) A blood transfusion may be needed for transient aplastic anemia

You are treating an 18-month-old who has tested positive for Respiratory Syncytial Virus (RSV). Which of the following signs and symptoms do you expect to see? Select all that apply. A. Thin nasal secretions B. Productive cough C. Bradypnea D. Nasal flaring Submit Answer

Explanation Choices A and D are correct. Thin nasal secretions are an expected symptom of Respiratory Syncytial Virus, otherwise known as RSV. This is an acute viral infection that affects the bronchioles. Children experience a lot of upper respiratory congestion when dealing with RSV; they need frequent suctioning to keep their airway clear and lessen their work of breathing (Choice A). Nasal flaring is an expected sign of RSV. This is a typical signal of respiratory distress in an infant or young child. As they take a breath, their nares flare outward with inspiration. This is because they are using a lot of effort to breathe. They are working so hard and using all of their accessory muscles that the sides of their nose flare outward with each inspiration. Nasal flaring is a symptom of RSV (Choice D). Choice B is incorrect. The cough found with RSV is typically nonproductive. Upon auscultation, you will note wheezing in the lungs and other signs of increased work of breathing. Their cough will sound dry and be spontaneous, but it does not typically produce any sputum. Choice C is incorrect. Bradypnea is not an expected finding of RSV. Instead, one would expect to see tachypnea. In children, we typically hope to see their vital sign numbers go up before they go down. This is because they are compensating. The child is working harder to breathe with RSV as they fight to keep their body oxygenated. They have increased work of breathing and start to breathe faster and faster to try to keep up. This is why tachypnea is an expected finding of RSV, not bradypnea. NCSBN Client Need: Topic: Physiological Integrity, Subtopic: Physiological adaptation; Pediatrics - Respiratory Last Updated - 13, Nov 2021

When educating an adolescent diagnosed with bacterial conjunctivitis about how to prevent the spread of their infection, which of the following points should you include? Select all that apply. A. Do not share towels or washcloths with family members. B. Stay home from school until they have taken antibiotics for 48 hours. C. Apply a warm compress to lessen any irritation. D. Throw out the contact lenses and get new ones. Submit Answer

Explanation Choices A and D are correct. To prevent the spread of bacterial conjunctivitis, it is essential not to share towels or washcloths with anyone while infected (Choice A). This is appropriate advice for preventing reinfection of bacterial conjunctivitis. If a patient wears the same contact lenses, they will likely spread the disease for a second time and become infected again. They should also be instructed to discard their eye makeup to prevent reinfection (Choice D). Choice B is incorrect. It is okay to go back to school after 24 hours of antibiotics, not 48 hours. Choice C is incorrect. Applying a compress will help improve comfort for the patient with bacterial conjunctivitis, but has nothing to do with preventing the spread of the infection. Furthermore, utilizing a warm compress would cause further irritation with bacterial conjunctivitis; instead, a cold compress should be used. NCSBN Client Need: Topic: Health Promotion and Maintenance, Subtopic: Integumentary Last Updated - 02, Nov 2021

The nurse is teaching parents of a child diagnosed with varicella. Which of the following information should the nurse include? Select all that apply. A. Your child may return to school once the lesions have crusted. B. Your child should take the entire course of antibiotics. C. Acetaminophen may be used for fever. D. Baths with baking soda may help with the itching. E. Do not use any aspirin or ibuprofen during the illness. Submit Answer

Explanation Choices A, C, D, and E are correct. Varicella is a highly contagious virus that may be spread by aerosolized droplets, contact with lesions, and contaminated surfaces. A child may return to school once all the lesions have crusted over. Fever is a common manifestation associated with varicella, and acetaminophen may be taken as prescribed to decrease the fever. Symptomatic care for a child with varicella includes cool baths with products such as baking soda or uncooked oatmeal added to relieve itching. Calamine lotion may also be applied to soothe the skin. Ibuprofen and aspirin should not be taken during the course of the illness because they may cause life-threatening skin infections. Choice B is incorrect. Varicella is a viral infection; antibiotics would be unnecessary in treating this infection. Additional Info ✓ Varicella is a highly contagious viral infection primarily spread by aerosolized droplets and direct contact with the lesions. ✓ Treatment is symptomatic with prescribed acetaminophen and therapeutic baths with cool water and uncooked oatmeal or baking soda. ✓ Prescribed antivirals, such as valacyclovir, may shorten the symptoms' duration. ✓ The client should be isolated using airborne and contact precautions until the lesions have crusted over. Last Updated - 15, Jan 2023

Which of the following educational points regarding fevers in children is essential for the LPN to review with a family being discharged home today? Select all that apply. A. Go to the emergency department for a temperature greater than 100.4 degrees F. B. Call the primary care office for a fever lasting longer than 3 days. C. Call the primary care office if the patient is not having any wet diapers. D. Go to the emergency department if the patient is eating less than usual and has a fever. Submit Answer

Explanation Choices B and C are correct. The parents should be educated to call the primary care office for fever lasting longer than three days. At that point, the child needs to be evaluated to determine the cause of the illness and appropriate action to decrease body temperature (Choice B). If the child is not having any wet diapers, they are severely dehydrated. The parents should be educated to monitor for this and call the primary care office for instructions. Likely, the child needs to be evaluated for the cause of the fever and subsequent dehydration determined then treated (Choice C). Choice A is incorrect. It is not necessary to go to the emergency room immediately for a temperature higher than 100.4 F. While this is our threshold for a fever, it does not require an emergency room visit. Instead, you should advise the parents to notify the primary care physician if the fever lasts longer than three days so that the child can be treated appropriately. Choice D is incorrect. If a child has a fever, it is very reasonable for their fluid/food intake to decrease. They likely do not feel well and do not have an appetite. If this persists for three days or longer, there are signs of dehydration, or the temperature surpasses 105 F, then the child needs to be seen by the healthcare provider. NCSBN Client Need: Topic: Health promotion and maintenance, Subtopic: Pediatrics Last Updated - 12, Nov 2021