Chapter 22: Communicable Diseases

45. Iona has been brought to the clinic for her well-child checkup and immunizations. When the nurse completes the assessment, Iona is noted to have a low-grade fever. The nurse knows that: 1. Iona should not receive the immunizations because her body is ill. 2. Iona can receive the immunizations since the fever is low grade. 3. Iona can receive the immunizations because the low-grade fever will increase the effectiveness of the vaccine. 4. It is important to remain on schedule with the immunizations.

1 (1. A patient should be in good health prior to the administration of vaccines to help reduce the side effects. 2. A patient should be in good health prior to the administration of vaccines to help reduce the side effects. 3. A low-grade fever will increase the occurrence of the child obtaining the disease process. 4. It is important to remain on schedule with immunizations, but typical childhood illnesses last 10 to 14 days, and this will not change the schedule enough to make a difference.)

66. Jasmine's mom calls the pediatric triage nurse and asks if she can give aspirin because of a fever and achiness due to chicken pox. The nurse knows that the mother understands the reason not to give the aspirin in this situation when she states: 1. "If I give aspirin, she is as risk for major issues with her brain and liver." 2. "I can give the aspirin in a low dose and be safe." 3. "I can give the aspirin in three separate doses throughout the day." 4. "I should not give her aspirin because this can make her blood thin and not help with her get better."

1 (1. Aspirin is not recommended for children due to the risk for liver and brain damage. 2. Any dose of aspirin for a child can cause damage to the liver and brain. 3. Any dosing schedule can cause damage to the child's liver and brain. 4. The asprin may cause blood to thin, but the main concern is the development of Reye's Syndrome.)

24. A 6-week-old infant is brought into the emergency department with a cough that ends in a crowing sound, followed by vomiting. The nurse suspects which of the following illnesses? 1. Pertussis 2. Diptheria 3. Bronchiolitis 4. Respiratory Syncytial Virus

1 (1. Characteristic signs and symptoms of pertussis, or whooping cough, include cold symptoms with coryza, mild cough and fever in the early stages, progressing to a cough ending with a crowing (whooping) that may be severe enough to cause vomiting and cyanosis. 2. The child will have diarrhea and fevers with diphtheria. 3. The child will have symptoms of wheezing and difficulty breathing with Bronchiolitis. 4. The child will have large amounts of mucous and wheezing present with RSV.)

15. A 6-year-old boy is admitted to the hospital with a severe case of chickenpox with persistent fever. The nurse monitors the child for which of the following complications? 1. Pneumonia 2. Kidney failure 3. Seizure activity 4. Rheumatic fever

1 (1. Complications from varicella-zoster or chickenpox include bacterial infections of the skin, pneumonia, septicemia, encephalitis, and bleeding problems. 2. Kidney issues are not usually present with chickenpox. 3. Seizures are rare with chickenpox. 4. Rheumatic fever is a complication of other bacteria.)

14. A mother brings in her 4-year-old daughter to be evaluated for a rash all over her torso. The mother states that the 4 year old was recently around her grandmother, who is presently recovering from shingles. The mother is now concerned that the child has contracted shingles. Which of the following would be an appropriate response by the nurse to the mother? 1. "It is possible that she has contracted shingles from her grandmother." 2. "She has contracted chickenpox since both diseases are from the same virus." 3. "She can only get shingles from someone who has chickenpox." 4. "This rash does follow the normal pattern along a dermatome or particular nerve fiber."

1 (1. However, a child may contract chickenpox from an individual with shingles. 2. Shingles is a reactivation of the Varicella-zoster virus that causes chickenpox. Caregivers should be educated that a child cannot get shingles from someone with chickenpox. However, a child may contract chickenpox from an individual with shingles. The chickenpox rash first appears on the trunk and face, whereas shingles follows dermatomes or particular nerve fibers. 3. Caregivers should be educated that a child cannot get shingles from someone with chickenpox. However, a child may contract chickenpox from an individual with shingles. The chickenpox rash first appears on the trunk and face, whereas shingles follows dermatomes or particular nerve fibers. 4. The chickenpox rash first appears on the trunk and face, whereas shingles follows dermatomes or particular nerve fibers.)

8. A 15-year-old girl has been diagnosed with Hepatitis B and will be starting treatment with Interferon-alpha (IFN). The nurse needs to educate the patient on this medication. Which of the following should be included in this education? 1. The medication reduces the replication of the Hepatitis B virus. 2. The patient needs to remain on treatment for one year. 3. Patients may develop resistance to Interferon-alpha over time. 4. Interferon-alpha has fewer side effects than Lamivudine, which is also used to treat Hepatitis B

1 (1. Interferon-alpha reduces the replication of the HBV virus. The medication is given as a subcutaneous injection three times a week for 4 to 6 months. Lamivudine, the other drug used to treat Hepatitis, has fewer side effects, but may patients develop a resistance. 2. The medication is given as a subcutaneous injection three times a week for 4 to 6 months. 3. Lamivudine, the other drug used to treat Hepatitis, has fewer side effects, but may patients develop a resistance. 4. Lamivudine, the other drug used to treat Hepatitis, has fewer side effects, but may patients develop a resistance.)

61. RSV can be life threatening for infants and young children. Children who are at high risk for vulnerability to RSV include all of the following except: 1. Immunocompromised school-age children. 2. Infants with congenital heart defects. 3. Premature infants. 4. Respiratory compromised toddlers.

1 (1. RSV tends to affect younger children. 2. Children with a congenital heart defect are at a higher risk for susceptibility to RSV. 3. A premature infant is at a higher risk due to an immature immune system. 4. A toddler with respiratory issues has a compromised immune system, placing him/her at higher risk.)

38. The pediatric nurse is discussing vaccines for a well-child check at 1 year of age. Common vaccines to give at this time include: 1. Hib (Hemophilus Influenzae Type B) 2. RotaTeq. 3. MCV4 (Meningococcal). 4. DRaP (Diphtheria, Tetanus, Pertussis).

1 (1. Recommended at this time 2. Not all children are required to have this vaccine. 3. Recommended later in life 4. Recommended earlier in life)

22. A 6 month old is brought in to the office for a well-child visit. The baby was born prematurely at 34 week's gestation. Which of the following vaccines is recommended for the infant to reduce the risk of Respiratory Syncytial Virus Bronchiolitis? 1. Synagis 2. RotaTeq 3. Relenza 4. Immune globulin

1 (1. Synagis has significantly reduced the incidence of RSV Bronchiolitis in infants. The immunization is recommended for infants who were born at less than 35 week's gestational age or who have chronic lung or heart disease. 2. RotaTeq is used for the prevention of rotovirus, not RSV 3. Relenza is used for the treatment of influenza, not RSV. 4. The immune globulin is used in situations for patients that are not able to have the synagis vaccine.)

55. Liza's mother calls the pediatric triage nurse because she is concerned about her usually healthy daughter's rosy, lacey cheeks, fever, and fussiness. The mother reports that this illness has been going around the day care. The nurse anticipates that the doctor's orders will include: 1. Acetaminophen, adequate hydration, and to let the virus run its course. 2. Having the child admitted to the emergency room because this is a medical emergency. 3. Having the mother speak with the day care and discuss good hand washing techniques. 4. Giving the child TLC and hydration.

1 (1. The child is exhibiting a viral infection. 2. The signs and symptoms are not a medical emergency. 3. This would be appropriate to educate the mother, but this is not the primary answer for this question. 4. This would be appropriate, but it does not answer the question for the mother.)

11. Which of the following should be considered in the administration of the influenza vaccine? 1. The vaccine is contraindicated for individuals who are allergic to eggs or egg products. 2. The Live Attenuated Influenza Virus (LAIV) is a safe alternative for children of any age. 3. The influenza vaccine is contraindicated in children with asthma and wheezing within the past 12 months. 4. Since influenza has a bimodal seasonal pattern, children under 18 years of age should receive two doses of the vaccine.

1 (1. The influenza vaccine is manufactured from the protein of eggs; therefore, the vaccine is contraindicated for those individuals who are allergic to eggs or egg products. 2. The live vaccine should not be given to children with asthma issues. 3. The nasal spray, live attenuated influenza virus is contraindicated for children with asthma and should not be given to children ages 2 to 4 who have been wheezing within the past 12 months. 4. Children through 8 years of age who are receiving their first influenza immunization need two doses, at least four weeks apart.)

65. Photophobia can occur in which communicable disease process? 1. German measles 2. Influenza 3. Rubeola 4. Hand-Foot-Mouth Disease

3 (1. Photophobia is not present in German measles. 2. Photophobia is not usually present in Influenza. 3. Photophobia is common with Rubeola. 4. Hand-Foot-Mouth Disease does not have photophobia as a symptom.)

16. A nurse is working on a pediatric unit and notices that many of the children on the unit are admitted with a communicable disease. She realizes that the best action she can take to prevent the spread of communicable diseases is: 1. Hand washing. 2. Wearing gloves. 3. Wearing gloves and a gown. 4. Placing the child in isolation.

1 (1. The key to preventing the spread of communicable diseases is hand washing. Caregivers and children must be taught to wash hands before and after caring for infants and children, before eating and handling food, after using the bathroom or changing diapers, after handling animals, after playing in water or in the sand, and after using tissues to wipe eyes or noses. 2. Wearing gloves is only effective if hand washing occurs before and after use. 3. Gowning and gloving are the not primary barriers for preventing the spread of disease. 4. The child does not need isolation at this time.)

44. A nurse is assessing a pediatric patient prior to giving the meningococcal vaccine. Which statement by the father would be an indication not to give the patient the vaccine? 1. "She is allergic to those latex gloves you are using, so can you please use the latex-free ones?" 2. "She is allergic to those latex-free gloves, so please use the latex gloves." 3. "She is allergic to gluten, so this vaccine should not be given." 4. "She is allergic to rubbing alcohol, so please do not cleanse the site with it."

1 (1. The meningococcal vaccine should not be given to a child with a latex allergy. 2. Latex-free gloves do not cause hypersensitivity to the vaccine. 3. Gluten is not in the meningococcal vaccine. 4. Rubbing alcohol will not cause a major allergic reaction.)

30. A 3 year old is brought to the emergency department with a fever that has lasted for the past three days. The mother is concerned because the toddler is very lethargic. The child is crying, but the nurse notices no tears, and her eyes look sunken. The nurse anticipates which of the following priority interventions? 1. Administering intravenous fluids 2. Placing the child in contact precautions 3. Decreasing stimulation and providing time to rest 4. Administering antibiotics to reduce the child's fever

1 (1. This child is demonstrating signs and symptoms of dehydration and needs immediate intervention with intravenous fluids. The nurse should also assess if the child has had a decreased urine output and continue to monitor the child's intake and output. 2. The child is past the transmission state of illness. 3. These are important factors, but they are not the priority at this time. 4. Viral infections can cause fevers, and no antibiotics should be used at that time.)

43. A 1 year old has received her MMR and Varivax vaccines at the clinic today. The nurse explains the chance for rash and gives visual aids to the mother to take home. The nurse knows that the mother understands the normal reaction to Varivax when she points out: 1. A varicella-type rash. 2. A maculopapular rash. 3. A pin point rash. 4. A strawberry-patterned rash on her tongue.

1 (1. This is a normal reaction 2. An abnormal reaction with the Varivax vaccine 3. An abnormal reaction with the Varivax vaccine 4. An abnormal reaction with the Varivax vaccine)

34. A mother and father are reading a pamphlet about the Hepatitis B series of vaccines for their newborn daughter. The father asks the nurse how many shots their baby will need to receive. The nurse knows that her teaching has been effective when the parents respond with: 1. "A shot will be given today, then at her two month checkup, and again at her six month checkup." 2. "The shot cannot be given until she is at least 6 months old because she will need to build some immunity to the virus first." 3. "The injection is given in just one does, and then a booster is administered before she goes to school." 4. "She does not need the immunization because her mother was Hepatitis B negative."

1 (1. This is the correct time frame for the vaccine administration for a newborn. 2. The vaccine can be given at birth, and the parents do not need to wait. 3. The vaccine requires a series of three injections. 4. Her mother's status does not influence the need for the vaccine.)

69. Malcolm has given his pediatric patient three vaccines. Documentation is being placed in the patient's chart. Malcolm knows that he must document: (Select all that apply.) 1. The lot number of the vaccine. 2. The site of the injection. 3. The date of administration. 4. The consent for administration. 5. The side effects the patient exhibited.

1, 2, 3, 4 (1. Needed for documentation 2. Needed for documentation 3. Needed for documentation 4. Needed for documentation 5. This is not required initially unless the patient exhibits a side effect.)

68. A 2-month-old presents to the pediatric clinic with a cough with crowing at the end, coryza, and vomiting. The diagnosis is whooping cough, and the child is taken immediately to the pediatric unit at the nearby hospital. The nurse explains the plan of care for the infant to the mother. The nurse should say: (Select all that apply.) 1. "Feedings will be small in an attempt to keep the infant from vomiting." 2. "We will be watching how the infant breathes and will provide extra support if needed." 3. "We plan to wake the infant every hour in order to assess and feed the infant to make sure that he/she is getting enough calories." 4. "Cool mist humidification will be continuous to help keep the fever down." 5. "An IV will be placed for antibiotics."

1, 2, 5 (1. Small, frequent feedings will decrease the chance for an emesis when the infant coughs. 2. Respiratory compromise occurs with whooping cough. It is important to provide support if needed. 3. Letting the infant rest is important to help with the healing process. 4. Cool mist humidification is used for keeping secretions thin, not for fever reduction. 5. IV antibiotics are an effective treatment for this disease process.)

33. A family recently returned from a trip to Mexico. About one month after returning, the parents noticed that their 6-year-old child has dark urine and has been complaining of a stomachache and a poor appetite. Considering the history and clinical presentation of the child, the nurse suspects that the child may have which of the following? 1. Malaria 2. Hepatitis A 3. Hepatitis B 4. Clostridium Difficile

2 (1. A child with malaria would have constant diarrhea and fevers. 2. The clinical presentation in this scenario is that of Hepatitis A. The disease is often contracted when children travel outside of the country and ingest contaminated food or water. They may present with malaise, poor appetite, nausea, jaundice, abdominal pain, and dark urine. Children under the age of 6 may have mild or no symptoms. Children who are at risk for the disease or are traveling should receive the Hepatitis A vaccine. 3. The child would have signs of liver issues if the diagnosis was Hepatitis B. 4. The child is at low risk of contracting C. Diff in a foreign country.)

6. When a fetus receives antibodies from the mother by way of the placenta, this is known as: 1. Active immunity. 2. Natural Passive immunity. 3. Transmission immunity. 4. Attenuated immunity.

2 (1. Active immunity is when a person is exposed to the disease organism and makes his or her own antibodies. 2. Natural Passive immunity, a form of passive immunity, is when antibodies are passed from mother to fetus by way of the placenta 3. Transmission immunity does not exist. 4. Attenuated immunity occurs when a vaccine is given.)

62. Jackson, a 9-month-old infant, is an inpatient on a pediatric floor due to a diagnosis of RSV. His mother is concerned because everyone comes into the room with a gown, mask, and gloves. The nurse attempts to educate his mother on the process of the disease. The nurse knows that the mother has an understanding of the illness when she states: 1. "I can catch the virus just like a cold." 2. "The virus is spread by droplets, and the health-care workers need to make sure not to carry Jackson's illness to other patients." 3. "This is to protect Jackson from getting an illness from the health-care providers." 4. "This is standard procedure on a pediatric floor during the RSV season."

2 (1. Adults rarely have RSV. 2. RSV is spread by droplets, and the parent acknowledges that the disease can be spread through the health-care workers. 3. The child is contagious, not the health-care workers. 4. Standard procedures are not always known to the parents.)

10. The mother of a 4-year-old girl brings her daughter in to be evaluated for a fever of 101 degrees and a headache that has lasted for the past three days. The mother was concerned this morning when the child woke up and had reddened cheeks that looked like she had been slapped. The nurse suspects the child has: 1. Impetigo. 2. Fifth's disease. 3. German measles. 4. Hand-Foot-Mouth Disease

2 (1. Crustations develop and serous drainage is present 2. The prodromal signs and symptoms of Fifth's disease include fever, aching, and a headache. The child will also have erythema of the cheeks, giving the appearance of "slapped cheeks." 3. Swelling of the glands and a rash occur 4. The hands and feet become very red, and a fever is usually present.)

52. Which of the following vaccines can be given subcutaneously? 1. MCV4 2. Varicella 3. MMR 4. Rotavirus

2 (1. Given IM 2. Given IM 3. Given subcutaneously 4. Given via IV infusion or IM)

56. A pregnant school teacher has been notified that there is a case of erythema infectiosum in her classroom. The school nurse speaks to the teacher because if she contracts erythema infectiosum, the mother and baby are at risk for: 1. Growth restrictions in an unborn baby. 2. The mother to have a miscarriage. 3. The mother to have slow weight gain and affect the placenta. 4. All of the above.

2 (1. Growth restriction is not a risk for the fetus. 2. The virus can cause a miscarriage in a pregnant woman. 3. Weight gain and the placenta are not affected by the virus. 4. One of the answers is correct.)

60. Logan, a, 11-year-old boy, was diagnosed with parotitis three days ago at the pediatric outpatient clinic. His mother calls the triage nurse to report that Logan is complaining of pain in his peritoneal area. The nurse knows that: 1. This is a medical emergency, and Logan should be brought to the emergency room right away. 2. The virus can cause orchitis. 3. The virus can cause oophoritis. 4. This is a common complaint because it is hard for a child with parotitis to urinate.

2 (1. Pain in the peritoneal area in common with this condition. 2. The virus is known to cause orchitis and has these signs and symptoms. 3. Oophoritis is not a sign or symptom of parotitis. 4. Urination is not an issue for a child with parotitis.)

27. The agent responsible for the Hand-Foot-Mouth Disease is: 1. Paramyxovirus. 2. Coxsackie Virus. 3. Human Herpesvirus 6. 4. Human Parvovirus B 19.

2 (1. Paramyxovirus is the agent responsible for mumps. 2. The Coxsackie, or enterovirus, is the responsible agent for Hand-Foot-Mouth Disease. 3. The Human Herpesvirus 6 is responsible for Roseola. 4. The Human Parvovirus B 19 is the agent responsible for Fifth's disease.)

67. A complication of scarlet fever is glomerulonephritis. This is because: 1. The high doses of penicillin used to treat the disease process are hard for the kidneys to process. 2. The group A beta-hemolytic streptococcus can affect the kidneys if not treated. 3. The Epstein-Barr virus can affect the kidneys if not treated. 4. The HIV irus can affect the kidneys if not treated.

2 (1. Penicillin does not affect kidney function. 2. Beta-hemolytic streptococcus can cause damage to the kidneys if not treated. 3. The Epstein-Barr virus is not present in scarlet fever. 4. The HAV virus is not present in scarlet fever.)

5. A mother is bringing her 2-month-old son in for his well-child visit. He is due to receive his Diphtheria, Tetanus, and Pertussis vaccine. The nurse is educating the mother on the possible side effects of the vaccine, which include: 1. Pain and swelling in the joints. 2. Irritability, loss of appetite, and seizures. 3. Nausea, vomiting, and abdominal pain. 4. Fever and decreased white blood cell count.

2 (1. Swelling occurs at the site, not the joints. 2. Side effects of the DTaP vaccine are irritability, loss of appetite, localized swelling, and seizures, which are rare. 3. Nausea and vomiting are rare. 4. Fever and a decreased white blood cell count are rare.)

20. Which of the following vaccines is contraindicated for those who are pregnant or immunocompromised? 1. Tdap and Rotarix 2. MMR and varicella 3. Hepatitis and pneumococcal 4. Pertussis and hemophilus influenza type b

2 (1. Tdap and Rotarix are not active viruses and can be given. 2. The MMR and varicella vaccines are manufactured from live attenuated or weakened viruses, and are contraindicated for those that are pregnant or immunosuppressed. 3. Hepatitis and pneumococcal are not live viruses. 4. Pertussis is not a live vaccine.)

36. The family is asking questions about the differences between Hepatitis A and Hepatitis B vaccines for their 2-year-old daughter. The nurse knows that the family understands the difference between the vaccines when the father states: 1. "The Hepatitis A vaccine should be given at birth, then repeated six months later." 2. "The Hepatitis A vaccine is given in two doses, at least six months apart." 3. "The Hepatitis B vaccine requires a live virus, and the Hepatitis A vaccine does not." 4. "The Hepatitis B vaccine should not be given because our child is allergic to eggs."

2 (1. The Hepatitis A vaccine should not be given until after the age of 12 months. 2. The Hepatitis A vaccine should be given in this manner. 3. Neither vaccine is live. 4. Hepatitis B vaccines can be given, even if the child is allergic to eggs.)

57. Tabitha has been admitted with influenza. The nurse discusses the plan of care with the family. The child will be in droplet isolation. The reason for the droplet isolation is because: 1. The goal is to not bring in any outside infections to the child, as pneumonia can be a complication. 2. The goal is to prevent the spread of the virus to any of the health-care workers and other patients. 3. The goal is to prevent a massive outbreak within the community. 4. The goal is to provide a quiet environment for the child to rest.

2 (1. The child's immune system is compromised, but the concern in droplet transfer to others. 2. Influenza is highly contagious through droplet formation. The isolation will help prevent the spread of the disease. 3. Influenza can be widespread, but the question is focusing on the family's needs. 4. The child needs rest to recover, but the answer addresses the droplet communicability of Influenza.)

48. Identify the vaccine that is given to students prior to living in college dormitories. 1. Influenza 2. Meningococcal vaccine 3. HPV 4. MMR

2 (1. The influenza vaccine is required every year. 2. This disease is highly contagious in close living quarters and is required by many universities priority to living in the dormitories. 3. The HPV vaccine should be given prior to living in the dorms. 4. MMR is wanted, but not a requirement for many universities.)

63. Synagis is being prescribed for Kenyon, a 60-day-old, premature infant, prior to leaving the NICU. The nurse explains the reason for the medication to his mother. The mother understands that the medication will need: 1. To be given in the pediatrician's office every 28 to 30 days for the next year. 2. To be given in the pediatrician's office every 28 to 30 days for the next 3 to 5 months while it is RSV season. 3. To be given in the pediatrician's office at 6 months and again at 9 months. 4. To be given in the pediatrician's office at 1 year of age.

2 (1. The medication is not needed for an entire year. 2. The medication is given during the months when RSV is most prevalent. 3. The medication needs to be given monthly during the RSV season. 4. The medication needs to be given monthly during the RSV season.)

39. A nurse is reviewing the immunization schedule for a 9-month-old infant. The schedule notes that the child is due to receive the Rotarix vaccine today. During the assessment, the mother tells the nurse that the child had surgery three weeks ago for intussusception. The nurse knows that: 1. The child should wait to get the vaccine because of the recent surgery. 2. The child should not receive the vaccine because of the past history of intussusception. 3. The child should be positioned so that the medication can be given orally. 4. The child should receive the medication regardless of past history.

2 (1. The timing of the vaccine is not the priority. 2. A child with a GI issue should not receive Rotarix. 3. Does not come in oral form 4. Past history influences if the child can have the vaccine.)

32. The parents of a 1 year old have brought their child in to receive his vaccinations. The child is due for his fourth and final dose of Haemophilus Influenzae type B (HIB). The nurse reviews with the parents the importance of the vaccine in the prevention of: 1. Pneumonia. 2. Otitis media. 3. Liver disease. 4. Vomiting and diarrhea.

2 (1. The vaccine prevents conjunctivitis, otitis media, sinusitis, and has greatly reduced meningitis in young children. 2. Haemophilus Influenzae type B is a bacteria that causes infection in various parts of the body. The vaccine prevents conjunctivitis, otitis media, sinusitis, and has greatly reduced meningitis in young children. 3. The vaccine does not prevent against liver disease. 4. The vaccine will not stop vomiting or diarrhea.)

49. Micah has come for his pre-kindergarten checkup at the pediatric clinic. His mother reports that Micah is behind on his immunizations because of issues with extreme prematurity. She also reports that Micah had chicken pox three months ago. The nurse knows that Micah will have which type of immunity toward the Varicella-zoster virus? 1. Vaccine-induced immunity 2. Natural active immunity 3. Passive active immunity 4. None of the above

2 (1. The varicella-zoster vaccine was not given in order to produce immunity. 2. Since the child had the disease, the body is now immune to the disease. 3. The child did not receive immunity from his mother. 4. At least one of the above is correct.)

37. A young mother calls the pediatric triage nurse because she is worried about her 4-month-old daughter. Her daughter had immunizations administered yesterday. The infant is not eating and is more irritable than usual. The nurse verifies that the infant had a DTaP immunization. The nurse knows that these signs and symptoms are: 1. A medical emergency. The mother should bring the infant to an emergency room to make sure that the child is not having an allergic reaction. 2. A normal reaction and will subside in a day or two. 3. Abnormal, and the mother should follow up with the doctor in two days. 4. Only occurring because the child has not been given Tylenol for the pain at the injection site.

2 (1. This is not a medical emergency. This is one of the side effects of the vaccine 2. This is a normal response to the vaccine. 3. This is normal and is one of the side effects of the vaccine. 4. The question does not assess what pain management has been done.)

53. The pediatric nurse is teaching a young mother prodromal signs of communicable diseases at an in-home visit. The nurse knows that the mother understands the prodromal signs and symptoms when she states: 1. "I will watch for coryza and vomiting to begin." 2. "I will need to watch for cough, coryza, and fevers." 3. "I will need to watch for a change in behavior and a low-grade fever." 4. "I will watch for a rash, fever, and vomiting."

2 (1. Vomiting is not part of the prodromal signs. 2. Cough, coryza, and fevers are prodromal signs. 3. A low-grade fever is not a prodromal sign. 4. A rash and vomiting are not seen as prodromal signs.)

71. Joshua is sent to the nurse's office because the teacher thinks he has pink eye. The school nurse begins to assess his eye. She should: (Number the following in the correct order.) __1_ Wash the eye from the inside corner to outside corner. _2__ Provide a cool cloth to comfort the eye. __3_ Wash hands and put on gloves. __4_ Call his parents so they can take Joshua to the doctor for treatment. _5___ Sanitize the nurse's office, including door handles. __6__ Sanitize Joshua's classroom work area.

2, 3, 1, 4, 5, 6

54. Anne goes into her pediatric patient's room for her 0400 assessment of a child who was admitted with dehydration 12 hours ago. Anne begins her assessment and knows that there is a medical emergency when the findings indicate: 1. A child with a regular heart rate and a respiratory rate at the high end of normal. 2. A child who is awake and wanting to play on the PS3. 3. A child who has a purple rash in his extremities, and it does not blanch. 4. A child who complains that he is tired and vomits thick mucus.

3 (1. A regular heart rate is not a medical emergency. 2. The child may not sleep well because of the environment. 3. The purple rash is a concern for the child's circulatory system. 4. The thick mucus occurs because the child has been dehydrated.)

2. A vaccine that contains fragments of cells that stimulate an immune response, but does not contain the whole cell is known as a: 1. Toxoid. 2. Subunit. 3. Acellular. 4. Attenuated

3 (1. A toxoid vaccine is made from toxins produced by bacteria that are inactivated so that they cannot cause harm, but can still stimulate an immune response. 2. A subunit is produced from small fragments of viral protein. 3. An acellular vaccine contains fragments of cells that stimulate an immune response, but do not contain the whole cell. 4. An attenuated vaccine is one produced from the weakened virus.)

18. A 16-year-old girl with mononucleosis is being evaluated for the development of a maculopapular rash. The nurse should ask the patient if she has taken which of the following medications? 1. Acetaminophen 2. Acyclovir 3. Amoxicillin 4. Aspirin

3 (1. Acetaminophen will not cause the side effects and is an acceptable medication. 2. Acyclovir is contraindicated. 3. A maculopapular rash will appear if amoxicillin or ampicillin is given to an individual with mononucleosis. 4. Aspirin should not be given to a child or an adolescent at any time.)

19. An 8-year-old boy was just diagnosed with the mumps. The nurse is developing a plan of care for the boy, which should include which of the following interventions? 1. Administer intravenous Acyclovir as ordered. 2. Drink plenty of fluids, including citrus juices high in Vitamin C. 3. Apply ice packs or warm compresses to the neck for comfort and pain relief. 4. Place the patient in contact precautions.

3 (1. Acyclovir is not an effective treatment for mumps 2. Citrus juice should not be provided during this time. 3. Interventions for mumps include respiratory isolation; acetaminophen or ibuprofen for fever and pain; bland, soft foods; hydration with intravenous fluids or bland liquids, avoiding citrus juices; ice packs or warm compresses for the neck for comfort and pain relief; and snug-fitting underwear and warmth to provide comfort and pain relief for orchitis. Acyclovir is ineffective for the treatment of mumps. 4. Good hand washing is needed, not contact precautions.)

42. A nurse has given instructions to the mother of a 5 year old child on common side effects after the measles, mumps, and rubella (MMR) vaccine. The common reactions include all but: 1. Fever. 2. Swollen cheeks. 3. Pin point rash. 4. Joint pain.

3 (1. Common side effect of the MMR vaccine 2. Common side effect of the MMR vaccine 3. An uncommon side effect and further assessment is needed 4. Common side effect of the MMR vaccine)

13. Reye's Syndrome can be a life-threatening disease affecting the brain and liver of children. The cause of this disease comes from the ingestion of: 1. Ibuprofen during a viral illness. 2. Ibuprofen during a bacterial illness. 3. Aspirin or other salicylates during a viral illness. 4. Aspirin or other salicylates during a bacterial illness.

3 (1. Ibuprofen is safe for viral illnesses. 2. Ibuprofen is safe for bacterial illnesses. 3. Reye's Syndrome typically follows a viral infection, such as chickenpox, influenza, or an upper respiratory infection. The ingestion of aspirin or other medication containing salicylates during a viral illness greatly increases the probability of developing the syndrome. Caregivers should be taught not to give aspirin or salicylate products to any child or adolescent during a febrile illness. 4. Reye's Syndrome typically follows a viral infection, so it is acceptable to give aspirin or other salicylates for a bacterial infection.)

23. Which of the following supplements has been recommended by the World Health Organization and has been found to reduce the risk of pneumonia and death from measles in children under age 2? 1. Iron 2. Folic Acid 3. Vitamin A 4. Vitamin D

3 (1. Iron deficiency does not influence the occurrence of pneumonia or measles. 2. Folic acid does not influence the occurrence of pneumonia or measles. 3. A systematic review and meta-analysis has found that Vitamin A therapy reduced the risk of pneumonia and death as a complication of measles for children under age 2 in areas of the world where Vitamin A deficiency was present. 4. Vitamin D does not influence the occurrence of pneumonia or measles.)

64. An outbreak of German measles has occurred at the middle school. The school nurse has been notifying the parents of the children, along with the staff. The best prevention against contracting the highly contagious disease is: 1. To keep ill children at home. 2. To let children come to school after 16 days from the last known day of exposure because if there are no signs and symptoms, the child will not become ill. 3. Receiving the MMR vaccine. 4. Good hand washing.

3 (1. Keeping the ill child at home is preferred, but not the priority intervention. 2. Incorrect. This is the incubation period for the German measles. 3. The best prevention is an immunization. 4. Hand washing is important for stopping the spread of the disease, but it is not the best option.)

40. Lacey, a 9-year-old African American girl, has a history of Sickle Cell disease. She is scheduled to receive her polio vaccine today. The nurse knows that she should give the Inactive Poliovirus Vaccine (IPV) because: 1. Lacey's race has a higher risk of reaction to the oral vaccine. 2. Lacey is too old for the oral vaccine. 3. Lacey is at high risk for paralysis because of her immunodeficiency. 4. The oral vaccine is not as effective for females as it is for males.

3 (1. Race does not cause the child to be at a higher risk for polio. 2. Age is not a disqualification for the vaccine. 3. Autoimmune deficiency can increase the occurrence of paralysis if the vaccine if given. 4. Gender does not determine the effectiveness of the vaccine.)

51. A nursing student is about to give a newborn baby a Hepatitis B injection. The student knows that the injection must be given IM. The best place to give an IM injection on a newborn is: 1. The deltoid. 2. The abdomen. 3. The rectus femoris. 4. The forearm.

3 (1. The deltoid lacks a large area of muscle in a newborn for IM injections. 2. IM injections should not be given in the abdomen. 3. The rectus femoris is easily identified and large enough for an IM injection for a newborn. 4. The forearm is not used for IM injections.)

58. The doctor has prescribed Zanamivir for a 4-year-old patient. The nurse questions this order because: 1. The medication is only to be given to adults with pneumonia. 2. The medication is only recommended for infants with Hand-Foot-Mouth Disease. 3. The medication is only recommended for ages 7 and older for Influenza. 4. The medication has proven to be ineffective in the management of Influenza.

3 (1. The medication is recommended for adults to treat Influenza. 2. The medication should not be used in infants and is used for Influenza, not Hand-Foot-Mouth Disease. 3. The medication is for Influenza in children over the age of 7. 4. The medication is effective for a child over the age of 7 for Influenza.)

50. In a nursing class, the instructor is discussing the differences between acellular vaccines and toxoids. The students are able to identify acellular vaccines because: 1. The vaccines produce a toxin to get an immune response. 2. The vaccine has a whole viral protein cell, unlike the toxoids. 3. The vaccine has fragments of cells to stimulate an immune response. 4. The vaccine is inactive and produced by whole cell bacteria.

3 (1. The toxin does not produce the immune response. 2. The cell proteins are not whole. 3. Fragments of the cell cause the immune response. 4. The vaccine is active and requires stimulation to create the immune response.)

35. A 9-year-old girl is scheduled to receive a series of the Hepatitis B vaccines because she did not receive them at birth. The child comes to the outpatient clinic for her second dose. Before offering the vaccine, the nurse assesses the child and asks the parents if she has an allergy to: 1. Eggs. 2. Penicillin. 3. The previous dose of the Hepatitis B vaccine. 4. Sulfonamides.

3 (1. This allergy does not affect the administration of the Hepatitis B vaccine. 2. This allergy does not affect the administration of the Hepatitis B vaccine. 3. If a reaction occurred with the first dose, there is a high probability the child is allergic to the vaccine, thus it should not be repeated. 4. This allergy does not affect the administration of the Hepatitis B vaccine.)

12. The period of time when a child begins to have mild signs and symptoms until the main illness appears, and which is associated with increased communicability, is referred to as: 1. Transmission. 2. Susceptibility. 3. Prodromal period. 4. Incubation period.

3 (1. Transmission is the mode of infecting others. 2. Susceptibility is the ability of a person to contract the illness. 3. Prodromal signs and symptoms may appear before a rash or the main illness appears and should be included in the physical assessment of a child with a communicable disease. The prodromal period is often associated with increased communicability of the disease. Prodromal signs and symptoms may include coryza, cough, fever, and malaise. 4. The incubation period is the time it takes for an individual to contract the disease to the start of the prodromal signs and symptoms.)

26. A 5-year-old girl is being admitted for dehydration from influenza. The girl is started on Tamiflu. Which of the following is true about the administration of this medication? 1. Tamiflu is only effective for Influenza type A. 2. Tamiflu is only effective for Influenza type B. 3. The medication must be given within 48 hours of the onset of symptoms. 4. The medication is not recommended for children with airway diseases, such as asthma

3 (1. Two FDA approved antiviral medications have been recommended for influenza: Tamiflu and Relenza. These medications must be given within 48 hours of the onset of symptoms and are effective for both Influenza types A and B. 2. Two FDA approved antiviral medications have been recommended for influenza: Tamiflu and Relenza. These medications must be given within 48 hours of the onset of symptoms and are effective for both Influenza types A and B. 3. Two FDA approved antiviral medications have been recommended for influenza: Tamiflu and Relenza. These medications must be given within 48 hours of the onset of symptoms and are effective for both Influenza types A and B. Tamiflu may be given to children over 1 year of age, whereas Relenza is recommended for children over 7 years old. Relenza is administered as an inhalation medication and is not recommended for children with airway diseases, such as asthma. 4. Relenza is administered as an inhalation medication and is not recommended for children with airway diseases, such as asthma.)

1. Which of the following is a consideration in the administration of immunizations? 1. Immunizations can only be administered if a child is free from any illnesses. 2. Caregivers should administer aspirin prior to the injection to prevent any side effects. 3. Children should be isolated from other children for 24 hours after receiving immunizations. 4. Caregivers should be advised that immunizations may cause a mild fever or soreness and redness at the injection site.

4 (1. Children with mild signs and symptoms of a cold may receive immunizations. However, if they are febrile, it is better to hold off on the immunization until later. 2. Acetaminophen or ibuprofen are recommended to relieve any pain or fever following immunizations. 3. Generally, children do not need to be isolated from others after immunizations. 4. Some immunizations may cause a mild fever, or soreness and redness at the injection site. Caregivers may give acetaminophen or ibuprofen to relieve any pain or fever. Warm compresses may also be applied to the injection site.)

46. The purpose of the vaccine information statement is: 1. To give the purpose of the vaccine. 2. To provide a list of possible side effects. 3. To answer some questions for the caregiver. 4. All of the above

4

41. Keegan, a 9-year-old patient, has been brought to the pediatric clinic for an influenza vaccine. The nurse knows that this is Keegan's first time receiving the vaccine. The nurse knows the mother understands the instructions for the vaccine when she states: 1. "I will not need to make sure he receives the vaccine every year." 2. "I cannot let him be around other children for at least 12 hours because he is contagious." 3. "I will need to watch him to see if he has an allergic reaction to eggs after this vaccine." 4. "I will need to bring him back in for a second immunization in four weeks."

4 (1. A two-step flu vaccine is required when receiving the vaccine for the first time. 2. The vaccine does not spread the flu virus. 3. Reactions with eggs do not occur with this vaccine. 4. A two-step vaccination process is needed when receiving the flu vaccine for the first time.)

29. A 2-month-old infant is presenting for a well-child visit and is due to receive the Rotavirus vaccine. The nurse recognizes that obtaining the patient's history is essential in the administration of immunizations and preventing communicable disease. Which of the following should the nurse assess for prior to administering this vaccine? 1. Lung disease 2. Cardiac defects 3. Seizure disorder 4. Gastrointestinal disorders

4 (1. The immunization does not interfere with lung disease. 2. The immunization does not interfere with cardiac defects. 3. The immunization does not interfere with seizure disorders. 4. Rotavirus causes severe diarrhea and dehydration. The first immunization is given between 6 and 14 weeks. The immunization should be avoided if the child has a history of intussusception or other gastrointestinal disorders.)

3. Which of the following is true about immunizations containing thimersal and autism? 1. Thimersal has been removed from all vaccines. 2. Only the MMR vaccine is associated with autism. 3. Thimersal has been linked to learning disabilities, but not autism. 4. Researchers have found no evidence that thimersal is linked to autism.

4 (1. Even though researchers have found no evidence that thimersal is linked to autism, the Advisory Committee on Immunization Practices has recommended that thimersal be removed from all vaccines. 2. Currently, this preservative is only found in very small amounts in some flu vaccines. Also, no evidence has been found that the MMR vaccine is associated with autism. 3. Even though researchers have found no evidence that thimersal is linked to autism, the Advisory Committee on Immunization Practices has recommended that thimersal be removed from all vaccines. 4. Even though researchers have found no evidence that thimersal is linked to autism, the Advisory Committee on Immunization Practices has recommended that thimersal be removed from all vaccines.)

25. A 17-year-old boy is admitted with meningitis and for treatment of dehydration. The patient needs to be placed on droplet precautions. Which of the following interventions should be taken for droplet precautions? 1. Anyone entering the room must wear gloves and a gown. 2. The patient needs to be placed in a negative pressure room. 3. Anyone entering the room needs to wear a respirator mask upon entering. 4. The patient must wear a mask when being transported outside of the room.

4 (1. Gloves and a gown are required for contact precautions. 2. A negative pressure room is required for those on airborne precautions. 3. Respirator masks are required for some airborne illnesses. 4. Droplet precautions prevent the spread of diseases by close respiratory contact or respiratory secretions. Those in close contact with the patient must wear a mask. The patient must wear a mask when being transported outside of the room. A negative pressure room is required for those on airborne precautions. Respirator masks are required for some airborne illnesses. Gloves and gown are required for contact precautions.)

17. An 18-year-old boy is getting ready to leave for college and will be living in a dormitory. Which of the following vaccines is recommended prior to his departure? 1. Hepatitis A 2. Pneumococcal polysaccharide (PPSV23) 3. Pneumococcal conjugate vaccine (PCV13) 4. Meningococcal conjugate vaccine (MCV4)

4 (1. Hepatitis A is not recommended at this time. 2. The vaccine is not recommended at this time. 3. The vaccine is not recommended at this time. 4. College students are an at risk population for contracting meningitis since they live in close proximity to each other. The meningococcal conjugate vaccine (MCV4) is recommended for college students for the prevention of meningitis.)

7. Which of the following is a high risk group among children and adolescents for contracting Hepatitis B? 1. Those living in institutions 2. Individuals infected by sexual partners 3. Children who are hemophiliacs or are receiving frequent blood transfusions 4. All of the above

4 (1. High risk groups include those living in institutions. 2. High risk groups include those living in institutions, those involved in IV drug use, and those infected by sexual partners. 3. Hepatitis B is transmitted by blood or blood products, or by sexual contact. Children who are hemophiliacs or are receiving frequent blood transfusions are at risk. Individuals who have traveled to Africa or Asia are also at higher risk. 4. Hepatitis B is transmitted by blood or blood products, or by sexual contact. High risk groups include those living in institutions, those involved in IV drug use, those infected by sexual partners, and children who are hemophiliacs or are receiving frequent blood transfusions. Individuals who have traveled to Africa or Asia are also at higher risk)

47. Stella, a 16-year-old girl, has come to the clinic to receive the HPV vaccine. Prior to the administration of the vaccine, the nurse must assess for: 1. Allergies to latex. 2. Allergies to eggs. 3. The last sexual encounter. 4. Pregnancy.

4 (1. Latex is not a concern with this vaccination. 2. An allergy to eggs would not be a concern. 3. The last sexual encounter will not influence administration of the vaccine. 4. A woman who is pregnant should not receive the vaccine.)

59. A 12-year-old girl presents to the emergency room with complaints of a sore throat, fever, and malaise for the past six days. The parents have noticed that she has been progressively sleeping more. The patient is diagnosed with mononucleosis. The caregiver education done by the nurse should include all of the following except: 1. Rest periods should follow play/activity periods. 2. After the girl goes back to school, she should not participate in ice hockey for 6 to 8 weeks. 3. Keep her well hydrated, and provide nutrition that is high in protein. 4. Give acetaminophen or ibuprofen for fever management.

4 (1. Rest periods should be provided for the child. 2. The child should not participate in contact sports for 6 to 8 weeks after having mononucleosis. 3. Hydration and a diet high in protein are needed for increasing the immune system. 4. Fever is not present at this stage of the healing process.)

21. Small red spots in the mouth with a bluish-white center, also known as Koplik spots, are a characteristic sign of: 1. Roseola 2. Rotavirus 3. Rubella 4. Rubeola

4 (1. Roseola will cause a fine pin point rash on the trunk of the body. 2. Rotovirus will cause massive diarrhea stools. 3. Rubella cause the swelling of lymph nodes and a fine rash. 4. The prodromal signs and symptoms include coryza, cough, conjunctivitis, fever, malaise, and Koplik spots, small red spots in the mouth with a bluish-white center.)

31. The Pneumococcal (PPSV23) vaccine is recommended for children with which of the following high-risk conditions? 1. Asplenia 2. Cochlear implants 3. Congenital heart defects 4. All of the above

4 (1. The Pneumococcal (PPSV23) vaccine is recommended for children and adolescents with high-risk conditions, such as asplenia. The vaccination should be repeated after five years. 2. The Pneumococcal (PPSV23) vaccine is recommended for children and adolescents with high-risk conditions, such as cochlear implants. The vaccination should be repeated after five years. 3. The Pneumococcal (PPSV23) vaccine is recommended for children and adolescents with high-risk conditions, such as congenital heart disease. The vaccination should be repeated after five years. 4. The Pneumococcal (PPSV23) vaccine is recommended for children and adolescents with high-risk conditions, such as cochlear implants, sickle cell anemia, congenital heart disease, or asplenia. The vaccination should be repeated after five years.)

28. A 16-year-old girl comes into the office for a sports physical. The recommendation is made for the girl to receive the Human Papillomavirus vaccine. Her mother is upset about the recommendation because she is sure her daughter is not yet sexually active. Which of the following responses would be most appropriate for the nurse to give? 1. "Your daughter should receive the vaccine even though she has a yeast allergy." 2. "We need to give her a pregnancy test as well prior to administering the vaccine." 3. "She is overdue for the vaccine because she should have received it when she was 9." 4. "It is best if the vaccine is given before she becomes sexually active in order to prevent genital warts and cervical cancer in the future."

4 (1. The vaccine should not be given if the child is allergic to yeast. 2. The nurse should educate the mother and daughter that the vaccine is best administered prior to becoming sexually active to prevent genital warts and cervical cancer from an HPV infection. 3. The HPV vaccine is generally given to girls ages 11 to 18, but can be given as early as age 9. 4. The HPV vaccine protects girls against HPV infections that may lead to genital warts and cervical cancer. It is generally given to girls ages 11to 18 prior to being sexually active, but can be given as early as age 9. The vaccine should not be administered if the girl is allergic to yeast. Health-care workers should check for pregnancy before giving the vaccine. Boys ages 9 to 18 may also receive the vaccine.)

4. A 27-year-old mother has just delivered a healthy 7 lb. 3 oz. baby boy. Which of the following is true regarding the baby's immunization schedule for Hepatitis B? 1. The infant will need two doses administered at least 6 months apart. 2. The infant should not receive the vaccine until at least 12 months of age. 3. The infant will not need any vaccines at this time because of passive immunity from the mother. 4. If the mother is Hepatitis B surface antigen positive, the baby will need 0.5ml of Hepatitis B Immune Globulin.

4 (1. Three doses of Hepatitis B are given before age 2: at birth, at 1 to 2 months of age, and after 24 weeks of age. 2. Three doses of hepatitis B are given before age 2: at birth, at 1 to 2 months of age, and after 24 weeks of age. 3. Immunity will not occur passively. 4. If the mother is Hepatitis B surface antigen (HbsAg) positive, 0.5 ml of Hepatitis B Immune Globulin (HBIG) is also given.)

9. A 6-year-old boy with Varicella-zoster (chickenpox) and a visible rash is being admitted to the hospital for treatment of dehydration. Which of the following isolation precautions needs to be taken? 1. Contact 2. Airborne 3. Contact and droplet 4. Contact and airborne

4 (1. Transmission of the Varicella-zoster virus is from contact with fluid from vesicles of an infected person, secretions from the nose, mouth and eyes, and airborne from coughing and sneezing. 2. Transmission of the Varicella-zoster virus is from contact with fluid from vesicles of an infected person, secretions from the nose, mouth and eyes, and airborne from coughing and sneezing. 3. The transmission does not occur with droplets. 4. Transmission of the Varicella-zoster virus is from contact with fluid from vesicles of an infected person, secretions from the nose, mouth and eyes, and airborne from coughing and sneezing.)

70. A day-care center calls the pediatric triage nurse because there has been an outbreak of Hand-Foot-Mouth Disease in the preschool room. It is important to teach the day-care center to: (Select all that apply.) 1. Clean surfaces and toys with a mixture of disinfectant and bleach water. 2. Practice good hand hygiene. 3. Have the children stay home if they are active cases. 4. Send information home with the parents. 5. All of the above information should be given to the day-care center.

5 (1. Cleaning and disinfecting is needed. 2. Hand hygiene helps prevent the spread of illness. 3. An infected child should stay home. 4. The parents should receive education about the disease and the presence of it in the daycare. 5. All of the information should be provided and completed in the day-care center.)

True/False 72. Children may be given a calculated dose of acetaminophen or ibuprofen following an immunization.

T (The medication will aid in comfort and should be given to the child.)