Pediatric Communicable diseases

The nurse is caring for a school-age patient diagnosed with hepatitis A. For which reason should the nurse begin implementing contact precautions for this patient? 1. Incontinent of feces 2. Evidence of dehydration 3. Development of dark urine 4. Severe nausea and vomiting

ANS 1 1 This is correct. A patient with hepatitis A should be placed in contact precautions in the event of fecal incontinence. 2 This is incorrect. Dehydration is not a reason to place the patient in contact precautions. 3 This is incorrect. Development of dark urine is not a reason to place the patient in contact precautions. 4 This is incorrect. Severe nausea and vomiting is not a reason to place the patient in contact precautions.

A 17-year-old patient with influenza tells the nurse, "I can't believe I got sick. I've been taking vitamin C, vitamin D, echinacea, and some other herbal remedies to boost my immune system." Which should the nurse say in response to this patient? Select all that apply. 1. "You probably weren't taking enough of the supplements." 2. "Those supplements help with focus and attention, not disease prevention." 3. "The safe use of supplements and herbs has not been determined." 4. "The vitamins you were taking may have reduced the effectiveness of the herbs." 5. "The effectiveness of supplements and herbs against influenza has not been determined."

ANS 3, 5 1. This is incorrect. Additional research is needed regarding alternative supplements to identify safety and efficacy of these therapies. 2. This is incorrect. The vitamins and supplements listed are ones that people commonly take for disease prevention. However, that does not mean they have been proved effective or safe. 3. This is correct. The safety of supplements and herbs have not been determined and need additional study. 4. This is incorrect. There is no evidence that taking vitamins and herbs concurrently reduces the effectiveness of herbs. 5. This is correct. The effectiveness of supplements and herbs for a specific health problem has not been determined and needs additional study.

A parent brings her school-age child to the physician's office for evaluation of a sore throat, fever, headache, and fine red rough rash over both arms and abdomen. For which health problem should the nurse plan care for this patient? 1. Croup 2. Tonsillitis 3. Epiglottitis 4. Scarlet fever with strep throat

ANS 4 1 This is incorrect. Croup causes a harsh "barky" cough and does not cause a rash. 2 This is incorrect. Tonsillitis does not cause a fine red rough rash. 3 This is incorrect. Epiglottitis does not cause a fine red rough rash. 4 This is correct. Strep throat and a fine red rough rash are main symptoms of scarlet fever.

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

ANS: 1 Feedback 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.

A 27-year-old mother has just delivered a healthy 7 lb. 3 oz. baby boy. Which of the following is true regarding the babys 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.

ANS: 4 Feedback 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.

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.

ANS: 3 Feedback 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.

A new mother contacts the health-care provider's office to ask for guidance regarding a change in the infant's health. For which reason should the nurse direct the mother to seek immediate medical attention? 1. Difficult to arouse 2. Wetting six diapers a day 3. Breastfeeding every 3 hours 4. Sleeping for several hours in the afternoon

ANS 1 1 This is correct. A change in responsiveness or being difficult to arouse could indicate a change in oxygenation or perfusion. The infant should be seen immediately for medical attention. 2 This is incorrect. Wetting six diapers a day is an expected behavior for an infant. 3 This is incorrect. An infant feeding every 3 hours is expected behavior. 4 This is incorrect. Infants have a great need for sleep. Sleeping for several hours in the afternoon is expected behavior.

A parent arrives at the family clinic seeking medical attention for his 14-year-old child. The child has a fever, malaise, nausea, and abdominal pain. Which finding should indicate to the nurse that the patient is experiencing hepatitis A? 1. Elevated serum bilirubin 2. Greater than 10% atypical lymphocytes 3. Presence of the virus in nasal secretions 4. Positive Paul-Bunnell heterophile antibody test

ANS 1 1 This is correct. Abnormal laboratory values that indicate the presence of hepatitis A include an elevated serum bilirubin level. 2 This is incorrect. The presence of greater than 10% of atypical lymphocytes is a finding associated with mononucleosis, not hepatitis A. 3 This is correct. The presence of the virus in nasal secretions is associated with influenza, not hepatitis A. 4 This is incorrect. A positive Paul-Bunnell heterophile antibody test is a finding associated with mononucleosis, not hepatitis A.

The nurse is caring for a 15-year-old patient who has been diagnosed with mononucleosis. The patient asks how the infection was obtained. Which information should the nurse include when responding to the patient? 1. Drinking from the cup of a person with the infection 2. Eating contaminated food 3. Eating meat that is undercooked 4. Inhaling airborne germs, such as after someone coughs

ANS 1 1 This is correct. The virus that causes mononucleosis is transmitted through person-to-person contact, sharing personal objects such as cups or toothbrushes, and through saliva. 2 This is incorrect. Contaminated food does not cause mononucleosis. 3 This is incorrect. Mononucleosis is not transmitted through undercooked meat. 4 This is incorrect. Mononucleosis is not airborne; that is, it is not transmitted through respiratory droplets or respiratory secretions.

An adolescent is diagnosed with mononucleosis. Which teaching should the nurse provide to the parents when providing care at home? Select all that apply. 1. Encourage ample fluids. 2. Avoid all contact sports for 6 to 8 weeks. 3. Encourage rest with quiet activities and play. 4. Limit the amount of caloric intake until recovered. 5. Provide ibuprofen or acetaminophen for elevated temperature.

ANS 1,2,3,5 1. This is correct. The patient with mononucleosis needs to ingest ample fluids to prevent the development of dehydration. 2. This is correct. To prevent injury to the spleen, contact sports are not permitted for 6 to 8 weeks if the spleen is enlarged. Even though the patient's status of the spleen is not identified, the patient should avoid these types of sports until approved by the health-care provider. Examples of contact sports include basketball, football, soccer, rugby, baseball, boxing, ice hockey, rodeo, wrestling, martial arts, lacrosse, and water polo. 3. This is correct. The patient with mononucleosis is easily fatigued and should engage in quiet activities and play. 4. This is incorrect. There is no reason to limit the patient's caloric intake. Adequate calories should be provided to ensure for the patient's nutritional status. 5. This is correct. The patient should be provided with acetaminophen or ibuprofen for fever control.

A school-age child is diagnosed with hand, foot, and mouth disease. Which should the nurse instruct the parent to do when caring for the patient at home? Select all that apply. 1. Provide bland foods and fluids. 2. Offer generous amounts of oral fluids. 3. Wash clothes with hot soapy water and bleach. 4. Use acetaminophen or ibuprofen for pain control. 5. Instruct to flush the mouth with an alcohol-based mouthwash.

ANS 1,2,4 1. This is correct. The patient with hand, foot, and mouth disease has oral lesions. The patient should consume bland foods and fluids to reduce pain when eating and drinking. 2. This is correct. The patient with hand, foot, and mouth disease should have ample fluids to ensure adequate hydration. 3. This is incorrect. Clothes do not need to be washed with hot soapy water and bleach for hand, foot, and mouth disease. 4. This is correct. The patient with hand, foot, and mouth disease should be provided with mild over-the-counter analgesics such as acetaminophen or ibuprofen. 5. This is incorrect. An alcohol-based mouthwash is irritating to oral tissues and should not be used.

The nurse is providing care to an 8-week-old infant who has symptoms of an upper respiratory infection. Which assessment finding should indicate to the nurse that the patient is experiencing pertussis? 1. An expiratory wheeze 2. A "whoop" sound after coughing 3. Three wet diapers each day 4. Bulging fontanelles

ANS 2 1 This is incorrect. Expiratory wheezing is a symptom of asthma. 2 This is correct. The characteristic "whoop" that occurs in pertussis occurs after coughing. 3 This is incorrect. For young infants, fewer than five or six wet diapers in 24 hours indicates dehydration. 4 This is incorrect. Bulging fontanelles indicates overhydration, which is unrelated to pertussis.

A parent brings a 2-month-old baby in for a routine wellness examination. Which vaccination should the nurse prepare to administer to this patient? 1. Hepatitis A 2. Hepatitis B 3. Inactivated poliovirus 4. Measles, mumps, rubella

ANS 2 1 This is incorrect. The hepatitis A vaccine is given to all children 12 months and older. 2 This is correct. The hepatitis B vaccine is provided to all newborns. Three doses of hepatitis B are given before age 2 years: at birth, at 1 to 2 months of age, and at 9 to 12 months of age. 3 This is incorrect. The inactivated poliovirus IPV is given in a series of four doses: at 2, 4, and 6 to 18 months as well as 4 to 6 years. 4 This is incorrect. The minimum age for receiving the measles, mumps, and rubella immunization is 12 months.

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 pediatricians office every 28 to 30 days for the next year. 2. To be given in the pediatricians office every 28 to 30 days for the next 3 to 5 months while it is RSV season. 3. To be given in the pediatricians office at 6 months and again at 9 months. 4. To be given in the pediatricians office at 1 year of age.

ANS: 2 Feedback 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.

The nurse is visiting the home of a patient with hepatitis B who is 1 week postpartum. Which information should the nurse include when teaching this patient? Select all that apply. 1. "Hepatitis B is only transmitted through sexual contact." 2. "The baby may have contracted hepatitis B through the pregnancy." 3. "There are no medications appropriate for children with hepatitis B." 4. "After the baby has received treatment, there is no need for follow-up." 5. "The baby should have received the hepatitis B immunization and hepatitis B immune globulin."

ANS 2, 5 1. This is incorrect. Hepatitis B virus (HBV) is commonly transmitted through blood or body fluids. 2. This is correct. Newborns may acquire HBV prenatally. Postexposure prophylaxis is needed to prevent the development of chronic hepatitis B. 3. This is incorrect. The newborn receives the hepatitis B vaccination and if the mother is positive for the infection, the newborn should also receive hepatitis B immune globulin. 4. This is incorrect. The newborn should receive adequate care and follow-up. 5. This is correct. The hepatitis B vaccine is administered to all newborns. If the mother is positive for hepatitis B surface antigen (HBsAg), 0.5 mL of hepatitis B immune globulin (HBIG) is also given.

A school-age patient with rubella is placed in droplet precautions. Which action should the nurse take when implementing these precautions? 1. Use a mask with a HEPA filter. 2. Instruct to cough into the hands. 3. Wear a mask when providing care. 4. Assign to a negative air pressure room.

ANS 3 1 This is incorrect. A mask with a HEPA filter is needed when caring for a patient with tuberculosis. 2 This is incorrect. The patient should be instructed to cover the mouth with a tissue when coughing, properly dispose of the used tissue, and wash the hands. 3 This is correct. For droplet precautions, health-care providers should wear a mask. 4 This is incorrect. A negative air pressure room is needed for the patient with tuberculosis.

A school-age child is brought to the clinic to be evaluated for a headache and stomachache. For which reason should the nurse prepare the patient to have a rapid strep test? 1. Runny nose 2. Productive cough 3. Strawberry tongue 4. Jaundiced conjunctiva

ANS 3 1 This is incorrect. A rapid strep test would not be used to assess for a runny nose. 2 This is incorrect. A rapid strep test is not done because of a productive cough. 3 This is correct. A rapid strep test would be done if a strawberry tongue is assessed, an indication of strep throat or scarlet fever. 4 This is incorrect. A rapid strep test would not be done for jaundiced conjunctiva.

An older patient with weeping lesions caused by herpes zoster asks if a trip to visit small grandchildren can still occur this upcoming weekend. Which should the nurse say to the patient in response? 1. "There is no reason for you to cancel your trip." 2. "You should not travel until all of the lesions are healed." 3. "Be sure to keep the lesions covered until they crust over." 4. "As long as the lesions are kept uncovered, you can travel without any issues."

ANS 3 1 This is incorrect. Shingles lesions must be covered to prevent spread. It is contagious until all lesions are crusted over. 2 This is incorrect. The patient can travel as long as the lesions are covered until they crust over. 3 This is correct. The lesions of shingles must be covered until they crust over to prevent the transmission of chickenpox to the grandchildren. 4 This is incorrect. Weeping lesions caused by herpes zoster must be covered to prevent transmission of chickenpox to others.

A parent with a school-age child with mumps asks for information about the illness and treatment. Which information should the nurse provide? Select all that apply. 1. "There is no need to isolate the child." 2. "There are no laboratory tests to detect the mumps virus." 3. "Sometimes the complications of mumps involve the testicles." 4. "Mumps are seen by observation of swelling around the ears and jaw." 5. "Provide food and drink that is nonirritating to the mouth and surrounding glands."

ANS 3, 4, 5 1. This is incorrect. Droplet isolation is required to prevent the spread of the infection. 2. This is incorrect. IgM enzyme immunoassay is used to detect the mumps virus. 3. This is correct. Boys may have painful swelling of the testicles (orchitis) from the mumps virus. 4. This is correct. Mumps is manifested by swelling of parotid salivary glands in front of the ear, below the ear, and/or under the jaw. 5. This is correct. The patient with mumps should be provided with bland, soft foods and bland liquids. Citrus juices should be avoided. The patient should be kept well-hydrated.

The nurse is writing teaching material about caring for a child with influenza. Which information should the nurse include? Select all that apply. 1. Zanamivir is only prescribed for children over 13 years old. 2. Only one antiviral has been approved by the FDA as of 2017. 3. Tamiflu can be given to children older than one on weight-based dosing. 4. Manifestations of the flu include fever, chills, headache, and myalgia (aching). 5. Medications for influenza must be given within 48 hours of the onset of symptoms.

ANS 3, 4, 5 1. This is incorrect. Zanamivir is recommended for children older than 7 years of age. 2. This is incorrect. Antiviral medications for influenza approved by the Food and Drug Administration (FDA) include oseltamivir (Tamiflu) and zanamivir (Relenza). 3. This is correct. Oseltamivir (Tamiflu) may be given to children older than 1 year and should be given on weight-based dosing. 4. This is correct. Symptoms of influenza include fever, chills, headache, sneezing, cough, malaise, conjunctivitis, and myalgia (aching). 5. This is correct. Medications for influenza must be given within 48 hours of the onset of symptoms.

A nurse is caring for a school-age child who has inflammation of the right eye. Which finding, if present, would indicate to the nurse that the child has bacterial conjunctivitis rather than viral conjunctivitis? 1. Eye swelling 2. Red conjunctiva 3. Watery discharge 4. Purulent drainage

ANS 4 1 This is incorrect. Eye swelling or edema occurs with both bacterial and viral conjunctivitis. 2 This is incorrect. Pink or red conjunctiva occurs in both bacterial and viral conjunctivitis. 3 This is incorrect. Viral conjunctivitis causes a watery discharge from the effected eye. 4 This is correct. Purulent drainage is a symptom of bacterial conjunctivitis.

An adolescent develops a fever, cough, and a maculopapular rash. Which question should the nurse ask when completing the health history with this patient? 1. "Did you receive any vaccinations recently?" 2. "Do you usually eat cold pizza left on the counter overnight?" 3. "Do you forget to wash your hands after using the bathroom?" 4. "Have you been around anyone with a cold over the last 3 weeks?"

ANS 4 1 This is incorrect. Receiving a vaccination does not cause the symptoms of a fever, cough, and maculopapular rash. 2 This is incorrect. Foodborne viruses do not cause a cough, fever, or maculopapular rash. 3 This is incorrect. Infections transmitted through the fecal-oral route do not cause a fever, cough, and maculopapular rash. 4 This is correct. Foodborne viruses manifest with gastrointestinal distress. Chickenpox is a respiratory-borne viral disease with an incubation period of about 21 days.

The nurse learns that a 16-year-old patient has not received the human papilloma virus vaccine (HPV-Gardasil). Which should the nurse explain to the patient at this time about the vaccination? 1. "The complete vaccine can be given today." 2. "You can wait a few years before needing the vaccination." 3. "A dose can be given today with the final dose in 6 months." 4. "A dose should be given today with follow-up doses in 1 to 2 months, and the last in 6 months."

ANS 4 1 This is incorrect. The vaccination for HPV is given as either two doses or three doses, depending on the patient's age. 2 This is incorrect. The HPV vaccination is recommended to be given at 11 to 12 years of age (minimum age is 9 years old) in a two-dose series with a minimum of 6 months between dosing. 3 This is incorrect. If vaccination is not begun by age 15, the patient requires a three-dose series: first injection, second injection in 1 or 2 months, and the third injection 6 months after the first. 4 This is correct. Because the patient is over age 15, a first dose should be given now, with follow-up doses in 1 to 2 months, and the final dose in 6 months.

A parent brings his school-age child to the clinic for a rash that developed over the face, trunk, and extremities. Which question should the nurse ask the parent when assessing the patient? 1. "Has the child been nauseated or has the child vomited?" 2. "How often is the child given acetaminophen, or Tylenol?" 3. "Has the child eaten any food that was not properly cooked?" 4. "Was the child exposed to anyone with a respiratory infection?"

ANS 4 1 This is incorrect. This patient's symptoms suggest fifth disease, which is not associated with nausea and vomiting. 2 This is incorrect. Acetaminophen use would not result in these symptoms. 3 This is incorrect. Eating improperly prepared food would not cause these symptoms. 4 This is correct. These symptoms are indicative of fifth disease, which is transmitted through respiratory secretions. Assessing whether the patient was exposed to anyone with a respiratory infection would be appropriate.

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

ANS 4 Contact and airborne

Jasmines 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.

ANS: 1 Feedback 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 childs liver and brain. 4. The asprin may cause blood to thin, but the main concern is the development of Reyes 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

ANS: 1 Feedback 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.

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.

ANS: 1 Feedback 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.

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.

ANS: 1 Feedback 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.

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.

ANS: 1 Feedback 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.

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 childs fever

ANS: 1 Feedback 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 childs 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.

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.

ANS: 1, 2, 5 Feedback 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.

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

ANS: 2 Feedback 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.

ANS: 2 Feedback 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.

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 Jacksons 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.

ANS: 2 Feedback 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.

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. Fifths disease. 3. German measles. 4. Hand-Foot-Mouth Disease

ANS: 2 Feedback 1. Crustations develop and serous drainage is present 2. The prodromal signs and symptoms of Fifths 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.

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.

ANS: 2 Feedback 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

ANS: 2 Feedback 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.

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.

ANS: 2 Feedback 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.

Anne goes into her pediatric patients 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.

ANS: 3 Feedback 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 childs circulatory system. 4. The thick mucus occurs because the child has been dehydrated.

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

ANS: 3 Feedback 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.

ANS: 3 Feedback 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.

Reyes 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.

ANS: 3 Feedback 1. Ibuprofen is safe for viral illnesses. 2. Ibuprofen is safe for bacterial illnesses. 3. Reyes 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. Reyes Syndrome typically follows a viral infection, so it is acceptable to give aspirin or other salicylates for a bacterial infection.

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.

ANS: 3 Feedback 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.

ANS: 3 Feedback 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.

ANS: 4 Feedback 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.

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

ANS: 4 Feedback 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.

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)

ANS: 4 Feedback 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

ANS: 4 Feedback 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

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

ANS: 4 Feedback 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.

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 patients 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

ANS: 4 Feedback 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.

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.

ANS: 4 Feedback 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.