Pediatrics: PrepU: Chapter 15

The father of a child with mononucleosis is concerned with his child's fever and cough. The father asks when antibiotic therapy will begin. What is the best response by the nurse?

"Mononucleosis is a viral infection so an antibiotic isn't used. We address the symptoms with appropriate therapy."

The parents of a 4-month-old diagnosed with sepsis tell the nurse that the physician explained sepsis to them but they don't really understand it. The parents state, "Could you please explain it to us?" What is the best response by the nurse?

"The infection your child has causes the release of toxins into the system, which can lead to impaired function in the lungs, liver, and kidneys."

The nurse is caring for a child newly diagnosed with diphtheria. Which nursing interventions would the nurse include in the child's plan of care? Select all that apply.

Administering antitoxin intravenously Monitoring for airway obstruction Adhering to droplet precautions Ensuring complete bed rest Explanation: Treatment of diphtheria involves intravenous administration of antitoxin in large doses. In addition, children are given penicillin or erythromycin intravenously. Complete bed rest is crucial during the acute stage of the illness. Droplet precautions must be followed until cultures are negative. Children need careful observation at all times to prevent airway obstruction. If obstruction occurs, endotracheal intubation may be necessary.

The mother of a 10-year-old child diagnosed with rubella asks what can be done to help her child feel better during her illness. What information can be provided?

Encourage rest and relaxation. Explanation: Rubella infection is usually mild and self-limited. The care given is normally supportive. Rest is encouraged. Medications administered are normally limited to anti-pyretics and analgesics. Antibiotic and antiviral therapies are not normally included in the plan of treatment. Range of motion is not needed as mobility of the client is not limited.

The nurse is preparing to administer acetaminophen to a 4-year-old child to provide comfort. Which precaution is specific to antipyretics?

Ensure proper dose and interval Explanation: It is very important to ensure that the proper dose is given at the proper interval because an overdose can be toxic to the child. Concerns with allergies and taking the entire, prescribed dose are precautions when administering antibiotics and all medications. Drowsiness is not a side effect of antipyretics.

The parents of a child voice concern to the nurse that they believe their child has Lyme disease but their physician won't do the proper testing. The nurse reviews the chart to determine if specific testing for the disease has been performed. Which tests is the nurse looking for?

Enzyme immunoassay (EIA) Immunofluorescent assay (IFA) Western immunoblot

Nursing students are learning about the infectious process. They correctly identify the first stage of an infectious disease to be which period?

Incubation period Infection occurs when an organism invades the body and multiplies, causing damage to the tissue and cells. The infectious process goes through four stages. The incubation period is the first stage of the infectious disease. It is the time between the invasion of an organism and the onset of symptoms of infection. The prodromal period is the time from the onset of nonspecific symptoms to specific symptoms, for example, cold/flu-like symptoms before Koplik spots occur in measles. The illness is the time during which symptoms of the specific illness occur. The convalescent stage is the time when the acute symptoms disappear.

The appearance of which hallmark clinical manifestation occurs in measles?

Koplik spots

A nurse is preparing a presentation for parents about common childhood infectious diseases. What conditions would the nurse include as being caused by a tick bite? Select all that apply.

Lyme disease Rocky Mountain spotted fever

A child in the clinic has a fever and reports a sore neck. Upon assessment the nurse finds a swollen parotid gland. The nurse suspects which infectious disease?

Mumps Mumps is an infectious disease with a primary symptom of a swollen parotid gland. It is a contagious disease spread by droplets. The child is contagious 1 to 7 days prior to the onset of the swelling and 4 to 9 days after the onset of the swelling. Pertussis is a respiratory disorder that causes severe paroxysmal coughing, which produces a whooping sound. Measles is recognized by Koplik spots in the mouth and the classic maculopapular rash that starts on the head and spreads downward. Scabies is a skin condition where lice lay eggs under the skin. The rash is very pruritic and is seen on the hands, feet, and folds of the skin.

The nurse is assessing a child who presents with a history of fever, malaise, fatigue, and headache. The nurse notes a bulls-eye rash on the child's right leg. Which action will the nurse take?

Notify the primary health care provider. Explanation: The nurse would suspect the child has Lyme disease and notify the health care provider for additional testing and potential antibiotic therapy. Precautions are not indicated for clients with Lyme disease. An ECG would only be needed if cardiac symptoms were noted. It is recommended to clean the site of the tick bite with rubbing alcohol when the tick is removed, not at a later time.

A child is diagnosed with scarlet fever. History reveals that the child has no known drug allergies. When preparing the child's plan of care, the nurse would anticipate administering which agent as the drug of choice?

Penicillin V Explanation: Penicillin V is the antibiotic of choice. In those sensitive to penicillin, erythromycin may be used. Trimethoprim-sulfamethoxazole and clarithromycin are not used.

A nurse practitioner suspects that a child has scarlet fever based on which assessment finding?

Red, strawberry tongue The characteristic assessment finding that distinguishes scarlet fever from other disorders is the appearance of the red, strawberry tongue. Sore throat, an enanthematous and exanthematous rash, and white exudate on the tonsils are also seen with scarlet fever, but it is the strawberry tongue that helps to confirm the diagnosis.

What is a true statement regarding varicella zoster virus infection?

Secondary bacterial infections of the skin can occur. Explanation: Varicella zoster virus infection carries with it the complication of a secondary bacterial infection of the skin. The lesions are intensely pruritic, making the child want to scratch the lesions and opening them to a variety of organisms to invade. The incubation period is 10 to 21 days. It is transmitted by direct contact with the vesicles and by airborne route. It tends to be more severe in adolescents and adults.

Parents bring their 9-year-old child to the clinic for a well-child visit. They are concerned because several children in the neighborhood have developed Lyme disease and ask for suggestions on what to do to reduce their child's risk. What would be appropriate for the nurse to suggest? Select all that apply.

Wearing protective clothing when playing in wooded areas. Inspecting the skin closely for ticks after the child plays in wooded areas. Contacting the health care provider if there is any area of inflammation that might be a bite.

The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see first

a child with erythema infectiosum experiencing fatigue and confusion A child with erythema infectiosum experiencing fatigue and confusion is showing signs of decreased oxygenation, possibly related to aplasia of erythrocytes caused by the virus. A child with signs and symptoms of decreased oxygenation should be seen first. Nausea and malaise are symptoms of chicken pox. A child with herpes simplex will most likely report pain an pruritis. Signs and symptoms of measles include photophobia and coryza.

Which child will the nurse identify as being at greatest risk for developing a hospital-acquired infection (HAI)?

an 18-month-old child receiving chemotherapy over 5 days

The nurse is caring for an adolescent diagnosed with syphilis. The drug of choice for treating syphilis is:

penicillin Syphilis responds to one intramuscular injection of penicillin G benzathine; if the child is sensitive to penicillin, oral doxycycline, tetracycline, or erythromycin can be administered as alternative treatment.

While assessing a child, the nurse notes a runny nose, temperature 100.4°F (38°C), and a whoop sound when the child coughs. On which diagnosis will the nurse anticipate providing education for this family?

pertussis Explanation: Pertussis, also known as whooping cough, begins as an upper respiratory illness and progresses to a persistent cough characterized by a whooping sound. Tuberculosis, influenza, and nasopharyngitis are not characterized by a whooping sound.

The nurse is caring for a child admitted to the hospital for sepsis. Which assessment finding is the most concerning?

urine output of 10 ml over 3 hours Explanation: Children with sepsis will show alteration in temperature, heart rate, respiratory rate, and white blood cell count. Septic shock with organ dysfunction is more serious and can be manifested by decreased urine output.

A group of nursing students are reviewing the functions of white blood cells. The students demonstrate an understanding of the information when they identify which white blood cell as responsible for combating allergic disorders?

Eosinophils Explanation: Eosinophils function to combat allergic disorders and parasitic infestations. Neutrophils function to combat bacterial infections. Lymphocytes function to combat viral infections. Monocytes function to combat severe infections.

What is the leading cause of neonatal sepsis and death?

Group B streptococcus Sepsis is a systemic overresponse to infection. It is very serious and can produce septic shock and death. In infants under the 3 months of age the most causative agents are group B streptococcus, Escherichia coli, Staphylococcus aureus, enteroviruses, and the herpes simplex virus. Any time a febrile, ill-appearing neonate is seen, a full septic work-up is done. Neonates have the poorest outcomes from sepsis. Neisseria meningitidis is one cause of sepsis in older children. The Epstein-Barr virus is a herpes virus that causes mononucleosis. The cytomegalovirus is a common herpes virus. It is spread through bodily fluids and is not necessarily a concern unless the person is immunocompromised or is pregnant.

A chief danger of scarlet fever is that children may develop:

acute glomerulonephritis. Explanation: Scarlet fever infection is the result of group A streptococci. It generally starts with a throat infection (strep throat). The bacteria produce a toxin that causes the rash over the body. Because this is a streptococci-based infection, the child will need to be monitored for the development of rheumatic fever or glomerulonephritis following the illness. Scarlet fever does not cause respiratory symptoms, attack the liver, or have open lesions.

The student nurse is discussing the plan of care for a child admitted to the hospital for treatment of an infection. Which action should be taken first?

Obtain blood cultures When treating a child suspected of having an infection, the blood cultures must be obtained first. The administration of antibiotics may impact the culture's results. A urine specimen may be obtained but is not the priority action. Intravenous fluids will likely be included in the plan of care but are not the priority action.

When the health care provider looks in a child's mouth during a sick-visit examination, the parent exclaims: "The tongue is bright red! It was not like that yesterday." The health care provider would most likely prescribe which medication based on the probable diagnosis?

Penicillin to prevent acute glomerulonephritis Explanation: A "strawberry tongue" is a classic sign of scarlet fever. Penicillin is prescribed to treat the beta-hemolytic group A streptococcal infection and to prevent the complication of developing acute glomerulonephritis and rheumatic fever. Erythromycin can be used to treat the disease if the child is allergic to penicillin. Antibiotics are not given prophylactically to siblings. The disease is spread via droplets, so keeping the siblings away from the infected child and handwashing are the best preventive measures. Acetaminophen can be administered for fever control. It works systemically and has very little, if any, affect locally. Antibiotics are the mainstay of treatment. Steroids are used infrequently.

A 9-month-old child has been admitted to rule out sepsis. Which finding offers the most support to the presence of this disorder?

The child has had 8 ounces of formula in the past 24 hours. Explanation: Sepsis is a systemic overresponse to infection resulting from bacteria and viruses, which are the most common fungi, viruses, rickettsia, or parasites. It can lead to septic shock, which results in hypotension, low blood flow, and multisystem organ failure. Signs of sepsis include a lack of appetite, lethargy, hypotonia, and temperature elevations.

The nurse is caring for a child whose family recently emigrated from a developing country. While completing the admission history, the parents report all the child's immunizations are up to date. Which nursing action is most appropriate

Ask parents which immunizations have been given. Explanation: When caring for a child recently emigrated from a developing country, the nurse should be aware that WHO recommended vaccinations and U.S. recommended vaccinations may be different. The most appropriate action is for the nurse to determine which vaccinations have been given to decide if additional immunizations may be needed.

A 10-year-old child has an unknown infection and will need to provide a urine specimen for culture and sensitivity. To assure that the sensitivity results are accurate, which step is most important?

Obtain specimen before antibiotics are given In order to ensure a successful culture, the nurse must determine if the child is taking antibiotics. Throat cultures require specimens taken from the pharyngeal or tonsillar area. Stool cultures may require three specimens, each on a different day. The nurse would use aseptic technique when getting a blood specimen as well as the urine, but antibiotics cannot be received by the child prior to the test being done.

A 6-year-old child is brought to the clinic by his parents. The parents state, "He had a sore throat for a couple of days and now his temperature is over 102°F (38.9°C). He has this rash on his face and chest that looks like sunburn but feels really rough." What would the nurse suspect?

Scarlet fever Explanation: Scarlet fever typically is associated with a sore throat, fever greater than 101° F (38.9° C), and the characteristic rash on the face, trunk, and extremities that looks like sunburn but feels like sandpaper. CAMRSA is typically manifested by skin and tissue infections. Diphtheria is characterized by a sore throat and difficulty swallowing but fever is usually below 102°F (38.9°C). Airway obstruction is apparent. Pertussis is characterized by cough and cold symptoms that progress to paroxysmal coughing spells along with copious secretions.

The nurse is caring for a 5-year-old girl with scarlet fever. Which intervention will most likely be part of her care?

Teaching proper administration of Penicillin V

A 5-year-old girl catches the flu from a friend at day care after the friend sneezed and wiped mucus on a toy that the girl subsequently played with. In this case, what is the portal of exit in the chain of infection?

Upper respiratory excretion Explanation: The portal of exit is the route by which an organism leaves an infected child's body to be spread to others. An organism can be carried out of the body by upper respiratory excretions, feces, vomitus, saliva, urine, vaginal secretions, blood, or lesion secretions. The friend would be the reservoir, which is the container or place in which an organism grows and reproduces. The toy would be the means of transmission. The 5-year-old girl would be the susceptible host.

The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see first?

a child with erythema infectiosum experiencing fatigue and confusion Explanation: A child with erythema infectiosum experiencing fatigue and confusion is showing signs of decreased oxygenation, possibly related to aplasia of erythrocytes caused by the virus. A child with signs and symptoms of decreased oxygenation should be seen first. Nausea and malaise are symptoms of chicken pox. A child with herpes simplex will most likely report pain an pruritis. Signs and symptoms of measles include photophobia and coryza.

Which child will the nurse identify as at greatest risk for developing a urinary tract infection?

an 8-month-old bottle-fed female with HIV Factors that make an individual more prone to a urinary tract infection include young age, female gender, and immunosuppression. Infants who are formula-fed are at greater risk than infants who are breastfed. To determine the child at greatest risk, the nurse should count risk factors and determine which child has the most risk factors.

Which diagnostic tool is used to identify children who may have an infection or inflammatory process?

erythrocyte sedimentation rate (ESR) Explanation: Several laboratory tests can be performed to determine infection or inflammation. A complete blood count is used to determine elevation of the white blood cells, which would indicate infection. The erythrocyte sedimentation rate (ESR) is a nonspecific screening procedure used in conjunction with other tests to determine infection or inflammation. A blood culture is utilized to confirm the presence of bacteria or yeast and to determine which type of bacteria is in the bloodstream. Gastric lavage is used to identify TB in a child when bronchoscopy cannot be performed, or it can be used in emergency settings when the child has ingested a toxic substance. An arterial blood gas analysis is performed to determine if there is respiratory or metabolic alkalosis or acidosis.