PrepU CH. 37: Nursing Care of the Child w/ an Infectious or Communicable Disorder (PEDs)
The nurse is assessing a child with a varicella infection. The nurse would be alert for which possible complication(s)? Select all that apply. Secondary bacterial infection Pneumonia Scarring Encephalitis Scarlet fever
Secondary bacterial infection Pneumonia Scarring Encephalitis Explanation: The most common complication of varicella is secondary bacterial infection caused by the child scratching the lesions. Other complications include pneumonia, scarring, and encephalitis. Scarlet fever is a complication associated with group A streptococcal infections.
After teaching the parents of a child with chickenpox (varicella zoster), the nurse determines that the parents have understood the teaching when they state that their child can return to school at which time? after day 5 of the rash when the rash is completely healed once the rash appears after the lesions have crusted
after the lesions have crusted Explanation: Children with chickenpox (varicella zoster) can return to school once the lesions have crusted.
The nurse is educating parents of a child admitted to the hospital with rubella (German measles). Which statement by the parents indicates the further education is needed? "Our child is contagious for 1 week after the rash appeared." "Acetaminophen or ibuprofen can be given to help with pain." "Antibiotics are needed to help our child recover from rubella." "Family members should wear a mask when coming to visit us."
"Antibiotics are needed to help our child recover from rubella." Explanation: Rubella (German measles) is caused by the rubella virus. Children will be contagious for 1 week before to approximately 1 week after the rash appears. Acetaminophen or ibuprofen can be given to help with pain or fever, and the child will be on droplet precautions (mask) while in the hospital.
The nurse is discussing fever with the parents of a child who is in the emergency department with a temperature of 101°F (38.3°C). Which statement by a parent indicates an understanding of fevers and their management in the ill child? "We've been giving them a little extra acetaminophen to help bring their fever down." "We've had to wake them up in the night to give them more medicine to reduce their temperature." "My spouse and I have been using cold water and washcloths on them because of the fever." "Fevers can be beneficial because they can slow down the growth of the bacteria or virus that may be causing the infection."
"Fevers can be beneficial because they can slow down the growth of the bacteria or virus that may be causing the infection." Explanation: Fevers can be protective and can help the body fight the infection. Fevers slow down bacterial or viral growth. Mismanaging fevers include inappropriate dosing of antipyretics, awakening a child at night to administer antipyretics, and using cold water or sponging the child with alcohol to reduce the temperature.
When providing care for a child with herpes zoster (shingles), the parents ask the nurse how the child contracted this infectious disorder. Which response by the nurse is most appropriate? "Your child must have been exposed to someone with herpes zoster." "Herpes zoster is a reactivation of a previous varicella zoster infection." "Children who are immunocompromised are more likely to contract shingles." "Handwashing is an effective way to prevent the spread of infectious disorders."
"Herpes zoster is a reactivation of a previous varicella zoster infection." Explanation: Herpes zoster (shingles) is reactivation of the latent varicella zoster (chickenpox) infection that occurs during times of immunosuppression and aging. Although it is possible to contract the varicella zoster virus from a person with herpes zoster or varicella zoster, a child diagnosed with herpes zoster has already been exposed to varicella zoster. Handwashing will not directly prevent herpes zoster.
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 Instituting airborne precautions Monitoring for airway obstruction Adhering to droplet precautions Ensuring complete bed rest
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 parent of a 10-year-old child diagnosed with rubella asks what can be done to help their child feel better during their illness. What information can be provided? Encourage rest and relaxation. Antibiotic therapy may be initiated. Antiviral medications can be prescribed. Range of motion to prevent contractures.
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 antipyretics 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? Check for medicine allergies. Take the entire course of medication. Ensure proper dose and interval. Warn of possible drowsiness.
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.
Nursing students are learning about the infectious process. They correctly identify the first stage of an infectious disease to be which period? Incubation period Prodromal period Illness period Convalescent period
Incubation period Explanation: 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.
A child is brought to the clinic with fever, cough, and coryza. The nurse inspects the child's mouth and observes what look like tiny grains of white sand with red rings. How would the nurse document these findings? Koplik spots Lymphadenopathy Slapped cheek appearance Nits
Koplik spots Explanation: Koplik spots are bright red spots with blue-white centers appearing primarily on the buccal mucosa and indicate rubeola (measles). They are often described as tiny grains of white sand surrounded by red rings. Lymphadenopathy is used to document enlargement of the lymph nodes. Slapped cheek appearance refers to the erythematous flushing associated with fifth disease. Nits refer to the adult eggs of pediculosis.
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 Psittacosis Ascariasis Scabies
Lyme disease Rocky Mountain spotted fever Explanation: Infectious diseases caused by tick bites include Lyme disease and Rocky Mountain spotted fever. Psittacosis is transmitted to children by birds. Ascariasis is a roundworm infection. Scabies is a parasitic infection caused by a female mite.
A 7-year-old child with an earache comes to the clinic. The child's parent reports that 1 day ago the child had a fever and headache and did not want to play. When the nurse asks where it hurts, the child points to the jawline in front of the earlobe. What does the nurse expect the diagnosis will be for this child? Measles Mumps Mononucleosis Fifth disease
Mumps Explanation: Mumps begins with a fever, headache, anorexia, and malaise. Within 24 hours an earache occurs. When pointing to the site of pain, however, the child points to the jawline just in front of the earlobe. Mumps is contagious 1 to 7 days prior to the onset of symptoms and 4 to 9 days after the parotid swelling begins. Fifth disease is also known as the "slapping disease," as the rash on the cheeks look like someone slapped the child's face. Measles does not involve parotid swelling or earaches. Mononucleosis does involve swollen lymph nodes but they are in the neck and the axillary area.
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. Initiate antibiotic therapy. Obtain urine specimen for analysis. Initiate intravenous therapy.
Obtain blood cultures. Explanation: 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.
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 7 wet diapers in the past 24 hours. The child cries when their parent is not in sight. The child has had 8 ounces of formula in the past 24 hours. The child's birth history indicates they are born at 42 weeks' gestation.
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.
What is a true statement regarding measles? It is transmitted by the fecal-oral route. It is not contagious. The incubation period is 10 to 12 days. Peak outbreaks are in the summer.
The incubation period is 10 to 12 days. Explanation: Measles is a highly contagious disease spread via droplets from the nasopharyngeal secretions. The typical incubation period is 10 to 12 days. Outbreaks peak in the winter and spring. It is communicable 1 to 2 days before the onset of symptoms. The initial symptoms are fever, cough, coryza and conjunctivitis. These symptoms are followed by Koplik spots seen in the mouth. A rash develops on the head and spreads downward and outward.
When caring for a child diagnosed with West Nile virus, the nurse will question which prescription from the primary health care provider? amoxicillin 40 mg/kg/day orally every 8 hours acetaminophen every 4 to 6 hours PRN fever Place client on fall precautions. Monitor the client's cardiac status.
amoxicillin 40 mg/kg/day orally every 8 hours Explanation: West Nile virus is transmitted to humans primarily through the bite of infected mosquitoes and manifestations include: fever, weakness, fatigue, balance problems, memory impairment, headache, myocarditis, hepatitis, myositis and orchitis, and rhabdomyolysis. Treatment is symptomatic. Since this is a viral illness, antibiotics would not be given and the nurse would question such prescriptions. It is appropriate to give acetaminophen for the fever or pain; place on fall precautions due to fatigue, balance problems, and weakness; and monitor the cardiac status for the development of myocarditis.
A child admitted to the pediatric unit is to have blood specimens obtained for testing. When preparing to obtain the specimens via venipuncture, which sites would the nurse likely use? Select all that apply. dorsal aspect of the hand antecubital fossa jugular vein femoral vein fingertip
dorsal aspect of the hand antecubital fossa Explanation: The usual sites for obtaining blood specimens via venipuncture are the superficial veins of the dorsal surface of the hand or the antecubital fossa, although other locations may also be used. In specific situations, the jugular or femoral vein may be used. Capillary puncture of the child's fingertip, the great toe, or the infant's heel may also be used to obtain blood specimens.
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 neutrophils lymphocytes monocytes
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.
A young client arrives at the clinic with a rash on the trunk and flexor surfaces of the extremities. The parent informs the nurse that the rash started a day before on the exterior surfaces of the extremities; 2 days before, the child had a really bad rash on the face. The health care provider diagnoses the child with erythema infectiosum. The nurse tells the parent that this is also known as: enterovirus. fifth disease. rosacea. pityriasis rosea.
fifth disease. Explanation: Erythema infectiosum is also known as "fifth disease." It starts with a fever, headache, and malaise. One week later, a rash appears on the face. A day later, the rash appears on the extensor surfaces of the extremities. One more day later, the rash appears on the trunk and flexor surfaces of the extremities. Pityriasis rosea is a skin rash that begins with a large spot on the chest, abdomen, or back that is followed by a pattern of small lesions. It is self-limiting and can be treated with steroid creams. Rosacea is a chronic inflammatory skin condition that causes redness to the face. An enterovirus infection can many times cause the same symptoms as the common cold or it can include the respiratory system. It is contagious.
A 6-year-old child is being treated for a parasitic infection. When reviewing results from the child's white blood cell count, which finding would be anticipated? elevated monocytes reduced basophil levels increased eosinophil levels reduced neutrophil levels
increased eosinophil levels Explanation: Eosinophils are the first line of defense against parasitic infections and allergic reactions and will be elevated. Monocytes are a second line of defense and will be elevated in response to leukemias, lymphomas, and chronic inflammation. Basophils respond to allergic disorders and hypersensitivity reactions. Neutrophils are the first line of defense upon invasion of bacteria, fungus, cell debris, and other foreign substances.
What would the nurse include in the teaching plan for parents and their child with a pruritic rash? Select all that apply. keeping fingernails trimmed short using distraction to prevent scratching encouraging pressure on the skin rather than scratching making sure the child's hands are clean using warm baths to soothe the skin
keeping fingernails trimmed short using distraction to prevent scratching encouraging pressure on the skin rather than scratching making sure the child's hands are clean Explanation: To reduce pruritus, teaching would include keeping the child's nails trimmed short, using distraction to prevent scratching, using pressure on the skin rather than scratching, and making sure the child's hands are clean. Cool baths and compresses would help relieve itching.
The nurse is obtaining a health history and assessment for a child being admitted who is suspected of having measles. What signs and symptoms does the nurse expect to find during the assessment? Select all that apply. maculopapular rash that began on the face and has spread to the rest of the body clear, fluid-filled vesicles fever upper respiratory infection symptoms erythematous flushing
maculopapular rash that began on the face and has spread to the rest of the body fever upper respiratory infection symptoms Explanation: Maculopapular rash that began on the face and has spread to the rest of the body, fever, and upper respiratory infection symptoms are characteristic of both rubella (German measles) and rubeola (measles). Clear, fluid-filled vesicles are characteristic of chickenpox (varicella zoster). Erythematous flushing is common with erythema infectiosum (fifth disease).
The client has a heavily draining wound for which there is an order to change the dressing every 4 hours. The nurse becomes busy and does not change the dressing as ordered. Which link in the chain of infection has the nurse allowed to flourish? susceptible host portal of exit reservoir mode of transmission
reservoir Explanation: The reservoir is the area where a pathogen grows and reproduces. Leaving the dressing unchanged allows for a dark, warm, nutrient-rich, and moist environment where many organisms will thrive. A susceptible host is a person who cannot fight off an infection. The portal of exit is the way a pathogen exits the host. The mode of transmission is the way the pathogen travels.
The nurse is attempting to control the infectious process while caring for a client. The nurse changes the client's wound dressing when the dressing becomes soiled. Which link of the chain of infection is the nurse interrupting with this intervention? reservoir portal of exit mode of transmission susceptible host
reservoir Explanation: The reservoir is the place where a microorganism grows and reproduces. Dressings left unchanged leave a dark, warm, moist environment for microorganisms to thrive. Covering the mouth and using personal protective equipment are ways to control portals of exit. Modes of transmission can be controlled with handwashing and personal protective equipment. The susceptible host is the person who is susceptible to developing an infection. Promotion of natural defenses is a good way to prevent infection.
The nurse is performing a physical examination on a 9-year-old child who has experienced a tick bite on the lower leg and is suspected of having Lyme disease. Which assessment finding does the nurse expect to find? swelling in the neck confusion and anxiety ring-like rash on lower leg hypersalivation
ring-like rash on lower leg Explanation: A ring-like rash at the site of the tick bite is characteristic for Lyme disease. Swelling in the neck is a symptom of mumps. Confusion, anxiety, and hypersalivation are symptoms of rabies.
Assessment of a child reveals black burrows of about 1-inch long between the fingers and toes and in the axilla. A diagnosis of scabies is made. When planning this child's care, the nurse anticipates which medication being prescribed? topical permethrin oral albendazole oral pyrantel pamoate oral nitazoxanide
topical permethrin Explanation: Topical permethrin 5% cream is the drug of choice for treating scabies. The oral medications albendazole, pyrantel pamoate and nitazoxanide are used to treat helminthic (parasitic worm) infections.
The nurse is taking a health history for an 8-year-old child who is hospitalized. Which is a risk factor for sepsis in a hospitalized child? infection or fever in the birthing parent use of immunosuppression drugs lack of juvenile immunizations resuscitation or invasive procedures
use of immunosuppression drugs Explanation: The use of immunosuppression drugs is a risk factor for the hospitalized child. Infection or fever in the birthing parent and resuscitation or invasive procedures are sepsis risk factors related to pregnancy and labor. Lack of juvenile immunizations is a risk factor affecting the overall health of the child but does not impact the chance of sepsis.
A 6-year-old child is brought to the clinic by their parents. The parents state, "Our child had a sore throat for a couple of days and now their temperature is over 102°F (38.9°C). They have this rash on their face and chest that looks like sunburn but feels really rough." What would the nurse suspect? Scarlet fever Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) Diphtheria Pertussis
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.
A parent calls the nurse triage line at the clinic. The parent is concerned and believes the preschool-aged child may have contracted rubeola. Which question(s) should the nurse ask the parent to aid in making this diagnosis? Select all that apply. "How long has your child had the cough and runny nose?" "Has your child been around any other children with measles?" "When you look in your child's mouth can you see any spots or anything unusual?" "Can you describe what your child's rash looks like?" "Has your child completed the measles vaccine series?"
"How long has your child had the cough and runny nose?" "Has your child been around any other children with measles?" "When you look in your child's mouth can you see any spots or anything unusual?" "Can you describe what your child's rash looks like?" Explanation: Rubeola is caused by the rubeola virus and is spread through droplet transmission. Symptoms generally start with a cough, coryza, conjunctivitis and fever. This stage can last 2 to 4 days. A classic sign is Koplik spots. These are bright red spots with blue-white centers on the buccal mucosa. The rash begins to appear 3 to 4 days after the prodromal symptoms. It is erythematous and maculopapular in nature. The rash starts on the head and expands downward and outward. If the preschool-aged child received a measles vaccine, it should have been administered between 12 to 15 months of age. The second dose would not be due until 4 to 6 years of age, so this preschool-aged child may be too young for the second dose. It would be important to know if the child had been around anyone else with measles. The virus could have been via another child's coughing and sneezing, and the preschool-aged child may not be thoroughly protected with only one dose of the vaccine.
After teaching a parent how to remove a tick from their 6-year-old child's arm, the nurse determines that additional teaching is needed when the parent makes which statement? "I will protect my fingers with a paper towel." "I will grasp the tick and pull it away quickly." "I should put the tick in a plastic bag in the freezer." "I need to grasp the tick close to my child's skin."
"I will grasp the tick and pull it away quickly." Explanation: Grasping the tick and pulling it away quickly indicates the need for additional teaching. When removing a tick, the parent should use fine-tipped tweezers while protecting their fingers with a tissue, paper towel, or latex gloves. The parent should grasp the tick as close to the skin as possible and pull upward with steady, even pressure. Once removed, the parent should place the tick in a sealable plastic bag in the freezer in case the child becomes sick and identification of the tick is needed.
A nurse is instructing a parent on how to obtain a stool culture for ova and parasites from a child with diarrhea. What will the nurse include in the teaching plan? "Give the child bismuth and then collect the next specimen." "Obtain the specimen from the toilet after the child has a bowel movement." "Keep the specimen from coming into contact with any urine." "Bring the specimen to the laboratory on the third day."
"Keep the specimen from coming into contact with any urine." Explanation: A stool specimen for culture must be free of urine, water, and toilet paper. Therefore, the parent needs to understand how to collect the specimen so that it does not come into contact with any of these. In addition, the specimen should not be retrieved out of toilet water. Mineral oil, barium, and bismuth interfere with the detection of parasites. In such cases, specimen collection should be delayed for 7 to 10 days. Once the specimen is collected, it should be brought to the laboratory immediately.
The parents of a 3-year-old child report they were exposed to pertussis 2 days ago. They are concerned and ask the nurse how long it will take until they become ill if they indeed contracted the infection. What response by the nurse is indicated? "If you child has contracted the illness they will become ill in about 2 weeks." "The signs of disease will be noted in 1 to 3 weeks." "If your child had contracted the disease symptoms would have be noted by this time." "It normally takes about 3 weeks before symptoms begin."
"The signs of disease will be noted in 1 to 3 weeks." Explanation: Pertussis is an acute respiratory disorder characterized by paroxysmal cough (whooping cough) and copious secretions. The disease is caused by Bordetella pertussis. The incubation period is 6 to 21 days, usually 7 to 10 days.
The parents of a 3-year-old child report they were exposed to pertussis 2 days ago. They are concerned and ask the nurse how long it will take until they become ill if they indeed contracted the infection. What response by the nurse is indicated? "If you child has contracted the illness they will become ill in about 2 weeks." "The signs of disease will be noted in 1 to 3 weeks." "If your child had contracted the disease symptoms would have be noted by this time." "It normally takes about 3 weeks before symptoms begin."
"The signs of disease will be noted in 1 to 3 weeks." Explanation: Pertussis is an acute respiratory disorder characterized by paroxysmal cough (whooping cough) and copious secretions. The disease is caused by Bordetella pertussis. The incubation period is 6 to 21 days, usually 7 to 10 days.
A child is diagnosed with varicella. The parent states the child is "just miserable" and wants to know how best to make the child feel more comfortable. Which instruction(s) would the nurse give this parent? Select all that apply. "You can administer acetaminophen to help with fever and pain." "Keep only light clothing on your child." "Keep your child's fingernails short so scratching will not disturb vesicles." "Administer prescribed topical steroid ointment to reduce inflammation." "Place the child in a soothing tepid bath."
"You can administer acetaminophen to help with fever and pain." "Keep only light clothing on your child." "Keep your child's fingernails short so scratching will not disturb vesicles." "Place the child in a soothing tepid bath." Explanation: Varicella is an extremely contagious disease spread via the airborne route or through direct contact with nasopharyngeal secretions. Initially, the rash is intensely pruritic. It begins as erythematous macules that evolve into papules and then form into fluid-filled vesicles. The child generally has a fever and is very uncomfortable. To help reduce some of the discomfort, the nurse should teach the parent to administer antipyretics and analgesics. Reducing the fever increases the comfort of the child and also decreases the fluid requirements. It is best to keep the child in light, restrictive clothing. Tighter clothing can cause more diaphoresis and more itching. Blankets should be kept off the child to reduce fever and provide comfort. The child's fingernails should be cut short to prevent opening lesions and potentially causing a secondary infection. Socks or mitts can be placed on the hands. Cool compresses or tepid baths can help with comfort by decreasing inflammation. The health care provider may prescribe an anti-itch medication. Steroids, either topical or oral, are not used in the treatment.
A school-aged child is recovering from varicella. The parent calls the school nurse and states, "my child is feeling much better" and asks when the child can return to school. What information does the nurse provide the parent? "Your child may return to school when all of the lesions have crusted over." "Your child may return to school when a health care provider has given written permission." "Your child may return to school when free of any lesions." "Your child may return to school when there has been no fever for 48 hours."
"Your child may return to school when all of the lesions have crusted over." Explanation: Varicella is a highly communicable disease. It is spread via airborne transmission or by direct contact with the nasopharyngeal secretions of an infected person. Varicella is communicable from 1 to 2 days before the rash occurs until all the vesicles have crusted over. The nurse would be correct in telling the parent the child cannot return to school, even though the child is feeling better, until all the vesicles have crusted over. The child does not have to be free of lesions. Being free of fever does not make the child less communicable. The child would not need a permission slip from the health care provider unless this is a specific requirement by the child's school district.
The nurse is caring for a school-aged child hospitalized with an infectious disease. The child is placed on transmission-based precautions. What would the nurse include in the plan of care? Select all that apply. Permit the immediate family to avoid wearing the gown and mask during visits in the room. Allow the child to view the staff's face through the door window before entering the room. Encourage the parents to contact friends and classmates so cards can be sent and displayed. Monitor the child for changes in mood or level of aggression. Provide the child with age-appropriate games and toys for their room. Plan for extra time to visit the child throughout the shift between assessments and procedures.
Allow the child to view the staff's face through the door window before entering the room. Encourage the parents to contact friends and classmates so cards can be sent and displayed. Monitor the child for changes in mood or level of aggression. Provide the child with age-appropriate games and toys for their room. Plan for extra time to visit the child throughout the shift between assessments and procedures. Explanation: The child in transmission-based isolation may experience feelings of isolation and sensory deprivation because of restricted visiting and the use of personal protective gear (gown, mask and gloves) by those in the child's hospital room. The use of age appropriate toys and games dedicated to the child's room, extra time spent with the child by staff, the display of cards from friends and classmates, and allowing the child to view staff members' faces from outside the room all promote sensory stimulation and lessen the feeling of isolation. The family would be taught to follow the same precautions as the staff. Sensory overload is not a concern for a child in transmission-based precautions.
The rash in roseola is pruritic. Which measure would the nurse teach the parent to provide comfort? Dress the child warmly to bring out the rash so that it fades quickly. Apply cool compresses to the skin to stop local itching. Discuss with the child the importance of not scratching lesions. Administer infant aspirin every 4 hours as necessary for comfort.
Apply cool compresses to the skin to stop local itching. Explanation: Rashes can be uncomfortable and irritating. Parents need to be educated on ways to relieve discomfort and to protect and maintain skin integrity. Cool compresses or cool baths will help to relieve the itching associated with the rash. Antipruritics may be necessary to help with itching. To protect the skin, the child should be instructed not to scratch the skin to alleviate itching. The child's fingernails should be kept short. Keeping the child dressed warmly will not bring out the rash any sooner. Being warm will, however, cause increased body temperature and intensify the itching. Aspirin should not be used in children as an antipyretic. There is an increased risk of developing Reye syndrome.
Which collaborative interventions will the nurse implement for a child with acute herpetic gingivostomatitis? Select all that apply. Assess intake and output. Provide popsicles and ice. Administer acetaminophen. Initiate contact precautions. Give an oral dose of acyclovir.
Assess intake and output. Provide popsicles and ice. Administer acetaminophen. Initiate contact precautions. Give an oral dose of acyclovir. Explanation: A child with acute herpetic gingivostomatitis will have painful mouth ulcers, drooling, anorexia, and a high fever. The nurse will provide acetaminophen for fever and pain, administer acyclovir to shorten the course of the illness, and offer popsicles and ice to help with mouth pain. Contact precautions will be initiated to prevent spreading the illness to others, and because the child is at risk for dehydration from a high fever and painful mouth, the nurse will assess intake/output.
The nurse is triaging a child diagnosed with poliomyelitis. After ensuring appropriate precautions are in place, what will the nurse do next? Place the child on bed rest. Begin physical therapy. Administer an antipyretic. Auscultate the child's lungs.
Auscultate the child's lungs. Explanation: Because poliomyelitis can cause motor paralysis of the respiratory muscles, assessing respiratory status is priority. Once the nurse has ensured respiratory function is intact, the nurse can place the child on bed rest, administer an antipyretic, and begin physical therapy.
Which collaborative intervention will the nurse provide when caring for an infant diagnosed with pertussis? Select all that apply. Have suction available in the room. Encourage small, frequent feedings. Administer erythromycin for 10 days. Utilize droplet and standard precautions. Restrict visitors for 48 hours of hospitalization.
Have suction available in the room. Encourage small, frequent feedings. Administer erythromycin for 10 days. Utilize droplet and standard precautions. Explanation: Infants with pertussis are generally admitted to the hospital for at least 48 hours to see how the disease course is progressing. Droplet precautions are used until 5 days after a child starts antibiotic therapy, and visitors may be restricted during this time (5 days). Standard precautions will be used throughout the hospitalization. Frequent small meals are vomited less than larger meals, making it easier for the infant to maintain nutritional status. A full 10-day course of erythromycin or azithromycin may be prescribed because these drugs have the potential to shorten the period of communicability and may shorten the duration of symptoms. Infants with pertussis may need airway suction for thick secretions.
The nurse at an outpatient facility is obtaining a blood specimen from a 9-year-old child. Which technique would most likely be used? Puncturing a vein on the dorsal side of the hand. Administering sucrose prior to beginning. Accessing an indwelling venous access device. Using an automatic lancet device on the heel.
Puncturing a vein on the dorsal side of the hand. Explanation: The usual sites for obtaining blood specimens are veins on the dorsal side of the hand or the antecubital fossa. Administration of sucrose prior to beginning helps control pain for young infants. Accessing an indwelling venous access device may be appropriate if the child is in an acute care setting. An automatic lancet device is used for capillary puncture of an infant's heel.
A nurse practitioner suspects that a child has scarlet fever based on which assessment finding? Severity of the sore throat An enanthematous rash Red, strawberry tongue White exudate on the tonsils
Red, strawberry tongue Explanation: 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.
The nurse is caring for a 7-year-old child in droplet precautions due to the diagnosis of pertussis. While visiting the child, which actions by the parents require the nurse to intervene? Select all that apply. The parents state, "We should postpone immunizing our 5-year-old since there has been contact with the infection." The parents remove their personal protective equipment (PPE) at the door before exiting, then wash their hands. The parents wear a respiratory mask when entering their child's room. The parents state, "We have been limiting our child's fluids to help decrease the amount of coughing." The parents state, "We will be sure to finish any antibiotic if our child is sent home with a prescription."
The parents state, "We should postpone immunizing our 5-year-old since there has been contact with the infection." The parents state, "We have been limiting our child's fluids to help decrease the amount of coughing." Explanation: All close contacts who are younger than 7 years of age and who are unimmunized or underimmunized should have pertussis immunization initiated or the series completed according to the recommended dosing schedule. Fluids should be increased in order to help thin secretions and prevent dehydration during the infection. The parents are correct in removing their PPE at the door and washing their hands when leaving the room, and wearing a mask. All antibiotics should be finished in order to treat the infection adequately and prevent immunity to antibiotics.
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. Dressing the child in dark clothing when going outdoors. Inspecting the skin closely for ticks after the child plays in wooded areas. Removing ticks by rubbing them away from the skin with a credit card. Contacting the health care provider if there is any area of inflammation that might be a bite.
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. Explanation: The nurse should teach the parents to have the child wear protective clothing and dress the child in light clothing when playing in wooded areas or going outdoors. The parents should inspect the child's skin closely for ticks after being outside in wooded areas and if any ticks are found, remove them with a tweezer, not rub them with a credit card. The parents also should be instructed to contact their health care provider if they notice any area of inflammation that might be a tick bite.
A chief danger of scarlet fever is that children may develop: acute glomerulonephritis. liver destruction. local areas of skin necrosis. respiratory obstruction.
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 nurse assesses a child and notes the following: oral temperature 101.1°F (38.3°C), pruritis, and a generalized rash that develops in crops with macules, papules, vesicles, and crusts present. The parent reports the child is immunocompromised. Which health care provider prescription(s) will the nurse request? Select all that apply. acyclovir liquid suspension complete blood count (CBC) placement in private hospital room acetylsalicylic acid orally for fever diphenhydramine topical cream for itching
acyclovir liquid suspension complete blood count (CBC) placement in private hospital room diphenhydramine topical cream for itching Explanation: Fever, itching, and a generalized rash in crops with macules, papules, vesicles, and crusts are signs and symptoms of varicella zoster (chicken pox). Diphenhydramine can be used because varicella zoster is very pruritic (itchy). Placement in a private hospital room is needed because varicella zoster is highly contagious. A complete blood count can be used to check for secondary infections of the lesions. Children with varicella zoster who are also immunocompromised may need acyclovir to reduce the course of infection.
A child hospitalized for surgery develops varicella. The health care provider prescribes isolation for the child. Which type of precautions will the nurse implement to provide care for this child? Select all that apply. airborne precautions droplet precautions contact precautions standard precautions protective isolation
airborne precautions contact precautions standard precautions Explanation: During hospitalization due to a complication of varicella infection, standard infection precautions along with airborne and contact precautions are adhered to until all lesions are crusted. Protective isolation would be used for a child who is immunocompromised and at high risk for infection. Droplet precautions reduce the risk of pathogens being spread through large-particle droplet contact by acts such as coughing, sneezing, and talking—or through procedures such as suctioning or bronchoscopy.
