411 Infectious Diseases & Vaccines

The school nurse prepares a list of home care instructions for the parents of school children who have been diagnosed with pediculosis capitis (head lice). Which should be included in the list? Select all that apply. 1.Siblings may also need treatment. 2.Use antilice sprays on all bedding and furniture. 3.Use a pediculicide shampoo and repeat treatment in 14 days. 4.Grooming items such as combs and brushes should not be shared. 5.Launder all the bedding and clothing in hot water and dry on high heat. 6.Vacuum floors, play areas, and furniture to remove any hairs that may carry live nits.

1.Siblings may also need treatment. 4.Grooming items such as combs and brushes should not be shared. 5.Launder all the bedding and clothing in hot water and dry on high heat. 6.Vacuum floors, play areas, and furniture to remove any hairs that may carry live nits. Bedding and linens should be washed with hot water and dried on a hot setting. Thorough home cleaning is necessary to remove any remaining lice or nits. Siblings may need to be treated and combs and brushes may need to be discarded or soaked in boiling water for 10 minutes. Antilice sprays are unnecessary. Additionally, they should never be used on bedding, furniture, or a child. The pediculicide product needs to be used as prescribed, and the parents are instructed to follow package instructions for timing the application and for contraindications for their use in children.

Which statement indicates that a father understands the treatment for his child who has scarlet fever? a. "I can stop the medicine when my child feels better." b. "I will apply antibiotic cream to her rash twice a day." c. "I will give the penicillin for the full 10 days." d. "My child can go back to school when she has been on the antibiotic for a week."

ANS: C Feedback A The bacteria will not be eradicated if a partial course of antibiotics is given. B Treatment of scarlet fever does not include topical antibiotic cream. C It is necessary to give the entire course of antibiotic for 10 to 14 days. Penicillin is the preferred treatment for any streptococcal infection. D The child is no longer contagious after 24 hours of antibiotic therapy and can return to daycare or school.

The nurse of a well-baby clinic prepares to administer an immunization to a child. The mother of the child tells the nurse that the child has had a fever and is taking antibiotics. The nurse takes the child's temperature and notes that it is 101.5° F rectally. The nurse plans to take which action? 1.Delay the immunization. 2.Administer the immunization. 3.Administer one of the three scheduled immunizations. 4.Administer one half of the prescribed dose of each scheduled immunization.

1.Delay the immunization. High fevers and severe illnesses are reasons to delay immunization, but only until the child has recovered from the acute stage of the illness. Minor illnesses such as a cold, otitis media, or mild diarrhea without fever are not contraindications to immunization.

child is diagnosed with chicken pox. The nurse collects data regarding the child. Which finding is characteristic of chicken pox? 1.Macular rash on the trunk and scalp 2.Pseudomembrane formation in the throat 3.Maculopapular or petechial rash on the extremities 4.Small, red spots with a bluish-white center and red base

1.Macular rash on the trunk and scalp A macular rash that first appears on the trunk and scalp and then moves to the face and the extremities is a characteristic of chicken pox. Pseudomembrane formation in the throat is characteristic of diphtheria. A maculopapular or petechial rash primarily on the extremities is characteristic of Rocky Mountain spotted fever. Small red spots with a bluish-white center and red base are known as Koplik spots and are characteristic of measles

The nurse reviews the home care instructions with a parent of a 3-year-old with pertussis. Which statement by the parent indicates a need for further teaching? 1."I know that my child will make a loud whooping sound." 2."I understand this whooping cough is viral and I have to let it run its course." 3."I understand that I need to watch for respiratory distress signs with pertussis." 4."I can reduce the environmental factors that can trigger coughing, like dust and smoke."

2."I understand this whooping cough is viral and I have to let it run its course." Pertussis is caused by the bacteria Bordetella pertussis and treatment requires antimicrobial therapy. Symptoms of pertussis consist of a respiratory infection followed by increased severity of cough with a loud whooping on inspiration. The child may experience respiratory distress, and the parents should be instructed on reducing environmental factors that cause coughing spasms, such as dust, smoke, and sudden changes in temperature.

A mother brings her 15-month-old child to the primary health care provider's office with complaints that the child has suddenly developed a bright red rash on her cheeks. She has no other symptoms and has been playing and eating as usual. Based on the appearance of the child, the nurse might suspect that the child has which communicable disease? 1.Rubella 2.Roseola 3.Fifth disease 4.Chickenpox

3.Fifth disease Fifth disease has the general appearance of "slapped cheeks." Many children do not have any symptoms before the appearance of the reddened cheeks. This characteristic is not associated with the communicable diseases identified in options 1, 2, or 4.

The nurse prepares to administer a measles, mumps, and rubella (MMR) vaccine to a 5-year-old child. How should the nurse plan to administer the vaccine? 1.Intramuscularly in the deltoid muscle 2.Subcutaneously in the gluteal muscle 3.Subcutaneously in the outer aspect of the upper arm 4.Intramuscularly in the anterolateral aspect of the thigh

3.Subcutaneously in the outer aspect of the upper arm MMR is administered subcutaneously in the outer aspect of the upper arm. Each child should receive two vaccinations, the first between 12 and 15 months of age and the second between 4 and 6 years or 11 and 12 years.

A mother brings her 4-month-old infant to the well-baby clinic for immunizations. Which immunizations should be administered to this infant? 1.Diphtheria, tetanus, acellular pertussis (DTaP), Measles, mumps, rubella (MMR), inactivated poliovirus vaccine (IPV) 2.Varicella and hepatitis B vaccines 3.MMR, Hib, DTaP 4.DTaP, Hib, IPV, pneumococcal vaccine (PCV)

4.DTaP, Hib, IPV, pneumococcal vaccine (PCV) DTaP, Hib, IPV, and PCV are administered at 4 months of age. DTaP is administered at 2 months, 4 months, 6 months, between 12 and 18 months, and between 4 and 6 years of age. Hib is administered at 2 months, 4 months, 6 months, and between 12 and 15 months of age. IPV is administered at 2 months, 4 months, 6 months, and between 4 and 6 years of age. The first dose of MMR is administered between 12 and 15 months of age; the second dose is administered at 4 to 6 years of age (if the second dose was not given by 4 to 6 years of age, it should be given at the next visit). The first dose of hepatitis B vaccine is administered between birth and 2 months, the second dose is administered between 1 and 4 months, and the third dose is administered between 6 and 18 months of age. Varicella zoster vaccine is administered between 12 and 18 months of age. PCV is administered at 2, 4, and 6 months of age and between 12 and 15 months of age.

he nurse provides instructions to the mother of a child with impetigo regarding the application of antibiotic ointment. The mother asks the nurse when the child can return to school. Which response by the nurse is appropriate? 1.Ten days after using the antibiotic ointment 2.One week after using the antibiotic ointment 3.As soon as the antibiotic ointment is started 4.Forty-eight hours after using the antibiotic ointment

4.Forty-eight hours after using the antibiotic ointment The child should not attend school for 24 to 48 hours after the initiation of systemic antibiotics or for 48 hours after the use of the antibiotic ointment. The school should be notified of the diagnosis. Therefore, the remaining options are incorrect.

The mother of a toddler with mumps asks the nurse what she needs to watch for in her child with this disease. The nurse bases the response on the understanding that mumps is which type of communicable disease?

4.Respiratory disease caused by a virus involving the parotid gland Mumps is caused by a paramyxovirus that causes swelling from the parotid gland, causing jaw and ear pain. It is transmitted via direct contact or droplets spread from an infected person, salive from infected saliva, and possibly by contact with urine. Airborne and contact precautions are indicated during the period of communicability. Options 1, 2, and 3 are incorrect.

Which statement MOST accurately describes the pharmacodynamics of vaccines? A. Vaccines work by stimulating the humoral immune system. B. Vaccines provide IgG antibodies to protect against infection. C. Vaccines prevent the formation of antibodies against a specific antigen. D. Vaccines work by suppressing the amino acid immunoglobulin sequence.

A. Vaccines work by stimulating the hormonal immune system Vaccines work by stimulating the humoral immune system, which synthesizes immunoglobulins. They also stimulate the formation of antibodies against their specific antigen, providing active immunity.

What should the nurse expect to observe in the prodromal phase of rubeola? a. Macular rash on the face b. Koplik spots c. Petechiae on the soft palate d. Crops of vesicles on the trunk

ANS: B Feedback A The macular rash with rubeola appears after the prodromal stage. B Koplik spots appear approximately 2 days before the appearance of a rash. C Petechiae on the soft palate occur with rubella. D Crops of vesicles on the trunk are characteristic of varicella.

The current immunization for tetanus and diphtheria toxoids and pertussis, Tdap, is administered to people in which age range? A. Younger than 6 years of age B. 11 years of age and older C. Any age range D. In the first 2 years of life

B. 11 years of age and older Currently, DTaP is the preferred preparation for primary and booster immunization against these diseases in children from 6 weeks to 6 years of age unless use of the pertussis component is contraindicated. Tdap is the recommended vaccine for adolescents and adults, those over the age of 11 years.

Which vaccination is marketed and recommended in the prevention of a virus that is known to cause cervical cancer? A. Herpes zoster vaccine (Zostavax) B. Papillomavirus vaccine (Gardasil) C. Pneumococcal vaccine (Prevnar 13) D. Hepatitis B virus vaccine (Recombivax HB)

B. Papillomavirus Vaccine Human papillomavirus virus (HPV) is a common cause of genital warts and cervical cancer. The HPV vaccine (Gardasil, Cervarix) is the first and only vaccine known to prevent cancer.

Administration of which substance provides passive immunity? A. Vaccines B. Toxoids C. Antitoxins D. Immunoglobulins

D. Immunoglobulins Vaccines, antitoxins, and toxoids provide active immunity by stimulating the humoral immune system. Immunoglobulins provide passive immunity by giving the patient substances to fight specific antigens.

The nurse is reinforcing instructions regarding the prevention of Lyme disease to a group of teenagers going on a hike in a wooded area. Which points should the nurse include in the session? Select all that apply. 1.Tuck pant legs into socks. 2.Wear closed shoes when hiking. 3.Apply insect repellent containing DEET. 4.Cover the ground with a blanket when sitting. 5.Remove attached ticks by grasping with thumb and forefinger. 6.Wear long sleeves and long pants in dark colors when in high-risk areas.

1.Tuck pant legs into socks. 2.Wear closed shoes when hiking. 3.Apply insect repellent containing DEET. 4.Cover the ground with a blanket when sitting. Measures to prevent tick bites focus on covering the body as completely as possible and spraying insect repellent containing DEET on the skin and clothing. Long sleeves and pants tucked into the socks along with closed shoes will offer some protection. Light-colored clothing should be worn so that ticks would be easily visible. Hikers should not sit directly on the ground and should cover the ground with an item such as a blanket. Ticks should be removed with tweezers.

The nurse is caring for a hospitalized child with a diagnosis of rubella (German measles). The nurse reviews the primary health care provider's progress notes and reads that the child has developed Forchheimer sign. Based on this documentation, which should the nurse expect to note in the child? 1.Swelling of the parotid gland 2.Petechiae spots located on the palate 3.A fiery red edematous rash on the cheeks 4.Small blue-white spots noted on the buccal mucosa

2.Petechiae spots located on the palate Forchheimer sign refers to petechiae spots, which are reddish and pinpoint and located on the soft palate. Small blue-white spots noted on the buccal mucosa are known as Koplik's spots seen in rubeola. A fiery red edematous rash on the cheeks, also called "slapped cheeks" is seen in erythema infectiosum. Swelling of the parotid gland is seen in mumps.

What should be included in health teaching to prevent Lyme disease? a. Complete the immunization series in early infancy. b. Wear long sleeves and pants tucked into socks while in wooded areas. c. Give low-dose antibiotics to the child before exposure. d. Restrict activities that might lead to exposure for the child.

ANS: B Feedback A Currently there is no vaccine available for Lyme disease. The Lyme disease vaccine had been approved for persons ages 15 to 70 years; however, was withdrawn from the market in 1992. B Wearing long sleeves and pants, and tucking the pants into socks keeps ticks on the clothing and prevents them from hiding on the body. C Antibiotics are used to treat, not prevent, Lyme disease. D Children should be allowed to maintain normal growth and development with activities such as hiking.

How should the nurse respond to a parent who asks, "How can I protect my baby from whooping cough?" a. "Don't worry; your baby will have maternal immunity to pertussis that will last until they are approximately 18 months old." b. "Make sure your child gets the pertussis vaccine." c. "See the doctor when the baby gets a respiratory infection." d. "Have your pediatrician prescribe erythromycin."

ANS: B Feedback A Infants do not receive maternal immunity to pertussis and are susceptible to pertussis. Pertussis is highly contagious and is associated with a high infant mortality rate. B Primary prevention of pertussis can be accomplished through administration of the pertussis vaccine. C Prompt evaluation by the primary care provider for respiratory illness will not prevent pertussis. D Erythromycin is used to treat pertussis. It will not prevent the disease.

The nurse obtains a health history from a mother of a 15-month-old child before administering a measles, mumps, and rubella (MMR) vaccine. Which is essential information to obtain before the administration of this vaccine? 1.A recent cold 2.Allergy to eggs 3.The presence of diarrhea 4.Any recent ear infections

2.Allergy to eggs Before the administration of a measles, mumps, and rubella vaccine, a thorough health history needs to be obtained. The MMR vaccine is used with caution in a child with a history of allergy to gelatin or eggs because the live measles vaccine is produced by chick embryo cell culture. The MMR vaccine also contains a small amount of the antibiotic neomycin. Options 1, 3, and 4 are not contraindications to administering this immunization.