Carman Essentials of Pediatric Nursing 3rd Ed - Ch. 15 Nursing Care of the Child With an Infection

The nurse is preparing to administer acetaminophen to a 4-year-old girl to provide comfort to the child. Which precaution is specific to antipyretics? a. Check for medicine allergies b. Take entire course of medication c. Ensure proper dose and interval d. Warn of possible drowsiness

Answer: c 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 precaution when administering antibiotics and all medications. Drowsiness is not a side effect of antipyretics.

The nurse is caring for a 10-year-old child with a skin rash. The nurse should include which intervention to manage the associated pruritis? a. Encourage warm baths b. Apply hot compresses c. Press the pruritic area d. Rub powder on the pruritic area

Answer: c Pruritus may be managed by pressing on the area instead of scratching. Increases in temperature will result in vasodilation and increase the pruritus. Warm baths and hot compresses should be avoided. Rubbing may result in increased itching.

A 6-year-old boy is suspected of having late-stage Lyme disease. Which assessment should the nurse use to produce findings supporting this concern? a. Inspecting for erythema migraines b. Asking the child if his knees hurt c. Observing for facial palsy d. Examining for conjunctivitis

Answer: b Recurrent arthritis in large joints, such as the knees, is an indication of late-stage Lyme disease. The appearance of erythema migraines would suggest early-localized stage of the disease. Facial palsy or conjunctivitis would suggest the child is in the early disseminated stage of the disease.

The nurse is caring for a 5-year-old girl with scarlet fever. Which intervention will most likely be part of her care? a. Exercising both standard and droplet precautions b. Palpating for and noting enlarged lymph nodes c. Monitoring for changes in respiratory status d. Teaching proper administration of penicillin V

Answer: d Penicillin V or erythromycin is the preferred antibiotic for treatment of scarlet fever. Scarlet fever transmission is airborne, not via droplet. Lymphadenopathy occurs with cat scratch disease and diphtheria. Close monitoring of airway status is critical with diphtheria because the upper airway becomes swollen.

The pediatric nurse knows that there are a number of anatomic and physiologic differences between children and adults. Which statement about the immune systems of infants and young children is true? a. Children have an immature immune response. b. Cellular immunity is not functional in children. c. Children have an increased inflammatory response. d. Passive immunity overlaps immunizations.

Answer: a Infants and young children are more susceptible to infection due to the immature responses of their immune systems. Cellular immunity is generally functional at birth; humoral immunity develops after the child is born. Newborns have a decreased inflammatory response. Young infants lose the passive immunity from their mothers, but disease protection from immunizations is not complete.

The nurse is taking a health history for an 8-year-old boy who is hospitalized. Which is a risk factor for sepsis in a hospitalized child? a. Maternal infection or fever b. Use of immunosuppression drugs c. Lack of juvenile immunizations d. Resuscitation or invasive procedures

Answer: b The use of immunosuppression drugs is a risk factor for the hospitalized child. Maternal infection or fever 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.

The nurse is reviewing the assessment data from a 4-year old admitted to the hospital for management of early onset sepsis. Which finding supports the diagnosis? a. The child is unhappy about having to stay in bed b. The child's tympanic temperature is 98.8°F (37.11°C) c. The child is hypotensive d. The child is irritable

Answer: d Sepsis may be associated with lethargy, irritability, or changes in level of consciousness. The septic child will likely not be anxious to have a high activity level and would prefer to remain in bed. The temperature elevation of 98.8°F (37.11°C) is not significant and does not confirm the presence of sepsis.

Which child needs to be seen immediately in the physician's office? a. 10-month old with a fever and petechiae who is grunting b. 2-month old with a slight fever and irritability after getting immunizations the previous day c. 4-month old with a cough, elevated temperature, and wetting eight diapers every 24 hours d. 8-month old who is restless, irritable, and afebrile

Answer: a The presence of petechiae can indicate serious infection in an infant. Grunting is abnormal, indicating respiratory difficulty. The behavior of the 2-month-old is normal after immunizations. The 4-month-old needs to be watched but is adequately hydrated and the 8-month-old also needs to be watched. What the 8-month-old is experiencing is common in infants who are teething and is not indicative of illness.

The nurse at an outpatient facility is obtaining a blood specimen from a 9-year-old girl. Which technique would most likely be used? a. Puncturing a vein on the dorsal side of the hand b. Administering sucrose prior to beginning c. Accessing an indwelling venous access device d. Using an automatic lancet device on the heel

Answer: a 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.

The nurse is providing education to the parents of a 5-year old with a fever. Which statements indicate the need for further instruction? Select all that apply. a. "Fever has many therapeutic properties." b. "I can administer two baby aspirin tablets to my child every 4 to 6 hours for the fever." c. "Sponging my child with cold water can be a soothing way to manage the fever." d. "I should use a cooling fan in my child's room to keep the fever down." e. "Ibuprofen has been shown to be more beneficial than acetaminophen when managing a fever."

Answer: b, c, d Aspirin should be avoided in children with fever. It may be associated with Reyes syndrome. Activities that result in overcooling or chilling such as using fans and cold baths should be avoided.

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? a. Obtain blood cultures b. Initiate antibiotic therapy c. Obtain urine specimen for analysis d. Initiate intravenous therapy

Answer: a 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.

The nurse is administering a chicken pox vaccination to a 12-month-old girl. Which concern is unique to varicella? a. This disease can reactivate years later and cause shingles. b. Vitamin A is indicated for children younger than 2 years. c. Dehydration is caused by mouth lesions. d. Children with this disease need to avoid pregnant women.

Answer: a Varicella zoster results in a life-long latent infection. It can reactivate later in life resulting in shingles. The American Academy of Pediatrics recommends consideration of Vitamin A supplementation in children 6 months to 2 years hospitalized for measles. Dehydration caused by mouth lesions is a concern with foot and mouth disease. Avoiding exposure to pregnant women is a concern with rubella, rubeola, and erythema infectiosum.

A 10-year-old girl with long hair is brought to the emergency room because she began acting irritable, reported a headache, and was very sleepy. Which question is most appropriate for the nurse to ask the parents? a. "Has she done this before?" b ."How long has she been acting like this?" c. "What were you doing prior to her beginning to feel sick?" d. "What medications is she currently taking?"

Answer: c If the family had been camping or in a wooded area, the girl could have been bitten by a tick which would not be easy to discover because of her long hair. Ticks like dark, hair-covered areas and the signs and symptoms presented are neurological, with a rapid onset, which can be characteristic of a tick bite. The other questions are important but are not focusing on the causative agent.

A 10-year-old boy 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? a. Ensure that the specimen is obtained from proper area b. Collect three specimens on three different days c. Use aseptic technique when getting the specimen d. Obtain specimen before antibiotics are given

Answer: d 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.