CH 6

Antitoxin

A solution of antibodies derived from the serum of animals immunized with specific antigens and used to confer passive immunity

Tonsils are enlarged, edematous, reddened, and covered with patches of exudate; rash is absent on face; desquamation occurs.

Scarlet fever

Cocooning

Strategy of protecting infants from pertussis by vaccinating all persons who come in close contact with the infant

Attenuated

To reduce the virulence of a pathogenic microorganism by treating it or cultivating it on a certain medium

Rash appears in three stages; stage I is erythema on face, chiefly on cheeks.

fifth disease Stage II: proximal-distal maculopapular red spts Stage III: rash subsides but will reappear if trauma (sunburn, cold, friction) - isolation not needed - may result in arthritis or fetal death

This condition results in earache that is aggravated by chewing.

mumps * swelling of carotid gland * worry about airway * easily can move to testes and cause sterility - droplet precaution - hot/cold compress - soft, bland foods that don't need chewing

The general contraindications for all immunizations are:

severe febrile illness, immunocpromised (for live; Tdap, MMR), allergy, parental fears, religion

Conjugate Vaccine

A carrier protein with proven immunologic potential combined with a less antigenic polysaccharide antigen to enhance the type and magnitude of the immune response; Hib

Rash appears 3 to 4 days after onset and maculopapular eruption on face with gradual spread downward; Koplik spots are present before the rash.

Measles (rubeola) - treat with Vit A (200k @ 1yr, 100k @ 6-11mo, 50k @ <6mo) - isolation until day 5 of rash - airborne precautions

What is recommended to prevent varicella in children who are immunocompromised, who have no previous history of varicella, whose mother had varicella within 5 days of child's birth, and who are likely to contract the disease and have complications as a result?

Varicella-zoster immune globulin

Clinical manifestations differentiate bacterial conjunctivitis from viral conjunctivitis. Which one of the following is present with bacterial conjunctivitis but not usually found with viral conjunctivitis? a. Child awakens with crusting of eyelids. b. Child has increase in watery drainage from eyes. c. Child has inflamed conjunctiva. d. Child has swollen eyelids.

a. Child awakens with crusting of eyelids. - conjunctivitis may be from Chlamydia, neisseria, HSV, or tear duct obstruction - usually self-limiting - fluoroquinolones approved > 1yr old - drops @ day, ointment @ night - NO compress, promotes BAC growth - keep washcloth/towel separate

Which of the following statements about rotavirus disease or immunization against rotavirus is correct? a. Rotavirus is one of the leading causes of diarrhea in infants and young children. b. Rotavirus is one of the leading causes of otitis media in young children. c. One vaccine for rotavirus is RotaTeq, which is approved for children 32 weeks of age or older. d. Rotavirus vaccine usually causes only mild reaction, redness, and soreness at the site of injection.

a. Rotavirus is one of the leading causes of diarrhea in infants and young children. @ 6 weeks + 4-10 week (x2) NOT after 32 weeks of age orally

Meningococcal conjugate vaccines (MCV4) are not recommended for which of the following populations? a. Routinely for children ages 9 months to 10 years b. Children aged 2 years to 18 years who travel to or reside in countries where N. meningitidis is hyperendemic or epidemic c. Children and adolescents 11 to 12 years of age d. College freshmen living in dormitories

a. Routinely for children ages 9 months to 10 years - NOT recommended b/c infection rate low in this age group high rate in adolescents @ 11 yrs and booster @ 16

Which one of the following techniques is recommended to provide atraumatic care for immunization administration to infants? a. Select a 25-mm needle to deposit vaccine deep into the muscle mass. b. Use an air bubble to clear the needle before injection. c. Use the deltoid muscle. d. Use the EMLA patch before administration.

a. Select a 25-mm needle to deposit vaccine deep into the muscle mass. EMLA patch after injection nonnutritive sucking

Which of the following statements about Haemophilus influenzae type b (Hib) vaccine is true? a. The vaccine protects against a number of infections including bacterial meningitis, epiglottitis, bacterial pneumonia, septic arthritis, and sepsis. b. The vaccine protects against the virus that produces influenza. c. Only two doses of Hib vaccine should be given to children 15 months of age or older who have not been previously vaccinated. d. Hiberix is a conjugate vaccine licensed for use in infants over the age of 2 months.

a. The vaccine protects against a number of infections including bacterial meningitis, epiglottitis, bacterial pneumonia, septic arthritis, and sepsis. @ 2, 4 months

Children with Lyme disease in the first stage are seen with clinical manifestations of: a. a small, erythematous papule that enlarges and has a circumferential ring with a raised, edematous, doughnut-like border resulting in a bull's-eye appearance. b. multiple, small secondary annular lesions without indurated centers that occur anywhere except on the palms and soles. c. flulike symptoms of headache, malaise, fever, fatigue, and generalized lymphadenopathy. d. musculoskeletal pains, swelling, and effusion characterized by intermittent painful swollen joints and spontaneous remissions and exacerbations.

a. a small, erythematous papule that enlarges and has a circumferential ring with a raised, edematous, doughnut-like border resulting in a bull's-eye appearance. Stage 1: "Bull's Eye", Fever, HA, malaise Stage 2: rash on hands and feet 3-10 weeks after inoculation Fever, fatigue, lymphadenopathy, cough Stage 3: Systemic involvement 2-12 mo

Rubella vaccine administration: a. is given as protection for the unborn child rather than for the recipient of the immunization. b. is recommended for all children beginning at 4 to 6 years of age. c. is given to all pregnant women if not previously immunized. d. is not given to children whose mother is currently pregnant.

a. is given as protection for the unborn child rather than for the recipient of the immunization. NOT for pregos (live attenuated) MMR @ 12 months and 4 years

A drug used to treat children diagnosed with giardiasis is: a. metronidazole (Flagyl). b. amoxicillin c. erythromycin. d. tetracycline.

a. metronidazole (Flagyl). tx: Flagyl or Tindamax and prevention of reoccurrence

Children with pinworm infections are seen with the principal symptom of: a. perianal itching. b. diarrhea with blood. c. evidence of small, ricelike worms in their stool and urine. d. abdominal pain.

a. perianal itching. also general irritability/distractability/short attention span, restelessness, bed-wetting, perineal dermatitis pinworms aka enterobiasis transmission by inhalation/ingestion of eggs tape test treat with Pyrantel Pamoate or Albendazole x 1, then again in 2 weeks. Treat family members Prevention of reoccurrence

Bryan, age 6 months, is starting daycare as his mother is returning to work. Bryan has had no immunizations. Which of the following statements provided by the nurse to the mother is the most appropriate at this time? a. "Since Bryan has not started his immunizations for streptococcal pneumococci yet, it is best to wait until after he gets established at daycare before beginning his injections." b. "Streptococcal pneumococci are responsible for a number of bacterial infections that are especially problematic for children under 2 years of age who attend daycare. Bryan should start his series of pneumococcal vaccine right away." c. "Why has Bryan not received any immunizations? He is past due. Don't you care about his health?" d. "Pneumococcal vaccine (PCV13) is the only vaccine recommended for Bryan at this time."

b. "Streptococcal pneumococci are responsible for a number of bacterial infections that are especially problematic for children under 2 years of age who attend daycare. Bryan should start his series of pneumococcal vaccine right away." @ 2, 4, 6, 12 months

What antiviral agent is used to treat varicella infections in children at increased risk for complications associated with varicella? a. Varicella-zoster immune globulin b. Acyclovir c. Salicylates d. Steroids

b. Acyclovir

When administering the pertussis vaccine, the nurse recognizes which of the following as incorrect? a. Can be given any time during pregnancy b. Cannot be given to the postpartum mother who is breastfeeding c. The acellular pertussis vaccine, from the same manufacturer, is recommended for the first three immunizations and is given along with diphtheria and tetanus at 2, 4, and 6 months of age. d. Is recommended for health care workers having close contact with infants under the age of 12 months

b. Cannot be given to the postpartum mother who is breastfeeding

In scheduling immunizations, the nurse knows which of the following is correct? a. The beginning primary immunization for infants begins at 2 months of age. b. Children who are born preterm receive only half the normal dose of each vaccine followed by the second half of the vaccine 2 weeks later. c. Children who begin primary immunization at the recommended age but fail to receive all the doses by the suggested age need to begin the series again. d. When there is doubt that the child will return for follow-up immunizations according to the optimum schedule, HBV vaccine (HepB), DTaP, IPV (poliovirus vaccine), MMR, varicella, and Hib vaccines can be administered simultaneously at separate injection sites.

b. Children who are born preterm receive only half the normal dose of each vaccine followed by the second half of the vaccine 2 weeks later.

The following statements are about hepatitis A illness or vaccination. Which one is correct? a. The illness has a gradual onset, with often dark urine and jaundice being the only symptoms. b. The vaccine is recommended for all children between the ages of 12 and 23 months. c. The vaccine consists of a series of 3 injections timed 2 months apart. d. The illness is spread by all body secretions.

b. The vaccine is recommended for all children between the ages of 12 and 23 months. @ 1 yr then + 6 months (2 injections) fecal-oral route

Which one of the following statements about scabies is incorrect? a. Clinical manifestations include intense pruritus, especially at night, and papules, burrows, or vesicles on interdigital surfaces. b. Treatment is the application of 5% Elimite for all family members. c. After treatment, all previously worn clothing is washed in very hot water and dried at the high setting in the dryer. d. The rash and itching will be eliminated immediately after treatment.

b. Treatment is the application of 5% Elimite for all family members. permethrin 5% cream x 8-14hrs

The nurse knows, regarding pertussis, that: a. the incidence has decreased in infants younger than 6 months of age. b. a booster vaccine (Tdap) is now recommended for all children 11 to 18 years of age. c. treatment should begin as soon as exposure is confirmed and includes the antibiotic amoxicillin. d. the disease is not contagious, so close household members do not need treatment.

b. a booster vaccine (Tdap) is now recommended for all children 11 to 18 years of age. incidence has increased in <6mo and 10-14 yr olds antibiotics to treat (azithromycin, erythromycin, etc)

Mumps immunization: a. is recommended for children ages 4 years of age or older. b. is typically given in combination with measles and rubella. c. can be administered to infants as young as 6 months of age. d. All of the above

b. is typically given in combination with measles and rubella. MUMPS not for < 12 MONTHS OLD MMR @ 12 months and 4 years

Anne, an 8-year-old, has been diagnosed with giardiasis. The nurse would expect Anne to have most likely been seen initially with which of the following signs and symptoms? a. Diarrhea with blood in the stools b. Nausea and vomiting with a mild fever c. Abdominal cramps with intermittent loose stools d. Weight loss of 5 lb in the past month

c. Abdominal cramps with intermittent loose stools In infants and young children: D, V, anorexia >5 y.o.: cramps, intermittent loose stools, C malodorous, water, pale, greasy stools spontaneous resolution usually in 4-6 weeks

Which of the following statements about polio vaccine and immunization is not correct? a. Inactivated poliovirus vaccine (IPV) is now recommended for routine childhood vaccination in the United States. b. Oral polio vaccine (OPV) has been associated with vaccine-associated polio paralysis. c. KINRIX contains DTaP, hepatitis B, and IPV and may be used only in children aged 4 years or older as the fourth dose. d. The combination vaccine PEDIARIX (containing DTaP, hepatitis B, and IPV) may be used as the primary immunization beginning at 2 months of age.

c. KINRIX contains DTaP, hepatitis B, and IPV and may be used only in children aged 4 years or older as the fourth dose.

Which of the following statements about varicella vaccine is correct? a. Varicella vaccine is recommended for all children regardless of past disease history. b. A single dose of 0.5 ml of varicella vaccine should be given by deep intramuscular injection. c. The first dose of varicella vaccine is recommended for children ages 12 to 15 months, and to ensure adequate protection, a second varicella vaccination is recommended for children at 4 to 6 years of age. d. Varicella vaccine should not be administered simultaneously with MMR.

c. The first dose of varicella vaccine is recommended for children ages 12 to 15 months, and to ensure adequate protection, a second varicella vaccination is recommended for children at 4 to 6 years of age. MMRV @ 12 months and 4 years - if not in MMRV, separate varicella immunization from MMR by 1 month live attenuated given subQ

Human papillomavirus (HPV) vaccine is recommended for all of the following populations except: a. female adolescents to prevent HPV-related cervical cancer. b. boys and men (9 to 26 years) to reduce the likelihood of genital warts. c. female preadolescents ages 7 to 9 years. d. female adolescents who are not sexually active.

c. female preadolescents ages 7 to 9 years. - MINIMUM AGE = 9 YRS IM @ 9 + 2mo + 6 mo

Measles immunization includes which of the following? a. Given at 12 to 15 months of age with a second dose given at age 4 to 6 years of age and revaccination at 11 to 12 years of age. b. Child vaccinated before 12 months of age should receive two additional doses beginning at 12 to 15 months and separated by at least 4 weeks. c. Revaccination of all individuals born after 1956 who have not received two doses of measles vaccine after 12 months of age. d. All of the above

d. All of the above MMR @ 12 months and 4 years

The nurse is instructing parents on the test-tape diagnostic procedure for enterobiasis. Which one of the following is included in the explanation? a. Use a flashlight to inspect the anal area while the child sleeps. b. Perform the test 2 days after the child receives the first dose of antiparasitic medication. c. Test all members of the family at the same time using frosted tape. d. Collect the tape in the morning before the child has a bowel movement or bath.

d. Collect the tape in the morning before the child has a bowel movement or bath. test may have to be repeated for 3 days before eggs collected use non-"frosted" tape place loosely in glass jar/plastic baggy test all members of the family

Joey, a 14-year-old adolescent, has recently relocated from Mexico to the United States. While helping his dad do farm work, Joey suffered a laceration in the horse barn. Review of Joey's immunization record from Mexico shows that Joey has had 2 previous tetanus and diphtheria vaccine immunization shots, the last one being at the age of 6 years. Which of the following would the nurse in the emergency department expect to give at this time? a. Tdap b. DTaP c. Td booster d. Tetanus immunoglobulin (TIG) human and Tdap

d. Tetanus immunoglobulin (TIG) human and Tdap

Which of the following is not an influenza vaccine recommendation? a. The vaccine is administered in early fall before the flu season begins and is repeated yearly. b. Fluzone, a quadrivalent influenza vaccine, offers protection against type A and type B and is approved for vaccine use in children ages 6 months and older. c. Children with severe egg allergy history should not routinely receive the influenza vaccine. d. The live attenuated influenza vaccine (LAIV) form is recommended for children 2 to 4 years of age with a history of wheezing or asthma.

d. The live attenuated influenza vaccine (LAIV) form is recommended for children 2 to 4 years of age with a history of wheezing or asthma. - NOT RECOMMENDED for this population group - nasally administered recommended anually from 6mo-18yrs intradermal IIV for 18-64 yrs may be given with other vaccines (diff needle and site) tri-/quadrivalent vaccine is IM

When instructing the parents caring for an infant with conjunctivitis, the nurse will include which one of the following in the plan? a. Accumulated secretions are removed by wiping from outer canthus inward. b. Hydrogen peroxide placed on cotton swabs is helpful in removing crusts from eyelids. c. Compresses of warm tap water are kept in place on the eye to prevent crusting. d. Washcloth and towel used by the infant are kept separate and not used by others.

d. Washcloth and towel used by the infant are kept separate and not used by others. - remove crust by wiping down and out - warm water to remove crust - NO compress

Susan, age 10 years, has been diagnosed with Lyme disease. She has no allergies to medications. The nurse can expect the treatment to be: a. erythromycin. b. cefuroxime. c. ciprofloxin. d. doxycycline.

d. doxycycline. Doxycycline >8 yrs Amox < 8 yrs

Tonsillar pharyngeal areas are covered with white or gray membrane; complications include myocarditis and neuritis.

diptheria - droplet precautions - antibiotics - suction and humidified O2 - observe RR for obstruction

For which of the following populations is pertussis vaccine currently recommended? i. All children from 6 weeks to the seventh birthday ii. Children ages 11 to 12 years who have completed the DTaP/DTP childhood series iii. A second booster for previously immunized adolescents and adults iv. Children ages 7 through 10 years who are not fully vaccinated for pertussis, (i.e., did not receive 5 doses of DTaP, or who received 4 doses of DTaP with the fourth dose being administered on or after the fourth birthday) v. Pregnant adolescents between 27 and 36 weeks' gestation, if not previously protected

i. All children from 6 weeks to the seventh birthday ii. Children ages 11 to 12 years who have completed the DTaP/DTP childhood series iv. Children ages 7 through 10 years who are not fully vaccinated for pertussis, (i.e., did not receive 5 doses of DTaP, or who received 4 doses of DTaP with the fourth dose being administered on or after the fourth birthday) v. Pregnant adolescents between 27 and 36 weeks' gestation, if not previously protected

When educating the public about diphtheria vaccine, the nurse recognizes which of the following as correct? i. Diphtheria vaccine is commonly administered in combination with tetanus and pertussis vaccines (DTaP) or DTaP and Hib vaccines for children under 7 years of age. ii. Diphtheria vaccine is administered with tetanus and acellular pertussin (Tdap) for children 11 years and older. iii. Diphtheria vaccine produces absolute immunity after 3 doses. iv. Several vaccines contain diphtheria toxoid (Hib, meningococcal, pneumococcal), which confers immunity to the disease.

i. Diphtheria vaccine is commonly administered in combination with tetanus and pertussis vaccines (DTaP) or DTaP and Hib vaccines for children under 7 years of age. ii. Diphtheria vaccine is administered with tetanus and acellular pertussin (Tdap) for children 11 years and older. DTaP < 7 years; Tdap > 7yrs DTaP @ 2, 4, 6, 15mo then again @ 4yrs * diptheria and tetanus booster q10yr * pertussive * Tdap for > 7 years old as booster

The American Academy of Pediatrics has recommended vitamin A supplements for certain pediatric patients with measles. Correct dosage of vitamin A and instructions to parents of these children include: i. single oral dose of 200,000 international units in children 1 year old. ii. single oral dose of 100,000 international units in children 6 to 12 months old. iii. dosage may be associated with vomiting and headache for a few hours. iv. safe storage of the drug to prevent accidental overdose.

i. single oral dose of 200,000 international units in children 1 year old. ii. single oral dose of 100,000 international units in children 6 to 12 months old. iii. dosage may be associated with vomiting and headache for a few hours. iv. safe storage of the drug to prevent accidental overdose.

How should HepB immunization be given?

in monovalent @ birth, 1, and 6 months - if preterm, @ 1 2 and 6 months

Combination vaccine

multiple vaccines into one parenteral form

Cough occurs at night, and inspirations sound like crowing.

pertussis - isolation and droplet precautions - 1-2 weeks persistent cough

Permanent paralysis may occur.

poliomyelitis Vaccine-acquired paralytic polio may occur as a result of the live oral polio vaccination (no longer available in the United States)

Rash composed of rose-pink macules or maculopapules, appearing first on trunk, then spreading to neck, face, and extremities; rash is nonpruritic.

roseola 3-7 day fever then drops to normal w/ rash development lasting 1-2 days - UPWARD movement - complications include febrile seizures, precautions if prone

Discrete pinkish red maculopapular rash appears on face and then spreads downward to neck, arms, trunk, and legs; greatest danger is teratogenic effect on fetus.

rubella - benign illness to affected child - droplet precautions - avoid contact with pregos

This condition has a rash that begins as macules, rapidly progressing to papules and then to vesicles, eventually breaking and forming crusts.

varicella - isolate until vesicles dry - bathe/change linen dialy - short/clean nails, mittens - keep child cool - apply pressure, don't scratch - AVOID ASPIRIN