chapter 6 infectious diseases

4. Wipe from the inner can thus downward and outward away from the opposite eye. To remove secretions from the eye, the nurse should instruct the parent to wipe from the inner canthus of the eye downward and outward away from the opposite eye. Applying continuous warm compresses on the eye can promote bacterial growth. Topical corticosteroids are avoided because they reduce ocular resistance to bacteria. Wiping from the outer canthus of the eye toward the opposite eye may spread the infection to the other eye.

How would the nurse instruct the parent to care for the eye of a child who has bacterial conjunctivitis? 1. Apply continuous warm compresses to the eye. 2. Use topical corticosteroids to reduce inflammation. 3. Wipe from the outer canthus toward the opposite eye. 4. Wipe from the inner can thus downward and outward away from the opposite eye.

2. Chickenpox Chickenpox is communicable through direct contact, droplet spread, and contaminated objects. The Center for Disease Control recommends contact and airborne isolation for these children until lesions have crusted over. Mumps is transmitted by way of direct contact with saliva of an infected person and is most communicable before the onset of swelling. The transmission and cause of exanthema subitum (roseola) are unknown. Erythema infectiosum (fifth disease) is communicable before the onset of symptoms.

The nurse would implement contact and airborne isolation precautions for a child who is hospitalized with which illness? 1. Mumps 2. Chickenpox 3. Exanthema subitum (roseola) 4. Erythema infectiosum (fifth disease)

C. Bacteria The signs and symptoms indicate that the child is suffering from bacterial conjunctivitis. This is characterized by reddening of the eyes, purulent discharge, and crusting and swelling of the eyelids. In cases of viral conjunctivitis, a serous discharge is often observed. Allergic conjunctivitis is characterized by a watery to thick, stringy discharge. In cases of conjunctivitis occurring due to a foreign body, the pain would be unbearable and only one eye would be affected.

Which causal agent would produce purulent discharge from the eyes, crusting, and swollen eyelids in a child? 1. Virus 2. Allergy 3. Bacteria 4. Foreign body

1. Varicella zoster virus Varicella zoster virus is the causative agent for chickenpox. Human parvovirus B19 is the causative agent for erythema infectiosum (fifth disease). Human herpesvirus type 6 is the causative agent for exanthema subitum (roseola). Group A ß-hemolytic streptococcus is the causative agent for scarlet fever.

Which causative agent results in chickenpox? 1. Varicella zoster virus 2. Human parvovirus B19 3. Human herpesvirus type 6 4. Group A ß-hemolytic streptococcus

2. Itching

Which chief complaint do patients complain of when suffering from rashes? 1. Fever 2. Itching 3. Swelling 4. Drainage

2. Abrupt high fever Abrupt high fever, vomiting, headache, chills, malaise, abdominal pain, and halitosis are clinical manifestations of scarlet fever in its prodromal stage. Enlarged tonsils and red "strawberry tongue" (enanthema) occur during the first 1 to 2 days. Body rash (exanthema) appears within 12 hours after the onset of prodromal signs.

Which clinical manifestation of scarlet fever is present in the prodromal stage of the disease? 1. Enlarged tonsils 2. Abrupt high fever 3. Rash over the body 4. Red "strawberry tongue"

1. Viral Conjunctivitis is inflammation of the conjunctiva. Upper respiratory tract infection, serous drainage, inflamed conjunctiva, and swollen eyelids are symptoms suggestive of viral conjunctivitis. Itching in the eye, stringy discharge, inflamed conjunctiva, and swollen eyelids are symptoms of allergic conjunctivitis. Purulent drainage, crusting of eyelids (especially on awakening), inflamed conjunctiva, and swollen eyelids are symptoms of bacterial conjunctivitis. Tearing, pain, and inflamed conjunctiva are symptoms of conjunctivitis caused by a foreign body. In foreign body conjunctivitis, usually only one eye is affected.

Which conjunctivitis condition is likely to be found in the patient with an upper respiratory tract infection, serous drainage, inflamed conjunctiva, and swollen eyelids? 1. Viral 2. Allergic 3. Bacterial 4. Caused by a foreign body

2. Mumps The signs and symptoms in this child indicate mumps. Fever, headache, and earache while chewing food are present in the prodromal stage of mumps. The swelling in the neck is caused by parotitis, an inflammation of the parotid salivary gland. Epididymo-orchitis is inflammation of the testes and epididymis, and it is caused by mumps. It is one of the common complications seen in male children. These findings are not present in the other childhood diseases such as rubella, rubeola, and pertussis.

Which disease would cause a child to have symptoms of fever, headache, earache while chewing, neck swelling, and testicular pain? 1. Rubella 2. Mumps 3. Rubeola 4. Pertussis

4. Acetaminophen

Which drug administered to a child with exanthema subitum reduces body temperature? 1. Cetirizine 2. Loratadine 3. Fexofenadine 4. Acetaminophen

3. Vitamin A Measles with vitamin deficiency can be fatal to children. Two doses of vitamin A (200,000 IU) should be given on 2 successive days after the diagnosis of measles is made. This can reduce the mortality rate, pneumonia-specific mortality, and morbidity associated with measles. Vitamin A prevents any complications associated with measles, such as diarrhea and infections. A single dose of vitamin A may not be effective. Vitamins C, D, and K do not play any role in treating or preventing measles. Vitamin C deficiency causes scurvy, vitamin D deficiency causes rickets, and vitamin K deficiency can lead to blood clotting abnormalities.

Which drug administration is recommended to decrease the risk of mortality in a child with measles? 1. Vitamin C 2. Vitamin D 3. Vitamin A 4. Vitamin K

4. Fluoroquinolones The child has developed bacterial conjunctivitis. Fluoroquinolones such as moxifloxacin, gatifloxacin, and besifloxacin are administered to children for treating bacterial conjunctivitis. Acyclovir is given to a child with viral herpetic gingivostomatitis. Vitamin A is administered to children with measles. Corticosteroids should be avoided in children with conjunctivitis because they reduce ocular resistance to bacteria.

Which drug would the nurse administer to a child with purulent drainage from the eyes, inflamed conjunctiva, and swollen lids? 1. Acyclovir 2. Vitamin A 3. Corticosteroids 4. Fluoroquinolones

2, 5 2. Albendazole 5. Pyrantel pamoate The child has developed enterobiasis (pinworms). Bedwetting, perianal itching, restlessness, poor sleep, perianal dermatitis, and excoriation are clinical manifestations of enterobiasis (pinworms). The drugs albendazole and pyrantel pamoate are administered to the child to treat the condition. Tinidazole, nitazoxanide, and metronidazole are administered to children to treat giardiasis.

Which drugs are administered to the child experiencing bedwetting, perianal itching, restlessness, poor sleep, who has also developed perianal dermatitis and excoriation? Select all that apply. 1. Tinidazole 2. Albendazole 3. Nitazoxanide 4. Metronidazole 5. Pyrantel pamoate

1, 3, and 4 The patient may feel discomfort due to the skin infection and may need special precautions. Calamine lotion can be used to reduce itching. Nonirritating clothing can also help to reduce irritation and itching. Hot baths should be avoided, because an increase in temperature increases itching. Sun exposure should be avoided, because exposure to the sun increases skin irritation and worsens the condition. If the patient has severe itching, hydroxyzine can be administered to reduce itching.

Which instruction would the nurse give to the parents of a toddler with a skin infection to reduce discomfort? Select all that apply. 1. Use nonirritating clothing. 2. Give hot baths to the patient. 3. Use a calamine lotion regularly. 4. Avoid sun exposure to the patient. 5. Avoid administering hydroxyzine.

4. Sodium sulfacetamide Bacterial conjunctivitis is inflammation of the conjunctiva due to bacterial infection and is treated with topical antibacterial agents. Sodium sulfacetamide is a topical antibacterial agent. Acyclovir is an antiviral agent that is used to treat varicella infections. Hydroxyzine is an antipruritic medication used to treat severe itching. Mebendazole is used for the treatment of pinworms.

Which medicine does the nurse expect to be prescribed for a toddler with bacterial conjunctivitis? 1. Acyclovir 2. Hydroxyzine 3. Mebendazole 4. Sodium sulfacetamide

1. Acyclovir Acyclovir is an antiviral agent. It is used to treat varicella infections in susceptible immunocompromised people. The patient's immunity is compromised by the immunosuppressive therapy. Acyclovir is effective in decreasing the number of lesions, shortening the duration of fever, and decreasing itching, lethargy, and anorexia. Hydroxyzine is an antipruritic medication used to treat severe itching. Acetaminophen is an antipyretic agent and helpful in reducing elevated temperature. Diphenhydramine is an antipruritic agent used for the treatment of severe itching.

Which medicine would the nurse expect in the treatment plan of the patient being treated with immunosuppressive therapy who has a varicella infection? 1. Acyclovir 2. Hydroxyzine 3. Acetaminophen 4. Diphenhydramine

2. Immunizations Communicable diseases are prevented through immunization, which constitutes primary prevention. Early diagnosis can prevent the spread of communicable disease by initiating treatment and isolation if necessary; this would be considered secondary prevention. Strict isolation would be considered part of the treatment regimen and would constitute tertiary prevention, which is the prevention of complications or sequelae. Treatment of disease would not prevent communicable disease.

Which method results in primary prevention of communicable disease? 1. Strict isolation 2. Immunizations 3. Early diagnosis 4. Treatment of disease

3. Droplet

Which mode of transmission of pertussis (whooping cough) is common? 1. Fecal 2. Blood 3. Droplet 4. Mucous membranes

4. Repeat dose the next day after 4 weeks Vitamin A supplementation reduces both morbidity and mortality in measles. The patient has ophthalmologic evidence of vitamin A deficiency. Therefore, the dose of vitamin A should be repeated the next day and after 4 weeks. Administration of a higher dose should be avoided, because it may lead to vomiting and headache for a few hours. A single oral dose of 200,000 IU is recommended for children who are at least 1 year old. A single oral dose of 100,000 IU is recommended for children aged between 6 and 12 months.

Which nursing action is appropriate when administering supplements to a toddler with measles that has ophthalmologic evidence of a vitamin A deficiency? 1. Using a higher dose. 2. Single oral dose of 200,000 IU. 3. Single oral dose of 100,000 IU. 4. Repeat dose the next day and after 4 weeks

2. The three-dose series would be started at this time. Adolescents should be vaccinated against hepatitis B at this age if they have not been previously. Three doses of HBV are required to achieve immunity. It is recommended that the HBV vaccine series be started at birth. The American Academy of Pediatrics recommends that vaccinations be completed by the age of 13 years.

Which nursing action is appropriate when considering a 12-year-old child who has not received the hepatitis B (HBV) vaccine? 1. One dose is needed at age 14 years. 2. The three-dose series would be started at this time. 3. Only one dose will be needed sometime during adolescence. 4. The three-dose series would be started at age 16 years or sooner if the adolescent becomes sexually active.

4. Providing an antipruritic medication such as diphenhydramine Antipruritic medicines such as diphenhydramine are useful for severe itching, which interferes with sleep and may contribute to secondary infection. Aspirin should never be given to children with chickenpox, because there is an increased risk of Reye syndrome. Caladryl lotion, which contains diphenhydramine, should be applied sparingly, not in thick coats, over open lesions to minimize absorption. An equine antitoxin (usually intravenously) is an intervention for diptheria, not chickenpox.

Which nursing intervention is appropriate for a child with itching related to chickenpox? 1. Giving aspirin or acetaminophen 2. Administering an equine antitoxin 3. Applying a thick coat of pramoxine lotion over open lesions 4. Providing an antipruritic medication such as diphenhydramine

4. Providing oral sucrose solution (24%) 2 minutes before immunization The nurse should provide sucrose solution (24%) orally for the neonate. This will reduce the immunization pain. A 16-millimeter needle should be used by the nurse for immunization for the 2-month-old infant. A 25-millimeter needle is used for older children. Using topical anesthesia before immunization at the injection site will reduce the pain.

Which nursing intervention would the nurse follow when injecting a hepatitis B vaccination into a 2-month-old infant? 1. Using a 25-millimeter needle 2. Injecting the vaccine in the deltoid muscle 3. Avoiding use of topical anesthesia before immunization 4. Providing oral sucrose solution (24%) 2 minutes before immunization

1. Prodromal The prodromal period is defined as the symptoms that occur between early manifestations of the disease and overt clinical symptoms. The incubation period is the time from exposure to the appearance of the first symptom. The desquamation period refers to the shedding of skin when applicable for a syndrome or disorder. The period of communicability describes the period when the child is infectious.

Which period describes the interval between early manifestations of a disease and the overt clinical syndrome? 1. Prodromal 2. Incubation 3. Desquamation 4. Period of communicability

4. Standard and all transmission-based precautions. The nurse should be aware that both standard and transmission-based precautions (contact, airborne, and droplet) must be instituted when an exanthema is undiagnosed. Exanthema can be a symptom of measles, chickenpox, mumps, and scarlet fever, and these conditions may spread if all precautions are not taken.

Which precautions should the nurse implement for a child with an undiagnosed exanthema? 1. Institute airborne and droplet precautions. 2. Institute droplet and standard precautions. 3. Institute standard and airborne precautions. 4. Standard and all transmission-based precautions.

4. "Is your child allergic to eggs of any kind?" In the preparation of the influenza vaccine, eggs are used. Therefore, if the child is allergic to eggs, the child may develop an allergic reaction after receiving influenza vaccine. Therefore, the nurse would ask the parent whether the child is allergic to eggs. The influenza vaccine is not contraindicated for children who have celiac disease. Celiac disease is a condition in which the patient is either allergic or intolerant to gluten, which is not related to egg allergy. It is safe to administer the influenza vaccine to children allergic to cow's milk and antibiotics, because neither is a component of the vaccine.

Which question is appropriate to ask the parent before giving influenza vaccination to a child? 1. "Is your child allergic to cow's milk?" 2. "Does your child have celiac disease?" 3. "Is your child allergic to any antibiotics?" 4. "Is your child allergic to eggs of any kind?"

4. Metallic taste in mouth Metronidazole (Flagyl), taken for giardiasis, can leave a metallic taste in the mouth. Inflammation, urine retention, and constipation are not side effects of metroindazole (Flagyl).

Which side effect of metronidazole would the nurse recognize in a child with giardiasis? 1. Constipation 2. Inflammation 3. Urine retention 4. Metallic taste in mouth

3. "We should use corticosteroids to treat conjunctivitis." Inflammation of the conjunctiva due to bacterial infection is called bacterial conjunctivitis. Corticosteroids should be avoided because they reduce ocular resistance to bacteria and worsen the infection. Eye drops should be used during the day and an ointment at bedtime because the ointment preparation remains in the eye for longer duration. Sodium sulfacetamide is a topical antibacterial agent and is used to treat bacterial conjunctivitis.

Which statement by the parents indicates the need for further teaching by the nurse about the use of medicine in bacterial conjunctivitis? 1. "We can use sodium sulfacetamide." 2. "We should apply eye ointment before bedtime." 3. "We should use corticosteroids to treat conjunctivitis." 4. "We can administer eye drops anytime during the day."

1. Infants should be immunized at birth or within 2 weeks of birth. The recommended age of immunization in infants is at birth or 2 weeks from birth. Preterm infants should receive vaccines based on their chronologic age. Hepatitis B vaccines, poliovirus vaccines, and varicella can be administered simultaneously at separate injection sites. Infants who miss an immunization dose in between do not have to start the entire course from the beginning, and only that particular dose can be injected.

Which statement is correct regarding immunization? 1. Infants should be immunized at birth or within 2 weeks of birth. 2. Preterm infants should receive initial immunization after 6 months. 3. Infants should not receive two vaccines for two different diseases simultaneously. 4. Infants who miss an immunization dose should begin the whole course from the beginning

2. Children can be vaccinated when they have they common cold. Immunization of children with varicella and measles, mumps, and rubella vaccines who have the common cold will not produce any contraindicating reactions. Immunization should not be provided to immunocompromised children. Immunization with varicella and measles, mumps, and rubella vaccines should not be carried out in children who have recently received acquired immunity through transfusion. Immunization should be postponed in these cases for a minimum of 3 months. When two immunizations are given simultaneously to children, injection sites should be far away from each other.

Which statement is correct regarding the administration of varicella and measles, mumps, and rubella vaccines? 1. Immunocompromised children may receive them. 2. Children can be vaccinated when they have the common cold. 3. They are allowed for children with recently acquired passive immunity. 4. Injection sites can be close to each other with simultaneous immunizations.

2, 3, 4 2. "I taught my child to defecate in the toilet." 3. "I teach my child to wash hands before eating." 4. "I rinse raw fruits and vegetables before eating." To prevent intestinal parasitic diseases, parents should teach their children to defecate in the toilet. Parents should teach their children to wash their hands before eating. Raw fruits and vegetables should be washed before using them for cooking or eating. These measures will help prevent children from developing intestinal parasitic diseases. Parents should not rinse diapers in the toilet; this would increase the risk of developing intestinal parasitic diseases. Parents should avoid public swimming pools due to an increased chance of diapered children in the pools.

Which statements made by the parent indicate effective learning about preventing intestinal parasitic diseases? Select all that apply. 1. "I rinsed my child's diapers in the toilet." 2. "I taught my child to defecate in the toilet." 3. "I teach my child to wash hands before eating." 4. "I rinse raw fruits and vegetables before eating." 5. "I allow my child to swim in the public swimming pool."