Essentials of Pediatric Nursing - Chapter 15

After teaching a class to a group of nursing students about reporting infectious diseases to the Centers for Disease Control and Prevention, the instructor determines a need for additional discussion when the students identify which infection as being reportable: Gonorrhea Lyme disease Pinworm Pertussis

Pinworm Pinworm infections are not required to be reported. Gonorrhea is a reportable infectious disease. Lyme disease is a reportable infectious disease. Pertussis is a reportable infectious disease.

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which skin condition best describes pustule? Discolored skin spot not elevated at the surface Redness of the skin produced by congestion of the capillaries Small, circumscribed, solid elevation of the skin Small elevation of epidermis filled with a viscous fluid

Small elevation of epidermis filled with a viscous fluid A pustule is a small elevation of epidermis filled with pus.

Which interventions will the nurse include when caring for a child with an infectious disorder? Select all that apply. Administer antibiotics for all infections. Ensure immunization status is current. Provide information about disease transmission. Use appropriate personal protective equipment. Educate the child and family about infection control.

Ensure immunization status is current. Provide information about disease transmission. Use appropriate personal protective equipment. Educate the child and family about infection control. Nursing interventions for care of children with infectious disorders center around preventing disease through immunization and preventing further spread by practicing good infection control measures. Educating parents about infection control measures and teaching them about how the particular infectious agent is spread remains critical to preventing the spread of disease once the child leaves the hospital. Although antibiotics are used for bacterial infections, antibiotics are not needed for other types of infections (viral, fungal, etc.).

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

Obtain specimen before antibiotics are given 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 tonsilar 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.

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. Femoral vein Dorsal aspect of the hand Fingertip Jugular vein Antecubital fossa

Dorsal aspect of the hand Antecubital fossa 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.

The parents of a child voice concern to the nurse that they believe their child has Lyme disease but their physician won't do the proper testing. The nurse reviews the chart to determine if specific testing for the disease has been performed. Which tests is the nurse looking for? Immunofluorescent assay (IFA) C-reactive protein (CRP) Enzyme immunoassay (EIA) Western immunoblot Erythrocyte-sedimentation rate (ESR)

Enzyme immunoassay (EIA) Immunofluorescent assay (IFA) Western immunoblot When testing for Lyme disease the CDC recommends a two-step test—a sensitive enzyme immunoassay (EIA) or immunofluorescent assay (IFA), if positive, followed by a Western immunoblot test. CRP and ESR may be tested as an indication of inflammation in the body, but they aren't specific to Lyme disease.

What is one of the most commonly reported communicable diseases in the United States? Measles Mononucleosis Syphilis Gonorrhea

Gonorrhea Gonorrhea is one of the most commonly reported communicable diseases in the United States.

A nursing instructor has presented a class on the stages of an infectious disease to a group of students and asks the students to place the stages in their proper sequence from beginning to end. Place the stages in their proper sequence.

Incubation Prodrome Illness Convalescence An infectious disease begins with incubation, then progresses to the prodrome stage, then to illness, and finally to convalescence.

The appearance of which hallmark clinical manifestation occurs in measles? Koplik spots Conjunctivitis Fever Cough

Koplik spots The hallmark symptom of measles is the appearance of Koplik spots. These occur a few days before the outbreak of the rash. They are classic in appearance, described as a red ring around white dots. They occur on the buccal mucosa generally around the first and second molars. Measles has fever, conjunctivitis, and a cough as prodromal symptoms, but these are not definitive for measles as they can occur with many other illnesses.

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? Mumps Mononucleosis Measles Fifth disease SUBMIT ANSWER

Mumps Mumps begin 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.

A child in the clinic has a fever and reports a sore neck. Upon assessment the nurse finds a swollen parotid gland. The nurse suspects which infectious disease? Whooping cough Measles Scabies Mumps

Mumps Mumps is an infectious disease with a primary symptom of a swollen parotid gland. It is a contagious disease spread by droplets. The child is contagious 1 to 7 days prior to the onset of the swelling and 4 to 9 days after the onset of the swelling. Pertussis is a respiratory disorder which causes severe paroxysmal coughing which produces a whooping sound. Measles is recognized by Koplick spots in the mouth and the classic maculopapular rash that starts on the head and spreads downward. Scabies is a skin condition where lice lay eggs under the skin. The rash is very puritic and is seen on the hands, feet, and folds of the skin.

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 Susceptible host Portal of exit Mode of transmission

Reservoir 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 hand washing and personal protective equipment. The susceptible host is the person who is susceptible to develop an infection. Promotion of natural defenses is a good way to prevent infection.

What is a true statement regarding measles? The incubation period is 10 to 12 days. It is transmitted by the fecal-oral route. Peak outbreaks are in the summer. It is not contagious.

The incubation period is 10 to 12 days. 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.

The most common complication of varicella is: scarring. encephalitis. secondary bacterial infections. pneumonia.

secondary bacterial infections. The most common complication of varicella is secondary bacterial infection caused by the child scratching the lesions. Other complications include pneumonia, scarring, and encephalitis.

The nurse is caring for an adolescent diagnosed with genital herpes. The drug of choice for treating genital herpes is: Ceftriaxone Penicillin Griseofluvin Acyclovir

Acyclovir The drug acyclovir is useful in relieving or suppressing the symptoms of genital herpes.

A nurse is assessing a neonate with sepsis. The nurse understands that most commonly the cause involves: Enterovirus Protozoa Herpes virus Bacteria

Bacteria Neonatal sepsis can be caused by viruses such as herpes simplex or enteroviruses and by protozoa (e.g., Toxoplasma gondii). However, bacteria are typically the culprits.

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? "Herpes zoster is a reactivation of a previous varicella zoster infection." "Children who are immunocompromised are more likely to contact shingles." "Your child must have been exposed to someone with herpes zoster." "Handwashing is an effective way to prevent the spread of infectious disorders."

"Herpes zoster is a reactivation of a previous varicella zoster infection." Herpes zoster (shingles) is reactivation of the latent varicella zoster (chicken pox) 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 parents of a 4-month-old diagnosed with sepsis tell the nurse that the physician explained sepsis to them but they don't really understand it. The parents state, "Could you please explain it to us?" What is the best response by the nurse? "The pathogens cause an overproduction of proinflammatory cytokines. These cytokines are responsible for the clinically observable effects of the sepsis." "The pathophysiology of sepsis is complex." "Sepsis results in systemic inflammatory response syndrome (SIRS) due to infection." "The infection your child has causes the release of toxins into the system, which can lead to impaired function in the lungs, liver, and kidneys."

"The infection your child has causes the release of toxins into the system, which can lead to impaired function in the lungs, liver, and kidneys." Keeping the answer to what sepsis is will help the parents understand the pathophysiology. While all answers are correct, the response: "The infection your child has causes the release of toxins into the system, which can lead to impaired function in the lungs, liver, and kidneys" provides the most understandable explanation and addresses the parent's question.

The nurse is assessing a child who presents with a history of fever, malaise, fatigue, and headache. The nurse notes a bulls-eye rash on the child's right leg. Which action will the nurse take? Place the child on contact precautions Clean the rash with rubbing alcohol Notify the primary health care provider Obtain an electrocardiography (ECG)

Notify the primary health care provider The nurse would suspect the child has Lyme disease and notify the health care provider for additional testing and potential antibiotic therapy. Precautions are not indicated for clients with Lyme disease. An ECG would only be needed if cardic symptoms were noted. It is recommended to clean the site of the tick bite with rubbing alcohol when the tick is removed, not at a later time.

The nurse is caring for an adolescent diagnosed with syphilis. The drug of choice for treating syphilis is: Griseofluvin Ceftriaxone Penicillin Acyclovir

Penicillin Syphilis responds to one intramuscular injection of penicillin G benzathine; if the child is sensitive to penicillin, oral doxycycline, tetracycline, or erythromycin can be administered as alternative treatment.

An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease (PID) is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. Which action by the nurse would be most appropriate? Take the child to a private room and interview her regarding her sexual history and partners. Contact the necessary authorities to report a suspected case of sexual abuse. Take the caregiver to a private room and tell her that the child's diagnosis can only come from sexual activity. Talk to the child and caregiver together and explain that the condition is often a result of a sexually transmitted infection and discuss the importance of safe sex practices.

Take the child to a private room and interview her regarding her sexual history and partners. Adolescents must be made aware of the seriousness of PID, a common result of a chlamydial infection. Pelvic inflammatory disease can cause sterility in the female, primarily by causing scarring in the fallopian tubes that prohibits the passage of the fertilized ovum into the uterus. A tubal pregnancy may be the consequence of a chlamydial infection. In the male, sterility may result from epididymitis caused by a chlamydial infection. All sexual partners must be treated.

The nurse is concerned that the child is developing septic shock. Which findings are consistent with this condition? Select all that apply. C-reactive protein is decreased. The child's respiratory rate is elevated. White blood cell count is elevated. The child is pale and lethargic. The child's blood pressure is reduced.

The child's respiratory rate is elevated. White blood cell count is elevated. The child is pale and lethargic. The child's blood pressure is reduced. Assessment findings consistent with sepsis include elevated white blood cell counts, pallor, lethargy, tachypnea, and hypotension. Often, the C-reactive protein level is elevated, not decreased.

A young girl arrives at the emergency room after being bitten by a neighbor's dog. The mother is concerned her daughter will get rabies. The nurse carefully examines and treats the bite and questions the mother and daughter about the details surrounding the dog biting her. What information would most strongly indicate a risk for rabies infection in this client? The dog was unprovoked when he bit the girl The dog was properly immunized for rabies There have been no other reported instances in the area The dog belonged to a neighbor

The dog was unprovoked when he bit the girl An unprovoked attack is much more suggestive that the animal is rabid, rather than if the bite happens during a provoked attack. The dog being immunized for rabies and there being no other reported instances of rabies in the area would indicate a lower risk that the dog was rabid. The fact that the dog belonged to a neighbor does not necessarily indicate a lower risk for rabies infection.

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 have been limiting our child's fluids to help decrease the amount of coughing." 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 state, "We will be sure to finish any antibiotic if our child is sent home with a prescription." The parents wear a respiratory mask when entering their child's room.

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." 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.

A nurse is assessing a child with a tick-borne disease. What finding would indicate to the nurse that the child has developed ehrlichiosis and not Rocky Mountain spotted fever? Fever Absence of rash Malaise Headache

Absence of rash Both Rocky Mountain spotted fever and ehrlichiosis are manifested by fever, headache, and malaise. However, there is rarely a rash with ehrlichiosis, which helps to differentiate it from Rocky Mountain spotted fever.

When developing the plan of care for a 5-year-old boy with Rocky Mountain spotted fever, the nurse knows the cause of the illness is: Infection with group A streptococcus Animal bite Contact with contaminated sports equipment Bite of a tick

Bite of a tick Rocky Mountain spotted fever is a tick-borne infection. Rabies is due to the bite of an animal. Community-acquired methicillin-resistant Staphylococcus aureus is transmitted through direct person-to-person contact, respiratory droplets, blood, or sharing of personal items and touching surfaces or items contaminated with methicillin-resistant S. aureus. Scarlet fever is an infection resulting from group A streptococcus.

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 Warn of possible drowsiness Take entire course of medication Ensure proper dose and interval

Ensure proper dose and interval 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.

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? Reduced basophil levels Reduced neutrophil levels Elevated monocytes Increased eosinophils levels

Increased eosinophils levels 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.

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? Initiate antibiotic therapy Obtain blood cultures Obtain urine specimen for analysis Initiate intravenous therapy

Obtain blood cultures 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.

When the health care provider looks in a child's mouth during a sick-visit examination, the parent exclaims: "The tongue is bright red! It was not like that yesterday." The health care provider would most likely prescribe which medication based on the probable diagnosis? Penicillin to prevent acute glomerulonephritis Steroids to decrease the inflammation Acetaminophen to decrease the throat pain Erythromycin to prevent the spread to siblings

Penicillin to prevent acute glomerulonephritis A "strawberry tongue" is a classic sign of scarlet fever. Penicillin is prescribed to prevent the complications of acute glomerulonephritis and rheumatic fever associated with beta-hemolytic group A streptococcal infections.

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

Puncturing a vein on the dorsal side of the hand 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.

What is a true statement regarding varicella zoster virus infection? It is transmitted by fecal-oral route. The incubation period is 7 days. Secondary bacterial infections of the skin can occur. It tends to be more severe in children.

Secondary bacterial infections of the skin can occur. Varicella zoster virus infection carries with it the complication of a secondary bacterial infection of the skin. The incubation period is 10 to 21 days. It is transmitted by direct contact with the vesicles and by airborne route. It tends to be more severe in adolescents and adults.

The nurse is caring for a child hospitalized with pertussis. Which nursing intervention would be the highest priority for this child? The nurse will administer oxygen. The nurse will encourage bed rest. The nurse will monitor caloric intake. The nurse will administer antibiotics.

The nurse will administer oxygen. The major complication of pertussis (whooping cough) is pneumonia and respiratory complications. Oxygen, bed rest, and monitoring for airway obstruction are nursing interventions. The highest priority is administering oxygen to maintain adequate oxygenation of cells.

The nurse is caring for a 10-year-old boy with diphtheria. What would the nurse institute as a tier 2 precaution? Use of a protective face shield Negative air pressure ventilation Use of a protective gown Use of a protective mask

Use of a protective mask Use of a protective mask if within 3 feet of the child is a tier 2 precaution with diphtheria, which is transmitted through contact with droplets. Use of a protective gown is a tier 2 precaution for contact transmission. Negative air pressure ventilation is a tier 2 precaution for airborne transmission. Face shields are part of tier 1 precautions against contaminated splashes

After teaching nursing students about childhood exanthems, the instructor determines that the teaching was successful when the students identify what as the primary cause? Parasites Bacteria Fungi Viruses

Viruses Most childhood exanthems are caused by viruses.

A chief danger of scarlet fever is that children may develop: respiratory obstruction. acute glomerulonephritis. local areas of skin necrosis. liver destruction.

acute glomerulonephritis. 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.

Which child will the nurse identify as at greatest risk for developing a urinary tract infection? a 2-year-old male with otitis media a 6-month-old breastfed female an 8-month-old bottle-fed female with HIV a 1-year-old formula-fed male

an 8-month-old bottle-fed female with HIV Factors that make an individual more prone to a urinary tract infection include young age, female gender, and immunosuppression. Infants who are formula-fed are at greater risk than infants who are breastfed. To determine the child at greatest risk, the nurse should count risk factors and determine which child has the most risk factors.

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: rosacea. pityriasis rosea. fifth disease. enterovirus.

fifth disease. 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.

A young child who has been reporting fatigue and having a low-grade fever for 4 days begins to have pustules over the entire body. The health care provider diagnoses chickenpox. When considering transmission to others, during which period would the nurse assess? During the convalescent period During the prodromal period During the predisease period During the incubation period

prodromal period The prodromal period is between the beginning of nonspecific symptoms and disease-specific ones.

The nurse is collecting data on an adolescent admitted with a diagnosis of a sexually transmitted infection. The child has a hard, red, painless lesion on his penis. The nurse recognizes the lesion as a chancre, which is a sign of: chalmydial infection. genital herpes. gonorrhea. syphilis.

syphilis. The cardinal sign of the primary stage of syphilis is the chancre, which is a hard, red, painless lesion at the point of entry of the spirochete. This lesion can appear on the penis, the vulva, or the cervix.

When caring for a child diagnosed with West Nile virus, the nurse will question which prescription from the primary health care provider? Acetaminophen every 4 to 6 hours PRN fever Place client on fall precautions Amoxicillin 40 mg/kg/day orally every 8 hours Monitor the client's cardiac status

Amoxicillin 40 mg/kg/day orally every 8 hours 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 6-year-old child is brought to the clinic by his parents. The parents state, "He had a sore throat for a couple of days and now his temperature is over 102°F (38.9°C). He has this rash on his 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 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 . Airway obstruction is apparent. Pertussis is characterized by cough and cold symptoms that progress to paroxysmal coughing spells along with copious secretions.

The mother of a 10-year-old child diagnosed with rubella asks what can be done to help her child feel better during her illness. What information can be provided? Range of motion to prevent contractures. Antiviral medications can be prescribed. Encourage rest and relaxation. Antibiotic therapy may be initiated.

Encourage rest and relaxation. Rubella infection is usually mild and self-limited. The care given is normally supportive. Rest is encouraged. Medications administered are normally limited to anti-pyretics 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 rash in roseola is pruritic. Which measure would you teach the parent to provide comfort? Apply cool compresses to the skin to stop local itching. Dress the child warmly to bring out the rash so that it fades quickly. 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. 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. Antipuretics may be necessary also 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 an increased temperature and intensify the itching. Aspirin should not be used in children as an antipyretic. There is an increased risk of developing Reye's syndrome.

The nurse is triaging a child diagnosed with poliomyelitis. After ensuring appropriate precautions are in place, what will the nurse do next? Begin physical therapy. Administer an antipyretic. Auscultate the child's lungs. Place the child on bedrest.

Auscultate the child's lungs. 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 bedrest, administer an antipyretic, and begin physical therapy.

A 3-week-old infant is diagnosed with pertussis. Which antimicrobial agent would the nurse expect the physician to prescribe? Azithromycin Clarithromycin Trimethoprim-sulfamethoxazole Erythromycin

Azithromycin The macrolides (erythromycin, azithromycin, and clarithromycin) are the drugs of choice for pertussis in children older than 6 months of age. Azithromycin and clarithromycin are not FDA approved for use in infants younger than 6 months; however, infants younger than 1 month old should be treated with azithromycin because erythromycin is associated with increased risk of infantile hypertrophic pyloric stenosis. Trimethoprim-sulfamethoxazole is an alternative antibiotic for children who cannot tolerate erythromycin.

The nurse is preparing an education plan for a pregnant woman who has venereal warts. What should the nurse include as teaching points for this client? "If delivered vaginally your newborn is at high risk for developing sepsis." "During a vaginal birth, your newborn may develop warts in the throat." "The teeth, bones, and brain of your newborn can be affected if you deliver vaginally." "Your newborn is at high risk for being large for gestational age if you deliver vaginally."

"During a vaginal birth, your newborn may develop warts in the throat." There is a high risk of the newborn developing warts in the throat, especially if the mother has large vaginal warts. Low birth weight and blindness are common with several sexually transmitted infections. Syphilis in the mother often leads to problems with the teeth, bones, and brain of the newborn.

What is the leading cause of neonatal sepsis and death? Epstein-Barr virus infection Group B streptococcus Nisseria meningitidis Cytomegalovirus infection

Group B streptococcus Sepsis is a systemic overresponse to infection. It is very serious and can produce septic shock and death. In infants under the 3 months of age the most causative agents are Group B streptococcus, Escherichia coli, Staphylococcus aureus, enteroviruses, and the herpes simplex virus. Any time a febrile, ill-appearing neonate is seen a full septic work-up is done. Neonates have the poorest outcomes from sepsis. Nisseria meningitidis is one cause of sepsis in older children. The Epstein-Barr virus is a herpes virus that causes mononucleosis. The cytomegalovirus is a common herpes virus. It is spread through bodily fluids and is not necessarily a concern unless the person is immunocompromised or is pregnant.

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. 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. Inspecting the skin closely for ticks after the child plays in wooded areas. Wearing protective clothing when playing in wooded areas. Dressing the child in dark clothing when going outdoors.

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. 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

The nurse is caring for a child whose family recently immigrated from a developing country. While completing the admission history, the parents report all the child's immunizations are up to date. Which nursing action is most appropriate? Administer varicella and meningococcal vaccines. Document that immunizations are up to date in the chart. Request parents follow WHO vaccine recommendations. Ask parents which immunizations have been given.

Ask parents which immunizations have been given. When caring for a child recently immigrated from a developing country, the nurse should be aware that WHO recommended vaccinations and U.S. recommended vaccinations may be different. The most appropriate action is for the nurse to determine which vaccinations have been given to decide if additional immunizations may be needed.

The nurse is caring for a child admitted to the hospital for sepsis. Which assessment finding is the most concerning? oral temperature 102.3°F (39°C) urine output of 10 ml over 3 hours apical heart rate 120 beats per minute white blood cell count 18,000 mm3

urine output of 10 ml over 3 hours Children with sepsis will show alteration in temperature, heart rate, respiratory rate, and white blood cell count. Septic shock with organ dysfunction is more serious as can be manifested by decreased urine output.

The nurse is discussing fever with the parents of a child who is in the emergency department with a temperature of 101 degrees Fahrenheit. Which statement by a parent indicates an understanding about fevers and their management in the ill child? "Fevers can be beneficial because they can slow down the growth of the bacteria or virus that may be causing the infection." "We've had to wake him up in the night to give him more medicine to reduce his temperature." "My wife and I have been using cold water and washcloths on him because of the fever." "We've been giving him a little extra acetaminophen to help bring his fever down."

"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 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.

The nurse is providing teaching to the parents of a child with varicella. Which statement indicates that the parents have understood the instructions? "We need to make sure that he washes his hands frequently." "If he has a fever, we can give him some aspirin." "The lesions should eventually form soft crusts that drain." "We should apply alcohol to the lesions every four hours."

"We need to make sure that he washes his hands frequently." The child with varicella needs to wash his hands frequently with antibacterial soap to reduce bacterial colonization. A cool bath with soothing colloidal oatmeal may help the skin discomfort. Alcohol would be too drying to the skin. Acetaminophen, not aspirin, should be used to reduce fever. The lesions should eventually crust over. Soft crusts with drainage may suggest an infection.

The physician has ordered ibuprofen 150 mg every 6 hours as needed for a 3-year-old child for a fever greater than 38 Celsius. The label of the ibuprofen bottle reads "ibuprofen oral suspension 100 mg/5 mL." How much ibuprofen liquid will the nurse administer if the child's temperature goes above 38 C? Record your answer using one decimal place.

7.5 ml The dose ordered (150 mg) is divided by the available dosage (100 mg) then multiplied by 5 mL

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? Inspecting for erythema migraines Asking the child if his knees hurt Observing for facial palsy Examining for conjunctivitis

Asking the child if his knees hurt 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 performing a physical examination for a 7-year-old girl who was bitten by a tick. What would alert the nurse to the possibility of early localized Lyme disease? Multiple erythema migrans on the skin Recurrent arthritis in the large joints Bull's-eye rash around the bite Cranial nerve palsies

Bull's-eye rash around the bite A bull's-eye rash (ring-like rash) around the bite is typical of early localized Lyme disease. Multiple erythema migrans on the skin occurs during early disseminated disease. Cranial nerve palsies are indicative of early disseminated disease. Recurrent arthritis in the large joints occurs in the late stage of the disease.

A nursing instructor is teaching the students about the standard and transmission-based precautions. What type of precautions require placing a client in an isolated room with limited access, wearing gloves during contact with the client and all body fluids or contaminated items, wearing two layers of protective clothing, and avoiding sharing equipment between clients? Contact precautions Airborne precautions Standard precautions Droplet precautions

Contact precautions Contact precautions means placing the client in an isolation room with limited access, wearing gloves during contact with the client and all body fluids, wearing two layers of protective clothing, limiting movement of the client from the room, and avoiding sharing equipment between clients. Standard precautions are used with every client. They involve good handwashing and the use of gloves for client contact. Airborne precautions are used for diseases where small particles are dispersed in the air. They require the client in a negative pressure room and, in addition to standard personal protective equipment, the mask should be N95 or higher. Varicella would need airborne precautions. Droplet precautions are used for diseases such as pertusis which produce large droplets. They require standard precautions plus a surgical mask, preferably with a face shield.

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. Psittacosis Rocky Mountain spotted fever Lyme disease Ascariasis Scabies

Lyme disease Rocky Mountain spotted fever 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 16-year-old is seen in the emergency department with symptoms including a high fever, chills, headache, nausea and vomiting, and painful joints. During the nursing history the teenager reports recently returning from a trip to a rain forest in South America. What infectious disease does the nurse suspect the client has contracted? West Nile disease Malaria Anaplasmosis Rabies

Malaria Malaria comes from a bite of Anopheles species of mosquito and is mostly found in Africa, Asia and South America. Anaplasmosis comes from a tick and occurs mostly in the upper Midwest and northeast United States. West Nile disease comes from a mosquito and is found throughout United States, with higher rates found in Great Plains and mountain regions. Rabies is a viral infection that comes from close contact with the saliva of a rabid animal.

A 15-year-old boy visits his primary care physician's office with fever, headache, and malaise, along with complaints of pain on chewing and pain in the jawline just in front of the ear lobe. The boy asks his mother to leave the exam room for a minute and then tells the nurse that he is also experiencing testicular pain and swelling. The nurse recognizes that this client most likely has which condition? Infectious mononucleosis Herpes zoster Mumps Poliomyelitis

Mumps Initial symptoms of mumps include fever, headache, anorexia, and malaise. Within 24 hours, pain on chewing and an "earache" occurs. When the child points to the site of the earache, however, he points to the jawline just in front of the ear lobe, the site of the parotid gland. By the next day, the gland appears swollen and feels tender; the ear becomes displaced upward and backward. Boys may also develop testicular pain and swelling (orchitis). None of the other conditions listed matches the symptoms indicated.

A child is diagnosed with scarlet fever. History reveals that the child has no known drug allergies. When preparing the child's plan of care, the nurse would anticipate administering which agent as the drug of choice? Penicillin V Clarithromycin Trimethoprim-sulfamethoxazole Erythromycin

Penicillin V Penicillin V is the antibiotic of choice. In those sensitive to penicillin, erythromycin may be used. Trimethoprim-sulfamethoxazole and clarithromycin are not used.

The nurse is caring for a 16-year-old child with a diagnosis of acquired immunodeficiency syndrome (AIDS). What treatment goal has the highest priority for this child? Promoting comfort Maintaining skin integrity Improving nutrition Preventing spread of infection

Preventing spread of infection Major goals for the child include maintaining the highest level of wellness possible by preventing infection and the spread of the infection. Because the adolescent has the belief that nothing can hurt him or her, and because of the increasing rate of sexual activity in this age group often involving multiple partners, the highest priority is teaching and preventing the spread of the infection. Other goals include maintaining skin integrity, minimizing pain, improving nutrition, alleviating social isolation, and diminishing a feeling of hopelessness. The primary goal for the family is improving coping skills and helping the teen cope with the illness.

A nurse practitioner suspects that a child has scarlet fever based on which assessment finding? Red, strawberry tongue White exudate on the tonsils An enanthematous rash Severity of the sore throat

Red, strawberry tongue 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.

What information should be included in the teaching plan for a child with varicella? Utilize salt solutions to assist in healing oral lesions. Place the child in a warm bath for skin discomfort. Administer aspirin for fever. Remind the child not to scratch the lesions.

Remind the child not to scratch the lesions. Varicella lesions appear first on the scalp. They spead to the face, the trunk and then to the extremities. There may be various stage of the lesions present at any one time. The lesions are intensely pruritic. The teaching plan for varicella should include that the child not scratch the lesions. Opening the lesions gives access for secondary infection to occur and causes acarring. Acetaminophen should be administered for fever, not aspirin, due to the link with Reye syndrome. The best treatment for skin discomfort is a cool bath with soothing colloidal oatmeal every 3 to 4 hours for the first few days. Warm baths cause more itching and dry the skin.

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's birth history indicates he was born at 42 weeks' gestation. The child has had 8 ounces of formula in the past 24 hours. The child cries when his mother is not in sight.

The child has had 8 ounces of formula in the past 24 hours. 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, letheragy, hypotonia, and temperature elevations.

A 5-year-old girl catches the flu from a friend at day care after the friend sneezed and wiped mucus on a toy that the girl played then with. In this case, what is the portal of exit in the chain of infection? Toy Upper respiratory excretion The 5-year-old girl The friend

Upper respiratory excretion The portal of exit is the route by which an organism leaves an infected child's body to be spread to others. Organism can be carried out of the body by upper respiratory excretions, feces, vomitus, saliva, urine, vaginal secretions, blood, or lesion secretions. The friend would be the reservoir, which is the container or place in which an organism grows and reproduces. The toy would be the means of transmission. The 5-year-old girl would be the susceptible host.

The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see first? a child diagnosed with chicken pox reporting nausea and malaise a child diagnosed with measles experiencing photophobia and coryza a child with erythema infectiosum experiencing fatigue and confusion a child with herpes simplex who is reporting mouth pain and pruritis

a child with erythema infectiosum experiencing fatigue and confusion A child with erythema infectiosum experiencing fatigue and confusion is showing signs of decreased oxygenation, possibly related to aplasia of erythrocytes caused by the virus. A child with signs and symptoms of decreased oxygenation should be seen first. Nausea and malaise are symptoms of chicken pox. A child with herpes simplex will most likely report pain an pruritis. Signs and symptoms of measles include photophobia and coryza.

Which child will the nurse identify as being at greatest risk for developing a hospital-acquired infection (HAI)? a 1-year-old receiving oral amoxicillin for otitis media a 2-year-old child with HIV being discharged later today an 18-month-old child receiving chemotherapy over 5 days a 3-year-old child with malnutrition and poor weight gain

an 18-month-old child receiving chemotherapy over 5 days The children at highest risk for contracting a healthcare-associated infection include children younger than 2 years of age, children with a nutritional deficit, those who are immunosuppressed, those who have indwelling vascular lines or catheters, are receiving multiple antibiotic therapy, or who remain in the hospital for longer than 72 hours. To determine the child a greatest risk, count risk factors and determine which child has the most risk factors.

A child is diagnosed with group A streptococcal pharyngitis. The nurse would teach the parents to be alert for signs and symptoms of: scarlet fever. osteomyelitis. pneumonia. impetigo.

scarlet fever. Group A streptococcal pharyngitis can progress to scarlet fever with the rash appearing in about 12 hours after the onset of the disease. Group A streptococcal pharyngitis is not associated with pneumonia. Impetigo is a group A strep infection involving the skin. Osteomyelitis can occur with an infection by group B streptococcus.