Peds: PrepU Ch. 15

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

A - 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.

A 9-month-old child has been admitted to rule out sepsis. Which finding offers the most support to the presence of this disorder? A. The child has had 8 ounces of formula in the past 24 hours. B. The child's birth history indicates he was born at 42 weeks' gestation. C. The child has had 7 wet diapers in the past 24 hours. D. The child cries when his mother is not in sight.

A - 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.

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? A. Immunofluorescent assay (IFA) B. Enzyme immunoassay (EIA) C. Western immunoblot D. Erythrocyte-sedimentation rate (ESR) E. C-reactive protein (CRP)

A, B, C - 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.

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? A. Whooping cough B. Scabies C. Mumps D. Measles

C - 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 appearance of which hallmark clinical manifestation occurs in measles? A. Fever B. Cough C. Conjunctivitis D. Koplik spots

D - 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.

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. A. The parents state, "We should postpone immunizing our 5-year-old since there has been contact with the infection." B. The parents remove their personal protective equipment (PPE) at the door before exiting, then wash their hands. C. The parents state, "We have been limiting our child's fluids to help decrease the amount of coughing." D. The parents wear a respiratory mask when entering their child's room. E. The parents state, "We will be sure to finish any antibiotic if our child is sent home with a prescription."

A, C -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.

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

D - A pustule is a small elevation of epidermis filled with pus.

The nurse is assessing a child brought to the emergency department for cough, nasal discharge, and fever. During the assessment, the nurse notes raised papules with an erythematous base on the buccal mucosa and a temperature of 102.5ºF (39°C). What will the nurse do next? A. "Close the curtains to prevent photophobia." B. "Place the child in a negative pressure room." C. "Administer acetaminophen orally for fever." D. "Educate the parents about comfort measures."

B - Coughing, coryza, fever, and Koplik spots are signs of measles (rubeola). If measles is suspected, the nurse's first action is to prevent the spread of this airborne virus to others by placing the child in a negative pressure room. Next, the nurse will administer acetaminophen, close curtains, and educate the parents about comfort measures for measles and associated rash.

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? A. Pertussis B. Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) C. Diphtheria D. Scarlet fever

D - 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 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? A. Administer varicella and meningococcal vaccines. B. Request parents follow WHO vaccine recommendations. C. Document that immunizations are up to date in the chart. D. Ask parents which immunizations have been given.

D - 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 student nurse is discussing the plan of care for a child admitted to the hospital for treatment of an infection. Which action should be taken first? A. Initiate antibiotic therapy B. Obtain blood cultures C. Initiate intravenous therapy D. Obtain urine specimen for analysis

B - When treating a child suspected of having an infection, the blood cultures must be obtained first. The administration of antibiotics may impact the culture's results. A urine specimen may be obtained but is not the priority action. Intravenous fluids will likely be included in the plan of care but are not the priority action.

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

B - 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.

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

C - 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.

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? A. Improving nutrition B. Preventing spread of infection C. Promoting comfort D. Maintaining skin integrity

B - 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.

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

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

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: A. fifth disease. B. pityriasis rosea. C. enterovirus. D. rosacea.

A - 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. Pityriasis rosea is a skin rash that begins with a large spot on the chest, abdomen or back that is followed by paatern of small lesions. It is self limiting and can be treated with steroid creams. Roseacea is a chronic inflmmatory skin condition that causes redness to the face. An enterovirus infection can many times cause the same symptoms as the common cold or it can include the respiratory system. It is contagious.

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

A - The usual sites for obtaining blood specimens are veins on the dorsal side of the hand or the antecubital fossa. Administration of sucrose prior to beginning helps control pain for young infants. Accessing an indwelling venous access device may be appropriate if the child is in an acute care setting. An automatic lancet device is used for capillary puncture of an infant's heel.

When the health care provider looks in a child's mouth during a sick-visit examinaiton, 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? A. Penicillin to prevent acute glomerulonephritis B. Steroids to decrease the inflammation C. Acetaminophen to decrease the throat pain D. Erythromycin to prevent the spread to siblings

A - A "strawberry tongue" is a classic sign of scarlet fever. Penicillin is prescribed to treat the beta-hemolytic group A strococcal infection and to prevent the complication of developing acute glomerulonephritis and rheumatic fever. Erythromycin can be used to treat the disease if the child is allergic to penicillin. Antibiotics are not give prophylactally to siblings. The disease is spread via droplets, so keeping the siblings away from the infected child and handwashing are the best preventative measures. Acetaminophen can be administered for fever control. It works systemically and has very little, if any, affect locally. Antibiotics are the mainstay of treatment. Steroids are used infrequently.

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: A. Pinworm B. Pertussis C. Gonorrhea D. Lyme disease

A - 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.

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? A. Fever B. Absence of rash C. Malaise D. Headache

B - 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.

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? A. Standard precautions B. Contact precautions C. Droplet precautions D. Airborne precautions

B - 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 group of nursing students are reviewing the functions of white blood cells. The students demonstrate an understanding of the information when they identify which white blood cell as responsible for combating allergic disorders? A. Lymphocytes B. Eosinophils C. Neutrophils D. Monocytes

B - Eosinophils function to combat allergic disorders and parasitic infestations. Neutrophils function to combat bacterial infections. Lymphocytes function to combat viral infections. Monocytes function to combat severe infections.

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

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

D - 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.

The father of a child with mononucleosis is concerned with his child's fever and cough. The father asks when antibiotic therapy will begin. What is the best response by the nurse? A. "It is common treatment to let the infection run its course and let the immune system take care of it." B. "We have to get all of the lab results back before the antibiotic can be started." C. "Mononucleosis is a viral infection so an antibiotic isn't used. We address the symptoms with appropriate therapy." D. "There aren't a lot of antibiotics that work for pertussis. We will just treat your son with medications to treat his fever and cough."

C - Antibiotics are only used for bacterial infections, not viral infections unless a secondary bacterial infection develops from the virus. Treatment for viral infections is aimed at treating the client's symptoms.

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

C - 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.

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

D - 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.

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

D - 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 being at greatest risk for developing a hospital-acquired infection (HAI)? A. a 2-year-old child with HIV being discharged later today B. an 18-month-old child receiving chemotherapy over 5 days C. a 1-year-old receiving oral amoxicillin for otitis media D. a 3-year-old child with malnutrition and poor weight gain

D - 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 nurse is teaching a mother about the correct use of acetaminophen to treat her child's fever. The child weighs 22 lb (10 kg). The nurse instructs the mother to give the child a specific dose each time. The nurse would most likely identify a dose within which range? A. 200 to 250 mg B. 50 to 100 mg C. 150 to 200 mg D. 100 to 150 mg

D - The dosage recommendation for acetaminophen is 10 to 15 mg/kg/dose. The child weighs 10 kg. 10 mg/kg/dose × 10 kg = 100 mg/dose; 15 mg/kg/dose × 10 kg = 150 mg/dose The correct dosage range would be 100 to 150 mg.

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. 1. Prodrome 2. Illness 3. Incubation 4. Convalescence

3, 1, 2, 4 - An infectious disease begins with incubation, then progresses to the prodrome stage, then to illness, and finally to convalescence.

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

A child has been brought to the pediatric clinic. The assessment reveals the child has a temperature of 100.9 F (38.3 C), as well as a rash that is pink and has raised areas. When the area is palpated the skin blanches. Which disease is most associated with these findings? A. Exanthem subitum B. Varicella zoster C. Rubeola D. Rubella

A - Exanthem subitum or 6th disease is a member of the herpes viruses. It presents with a pinkish rash that may be flat or raised. The rash area blanches when palpated. A maculopapular rash that begins on face and spreads head to foot is consistent with rubella. Rubeola presents with bright red spots with blue white centers on mucous membranes, mainly on the buccal mucosa. It looks like tiny grains of white sand surrounded by red ring. Varicella zoster presnts with erythematous macules that evolve to papules and then form clear, fluid-filled vesicles.

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? A. "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." B. "The pathogens cause an overproduction of proinflammatory cytokines. These cytokines are responsible for the clinically observable effects of the sepsis." C. "Sepsis results in systemic inflammatory response syndrome (SIRS) due to infection." D. "The pathophysiology of sepsis is complex."

A - 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.

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

A - 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.

A child is brought to the emergency department by his parents. The parents report that he stepped on a rusty nail about a week and a half ago. The child is complaining of cramping in his jaw and some difficulty swallowing. The nurse suspects tetanus. When assessing the child, the nurse would be alert to which muscle groups being affected next? A. Neck B. Arms C. Legs D. Stomach

A - Tetanus progresses in a descending fashion to other muscle groups, causing spasms of the neck, arms, legs, and stomach.

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? A. West Nile disease B. Rabies C. Malaria D. Anaplasmosis

C - 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.

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? A. Place the child on contact precautions B. Clean the rash with rubbing alcohol C. Notify the primary health care provider D. Obtain an electrocardiography (ECG)

C - 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.

A nurse is obtaining a history from the parents of a child diagnosed with an infection. The parents report that the child started with "a fever a couple of days ago. He just didn't seem himself. Then this morning, he started with yellow-green discharge from his nose." The nurse would identify the child has just completed which stage of an infectious disease? A. Illness B. Incubation C. Convalescence D. Prodrome

D - The child is in the prodrome stage of the infection. Prodrome refers to the time of onset of nonspecific symptoms, such as fever, malaise and fatigue to more specific symptoms. Incubation refers to the time from the entrance of the pathogen into the body to the appearance of the first symptoms. The illness stage is the time during which the child demonstrates signs and symptoms specific to an infection type. Convalescence refers to the time when the acute symptoms of the illness disappear.

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

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