Peds PrepU: Chapter 15
The rash in roseola is pruritic. Which of the following measures would you teach the father to provide comfort? a) Discuss with the child the importance of not scratching lesions. b) Dress the child warmly to bring out the rash so that it fades quickly. c) Apply cool compresses to the skin to stop local itching. d) Administer infant aspirin every 4 hours as necessary for comfort.
c) Apply cool compresses to the skin to stop local itching. Explanation: Cool compresses can minimize pruritus. Aspirin should not be given with increased temperature (flu-like symptoms).
Question: Put the following stages of infectious disease in correct order:
Incubation period Prodromal period Illness Convalescent period Explanation: Infectious diseases follow certain stages during which the communicability (ability to be spread to others) or severity of the illness can be predicted: 1) incubation period, 2) prodromal period, 3) illness, and 4) convalescent period.
Question: A nursing instructor is describing the progression of signs and symptoms associated with varicella from earliest to latest. Place the signs and symptoms below in the sequence that the instructor would describe them.
Low-grade fever Macular rash Papular rash Vesicle formation Crusting Explanation: The disease is marked by a low-grade fever, malaise, and, in 24 hours, the appearance of a rash. The lesion begins as a macula, then progresses rapidly within 6 to 8 hours to a papule, then to a vesicle that first becomes umbilicated and then forms a crust.
A 13-year-old boy who recently immigrated to the United States from India is found to be infected by a strain of the poliovirus. After initial symptoms of fever, headache, nausea, vomiting and abdominal pain subside, the virus proceeds to his central nervous system. Which of the following would be the best intervention for this client at this point? a) Bed rest, analgesia, and application of moist hot packs b) Salicylic acid solution c) Antibiotics d) Vaccination
a) Bed rest, analgesia, and application of moist hot packs Explanation: Treatment for poliomyelitis is bed rest with analgesia and moist hot packs to relieve pain. Vaccination would be too late, at this point, as the infection has already occurred. Antibiotics would be ineffective as this is a viral, not a bacterial, infection. Salicylic acid solution is used to treat warts.
A child is diagnosed with an enterovirus infection. Which type of infection control precaution would be most important for the nurse to use? a) Airborne b) Contact c) Standard d) Droplet
b) Contact Explanation: For the child with an enterovirus infection, contact precautions are used during the illness. Standard precautions are followed at all times and are appropriate for any child. Droplet precautions would be used for a child infected with pertussis. Airborne precautions would be indicated for the child with varicella.
The nurse is providing teaching to the parents of child with varicella. Which of the following statements indicates that the parents have understood the instructions? a) "We need to make sure that he washes his hands frequently." b) "We should apply alcohol to the lesions every four hours." c) "If he has a fever, we can give him some aspirin." d) "The lesions should eventually form soft crusts that drain."
a) "We need to make sure that he washes his hands frequently." Explanation: The child with varicella needs to wash his hand 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 major reservoir for MRSA is which of the following areas? a) Lungs b) Anterior nares c) Larynx d) Trachea
b) Anterior nares Explanation: The major reservoir for MRSA is the lower part of the nose (anterior nares).
A nursing instructor is teaching students about normal childhood infectious diseases. Which disease does the teacher tell students is transferred by the varicella-zoster virus? a) Mumps b) Chickenpox c) Rubella d) Measles
b) Chickenpox Explanation: The causative agent for chickenpox is the varicella-zoster virus.
A nursing instructor is teaching students about the chain of infection. Which of the following does the instructor tell students is responsible for allowing the pathogen to enter? a) reservoir b) means of transmission c) portal of exit d) portal of entry
d) portal of entry Explanation: The portal of entry, or the opening through which a pathogen can enter a child's body, can be inhalation, ingestion, or breaks in the skin.
A nurse is assessing a child with a tick-borne disease. Which of the following would indicate to the nurse that the child has developed ehrlichiosis and not Rocky Mountain Spotted Fever? a) Absence of rash b) Fever c) Headache d) Malaise
a) Absence of rash Explanation: 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.
The most common complication of varicella includes which of the following? a) Scarring b) Pneumonia c) Secondary bacterial infections d) Encephalitis
c) Secondary bacterial infections Explanation: The most common complication of varicella is secondary bacterial infection caused by the child scratching the lesions. Other complications include pneumonia, scarring, and encephalitis.
Which of the following is a symptom of neonatal sepsis? a) Increased urine output b) Hypertension c) Hyperglycemia d) Bradycardia
d) Bradycardia Explanation: Symptoms of neonatal sepsis are bradycardia or tachycardia, hypotension, decreased urine output, and hypoglycemia.
A 5-year-old girl catches the flu from a friend at daycare after the friend sneezed and wiped mucus on a toy that the girl played then with. In this case, which of the following is the portal of exit in the chain of infection? a) The 5-year-old girl b) The friend c) Toy d) Upper respiratory excretion
d) Upper respiratory excretion Explanation: 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.
Which of the following is the leading cause of neonatal sepsis and death? a) Group B streptococcus b) Epstein-Barr virus infection c) Cytomegalovirus infection d) Herpes simplex virus infection
a) Group B streptococcus Explanation: Group B streptococcus is the leading cause of neonatal sepsis and death. Herpes simplex virus, Epstein-Barr virus, and cytomegalovirus are not leading causes of neonatal sepsis and death.
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 of the following infectious diseases? a) measles b) mumps c) whooping cough d) scabies
b) mumps Explanation: Mumps is an infectious disease with a primary symptom of a swollen parotid gland.
A nursing instructor has performed effective teaching of the functions of white blood cells when a student correctly identifies which of the following as a backup for neutrophils in an acute infection? a) Monocytes b) Eosinophils c) Neutrophils d) Lymphocytes
a) Monocytes Explanation: Monocytes are a type of white blood cell that act as a backup for neutrophils in acute infections.
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 of the following infectious diseases? a) measles b) mumps c) scabies d) whooping cough
b) mumps Explanation: Mumps is an infectious disease with a primary symptom of a swollen parotid gland.
Which of the following is a true statement regarding measles? a) The incubation period is 8 to 12 days. b) Peak outbreaks are in the summer. c) Rarely is it contagious. d) It is transmitted by the fecal-oral route.
a) The incubation period is 8 to 12 days. Explanation: The typical incubation period is 8 to 12 days. Outbreaks peak in the winter and spring. It is highly contagious and is transmitted by airborne suspended droplets.
The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which of the following best describes pustule? a) Small elevation of epidermis filled with a viscous fluid b) Discolored skin spot not elevated at the surface c) Redness of the skin produced by congestion of the capillaries d) Small, circumscribed, solid elevation of the skin
a) Small elevation of epidermis filled with a viscous fluid Explanation: A pustule is a small elevation of epidermis filled with pus.
A 3-week-old infant is diagnosed with pertussis. Which antimicrobial agent would the nurse expect the physician to prescribe? a) Erythromycin b) Clarithromycin c) Trimethoprim-sulfamethoxazole d) Azithromycin
d) Azithromycin Explanation: The macrolides (erythromycin, azithromycin, and clarithromycin) are the drugs of choice for pertussis in children over 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 parent of a child with mumps calls the clinic to find out how long the child needs to stay home from school. The nurse would instruct the parent to allow the child to return to school at which time? a) After 9 days from the onset of swelling b) Within 3 days of starting antiviral therapy c) Usually 7 days after the last lesion appears d) In about 5 days, once the lesions crust
a) After 9 days from the onset of swelling Explanation: In the home, educate the family to keep the child with mumps from attending school or daycare until 9 days after the onset of swelling. Mumps involves swelling of the salivary glands; no lesions are present. Therapy for mumps is primarily supportive; antiviral agents are not used.
In understanding the body and its functions, the nurse recognizes that protecting the body from attacks by microorganisms and helping the body get rid of or resist invasion by foreign materials is a major role of which of the following body systems? a) Immune System b) Respiratory System c) Nervous System d) Musculoskeletal System
a) Immune System Explanation: Protecting the body from attacks from microorganisms and helping the body get rid of or resist invasion by foreign materials are the major roles of the immune system. Unlike other systems in the body that are made up of organs, the immune system is made up of cells and tissues that work to protect the body.
A group of camp nurses is discussing various types of tick bites. One of the nurses states that deer ticks are carried by white-footed mice and white-tailed deer, and can carry the organism that causes which of the following diseases? a) Acquired immunodeficiency syndrome b) Gonorrhea c) Lyme disease d) Rheumatic fever
c) Lyme disease Explanation: Deer ticks, carried by white-footed mice and white-tailed deer, can carry the organism that causes lyme disease.
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) Eosinophils b) Neutrophils c) Monocytes d) Lymphocytes
a) Eosinophils Explanation: 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.
A child is diagnosed with group A streptococcal pharyngitis. The nurse would teach the parents to be alert for signs and symptoms of which of the following? a) Scarlet fever b) Osteomyelitis c) Pneumonia d) Impetigo
a) Scarlet fever Explanation: 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.
A 7-year-old patient with an earache comes to the clinic. The child's mother reports that 1 day ago the patient had a fever and headache and did not want to play. When the nurse asks where it hurts, the patient points to the jawline in front of the earlobe. What does the nurse expect the diagnosis to be for this patient? a) Mononucleosis b) Measles c) Fifth disease d) Mumps
d) Mumps Explanation: 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.
The nurse is caring for a 6-year-old boy with mumps. Which of the following statements by the child would cause the nurse to suspect the boy is experiencing a complication of mumps? a) "I keep coughing up mucus." b) "Please talk a little louder." c) "I feel wobbly when I walk." d) "My knees are sore and stiff."
b) "Please talk a little louder." Rationale: Complications of mumps include meningoencephalitis with seizures and auditory neuritis, which can result in deafness. Joint complaints, which might suggest arthritis, are a complication of erythema infectiosum. Difficulty walking, which might suggest cerebellar ataxia, is a complication of chickenpox. Coughing, which might suggest bronchopneumonia, is a complication of rubeola.
A group of grade-school children is going camping. As a school nurse, you would offer them which advice to prevent Lyme disease? a) "Don't touch any bush without knowing what kind it is." b) "Wear jeans tucked inside your socks when in the woods." c) "Don't approach strange animals outside the campsite." d) "Don't drink water from mountain streams while hiking."
b) "Wear jeans tucked inside your socks when in the woods." Explanation: Lyme disease is prevented by measures to reduce the possibility of tick bites.
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 has been over 102°F. He has this rash on his face and chest that looks like sunburn but feels really rough." Which of the following would the nurse suspect? a) Scarlet fever b) Pertussis c) Diphtheria d) Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA)
a) Scarlet fever Explanation: Scarlet fever typically is associated with a sore throat, fever greater than 101°F, 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.
A 6-month-old boy develops roseola. When obtaining information from his father, which of the following information would you expect him to report? a) The infant's temperature fell when the rash appeared. b) The infant is lethargic and not interested in playing. c) The infant's temperature rose at the same time as the rash appeared. d) The rash is a mixture of papules and pustules.
a) The infant's temperature fell when the rash appeared. Explanation: The mark of roseola is that the rash appears as the initial temperature decreases.
The nurse is caring for an adolescent diagnosed with genital herpes. The drug of choice for treating genital herpes is which of the following? a) Griseofluvin b) Penicillin c) Acyclovir d) Rocephin
c) Acyclovir Explanation: The drug acyclovir (zovirax) is useful in relieving or suppressing the symptoms of genital herpes.
The nurse is caring for a 10-year-old boy with diphtheria. Which of the following would the nurse institute as a tier 2 precaution? a) Use of a protective face shield b) Use of a protective gown c) Negative air pressure ventilation d) Use of a protective mask
d) Use of a protective mask Explanation: 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.
A nursing instructor is teaching the students about the standard and transmission-based precautions. What type of precautions requires placing a patient in an isolated room with limited access, wearing gloves during contact with the patient and all body fluids or contaminated items, wearing two layers of protective clothing, and avoiding sharing equipment between patients? a) Standard precautions b) Contact precautions c) Droplet precautions d) Airborne precautions
b) Contact precautions Explanation: Contact precautions means placing the patient in an isolation room with limited access, wearing gloves during contact with the patient and all body fluids, wearing two layers of protective clothing, limiting movement of the patient from the room, and avoiding sharing equipment between patients.
A child is brought to the clinic with fever, cough, and coryza. The nurse inspects the child's mouth and observes what look like tiny grains of white sand with red rings. The nurse documents this as which of the following? a) Koplik spots b) Nits c) Slapped cheek appearance d) Lymphadenopathy
a) Koplik spots Explanation: Koplik spots are bright red spots with blue-white centers appearing primarily on the buccal mucosa and indicate rubeola (measles). They are often described as tiny grains of white sand surrounded by red rings. Lymphadenopathy is used to document enlargement of the lymph nodes. Slapped cheek appearance refers to the erythematous flushing associated with fifth disease. Nits refer to the adult eggs of pediculosis.
A young patient in the clinic has a rash, cough, and fever that the mother says spiked on day 5 of the rash. The patient also had conjunctivitis. What would the nurse expect the physician to tell the family that the child has? a) Measles b) Scarlet fever c) Chickenpox d) Rubella
a) Measles Explanation: Measles are diagnosed based on the symptoms of a rash, Koplik spots, conjunctivitis, coryza, cough, and a fever that usually spikes on day 5.
When describing sexually transmitted infections (STIs) to a group of adolescents, the nurse identifies which of the following as curable? Select all that apply. a) Trichomoniasis b) Condylomata acuminata c) Herpes type II virus d) Gonorrhea e) Chlamydia
a) Trichomoniasis d) Gonorrhea e) Chlamydia Explanation: Chlamydia is curable with antibiotic therapy. Gonorrhea is curable with antibiotic therapy. Trichomoniasis is curable with metronidazole or tinidazole. Although the warts can be removed, the virus remains and is not cured. Antivirals control the symptoms but do not cure the disease.
A chief danger of scarlet fever is that children may develop a) local areas of skin necrosis. b) acute glomerulonephritis. c) respiratory obstruction. d) liver destruction.
b) acute glomerulonephritis. Explanation: Because this is a streptococci-based infection, there is a chance the child will develop rheumatic fever or glomerulonephritis following the illness.
Which of the following is one of the most commonly reported communicable diseases in the United States? a) Measles b) Syphilis c) Mononucleosis d) Gonorrhea
d) Gonorrhea Explanation: Gonorrhea is one of the most commonly reported communicable diseases in the United States.
The nurse at the pediatrician's office receives a call from the mother of a child who has just been bitten by the neighbor's dog. Which of the following would be the priority? a) Explain how to care for the dog bite. b) Explain how to educate the child about animals. c) Describe methods of managing a fever. d) Tell the mother to seek medical help immediately.
d) Tell the mother to seek medical help immediately. Explanation: The mother should seek medical help for her child immediately. Once the child has been seen by a physician, it can be determined whether immunoprophylaxis is necessary. Education about animals is important to prevent any recurrent bites, but this is appropriate only after the child has been seen and a plan has been determined. Flu-like symptoms such as fever occur early in rabies infection. However, the child must be seen first. Explaining how to care for the bite would be done only after the child is seen and an appropriate plan is determined.
When preparing a teaching plan for a female adolescent with a sexually transmitted infection (STI), the nurse plans to address the fact that the adolescent is at increased risk for cervical cancer. Which STI would the adolescent most likely have? a) Syphilis b) Genital herpes c) Chlamydia d) Venereal warts
d) Venereal warts Explanation: Venereal warts or condylomata acuminata is caused by the human papilloma virus (HPV), which places the adolescent at increased risk for cervical cancer. An increased risk for cervical cancer is not associated with genital herpes. An increased risk for cervical cancer is not associated with syphilis. An increased risk for cervical cancer is not associated with chlamydia.
Nursing students are learning about the infectious process. They correctly identify the first stage of an infectious disease to be which of the following? a) Prodromal period b) Convalescent period c) Illness period d) Incubation period
d) Incubation period Explanation: The incubation period is the first stage of the infectious disease. It is the time between the invasion of an organism and the onset of symptoms of infection.
Which of the following would you expect to observe about the rash associated with chickenpox (varicella)? a) Various stages of lesions present at the same time b) Dark red color (red hen marks) c) Noticeable crusts but no pruritus d) Dark red, macular, very pruritic lesions
a) Various stages of lesions present at the same time Explanation: Chickenpox lesions appear "in waves," so many stages of lesions are present at the same time.
After teaching nursing students about childhood exanthems, the instructor determines that the teaching was successful when the students identify which of the following as the primary cause? a) Viruses b) Parasites c) Fungi d) Bacteria
a) Viruses Explanation: Most childhood exanthems are caused by viruses.
Parents usually ask when their child can return to school after having chickenpox. The correct answer would be a) as soon as all lesions are crusted. b) as soon as the temperature is normal. c) 10 days after the initial lesions appear. d) not until all lesions have completely faded.
a) as soon as all lesions are crusted. Explanation: Chickenpox lesions are infectious until they crust.
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 of the following conditions? a) Infectious mononucleosis b) Poliomyelitis c) Herpes zoster d) Mumps
d) Mumps Explanation: 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, the child points, not to the ear, but 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.
The public health nurse is discussing immunizations with a group of caregivers of infants. One of the mothers asks the nurse why the child will need immunizations. Which of the following statements would be the most appropriate statement for the nurse to make to this mother? a) "The immunities that the infant is born with are not for the same diseases they will be immunized against." b) "The antibodies the fetus gets from the mother are in the placenta, so after birth they are no longer available to the infant." c) "Infants are unable to develop antibodies to protect them from diseases so they must be immunized." d) "The infant is born with immunity to some diseases, but those immunities decrease over the first year of life."
d) "The infant is born with immunity to some diseases, but those immunities decrease over the first year of life." Rationale: During fetal life, the mother's antibodies cross the placenta, giving the fetus a temporary immunity against certain diseases. This immunity is present at birth and decreases during the first year of life. In the meantime, the infant begins developing antibodies to fight against pathogens and disease. In addition, during the first year of life immunizations are started to help the infant develop protection against certain diseases.
The nurse is teaching a group of middle school students about sexually transmitted infections (STIs). Which statement by the students indicates a need for additional teaching about condom use? a) "Putting the condom on just before insertion defeats the purpose." b) "Put the condom on just before orgasm." c) "Don't store condoms in your wallet." d) "Latex condoms provide the best protection against STIs."
b) "Put the condom on just before orgasm." Explanation: Condoms should be placed on the penis before any genital contact occurs. Latex condoms are best to protect against infection. Condoms should be applied before any genital contact occurs. Applying them at a later time decreases their effectiveness. Condoms should be stored in a cool, dry place that is away from direct sunlight. A wallet is subject to extreme changes in temperature and is an inappropriate place to store a condom.
Which of the following is a true statement regarding varicella zoster virus infection? a) It tends to be more severe in children. b) A complication of this infection includes secondary bacterial infections of the skin. c) It is transmitted by fecal-oral route. d) The incubation period is 7 days.
b) A complication of this infection includes secondary bacterial infections of the skin. Explanation: 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.
Which of the following is a true statement regarding varicella zoster virus infection? a) The incubation period is 7 days. b) A complication of this infection includes secondary bacterial infections of the skin. c) It tends to be more severe in children. d) It is transmitted by fecal-oral route.
b) A complication of this infection includes secondary bacterial infections of the skin. Explanation: 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.
A nurse is preparing a presentation for a local mothers group about common viral infections associated with a rash during childhood. When describing rubella, which of the following would the nurse include? Select all that apply. a) The disease most often occurs during late summer and early fall. b) Any itching with the rash is usually mild. c) The rash typically begins on the trunk and spreads to the face. d) Incubation period usually ranges from 16 to 18 days. e) The infection is communicable for a week before to a week after the rash appears.
b) Any itching with the rash is usually mild. d) Incubation period usually ranges from 16 to 18 days. e) The infection is communicable for a week before to a week after the rash appears. Explanation: Rubella has an incubation period ranging from 12 to 23 days, but usually 16 to 18 days. It is communicable for 7 days before the rash to 7 days after the onset of the rash. Itching is usually mild. It occurs most commonly during late winter and early spring and the rash typically begins on the face and spreads down the neck, trunk, and extremities.
Which of the following is a diagnostic tool used to identify children who may have an infection or inflammatory process? a) Gastric lavage b) Erythrocyte sedimentation rate (ESR) c) Blood culture d) Arterial blood gas analysis
b) Erythrocyte sedimentation rate (ESR) Explanation: The ESR is a screening procedure to identify children who may have an infectious or inflammatory process. A blood culture is utilized to confirm sepsis. Gastric lavage is used to identify TB in a child when bronchoscopy cannot be performed.
Tinea cruris (jock itch) is a protozoan infection. a) True b) False
b) False Explanation: Tinea cruris (jock itch) is a fungal infection that occurs on the inner aspects of the thighs and scrotum.
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 asks for suggestions on what to do to reduce their child's risk. Which of the following would be appropriate for the nurse to suggest? Select all that apply. a) Removing ticks by rubbing them away from the skin with a credit card. b) Inspecting the skin closely for ticks after the child plays in wooded areas. c) Dressing the child in dark clothing when going outdoors. d) Wearing protective clothing when playing in wooded areas. e) Contacting the health care provider if there is any area of inflammation that might be a bite.
b) Inspecting the skin closely for ticks after the child plays in wooded areas. d) Wearing protective clothing when playing in wooded areas. e) Contacting the health care provider if there is any area of inflammation that might be a bite. Explanation: 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.
Which of the following would the nurse include in the teaching plan for parents and their child with a pruritic rash? Select all that apply. a) Using warm baths to soothe the skin b) Keeping fingernails trimmed short c) Encouraging pressure on the skin rather than scratching d) Using distraction to prevent scratching e) Making sure the child's hands are clean
b) Keeping fingernails trimmed short c) Encouraging pressure on the skin rather than scratching d) Using distraction to prevent scratching e) Making sure the child's hands are clean Explanation: To reduce pruritus, teaching would include keeping the child's nails trimmed short, using distraction to prevent scratching, using pressure on the skin rather than scratching, and making sure the child's hands are clean. Cool baths and compresses would help relieve itching.
The nurse is caring for an adolescent diagnosed with syphilis. The drug of choice for treating syphilis is which of the following? a) Rocephin b) Penicillin c) Acyclovir d) Griseofluvin
b) Penicillin Explanation: 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.
Which of the following begins as an upper respiratory illness and progresses to a persistent cough characterized by an inspiratory whoop? a) Sepsis b) Pertussis c) HIV d) TB
b) Pertussis Explanation: Pertussis, also known as whooping cough, begins as an upper respiratory illness and progresses to a persistent cough characterized by an inspiratory whoop. TB is not characterized by an inspiratory whoop. Sepsis and HIV are not associated with an inspiratory whoop.
The nurse is caring for a 16-year-old child with a diagnosis of acquired immunodeficiency syndrome (AIDS). Which of the following goal has the highest priority for this child? a) Maintaining skin integrity b) Preventing spread of infection c) Promoting comfort d) Improving nutrition
b) Preventing spread of infection Explanation: 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 also because of the increasing rate of sexual activity in this age group which often involves 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 young child who has been reporting fatigue and running a low-grade fever for 4 days begins to have pustules over the entire body. The physician diagnoses chicken pox. The period before the pustules developed is referred to as which of the following? a) Incubation period b) Prodromal period c) Convalescent period d) Pre-disease period
b) Prodromal period Explanation: The prodromal period is between the beginning of nonspecific symptoms and disease-specific ones.
A child is diagnosed with group A streptococcal pharyngitis. The nurse would teach the parents to be alert for signs and symptoms of which of the following? a) Pneumonia b) Scarlet fever c) Impetigo d) Osteomyelitis
b) Scarlet fever Explanation: 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 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 which of the following infections? a) Gonorrhea b) Syphilis c) Genital Herpes d) Chalmydial Infection
b) Syphilis Explanation: 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.
One method of preventing communicable diseases in children is to administer vaccines to stimulate the development of antibodies. Which of the following best describes what occurs in the child when vaccines are given? a) The child becomes a carrier of the disease. b) The child develops an active immunity. c) The child develops a passive immunity. d) The child becomes a host for the disease.
b) The child develops an active immunity. Explanation: When a vaccine is given, active immunity occurs which then stimulates the development of antibodies to destroy infective agents without causing the disease.
The nurse is caring for a child diagnosed with Haemophilus Influenzae type B. Which of the following nursing interventions would be the highest priority in the prevention of complications seen with this disorder? a) The nurse will monitor fluid intake. b) The nurse will administer antibiotics. c) The nurse will monitor for seizure activity. d) The nurse will elevate the head of the bed.
b) The nurse will administer antibiotics. Rationale: A serious complication of Haemophilus Influenzae type B is meningitis. Antibiotics are administered to treat the bacterium infection caused by Haemophilus Influenzae type B.
A neonate is brought to the emergency department by her mother because she "just doesn't look right." The neonate is suspected of having sepsis. Which statement by the mother would help to confirm this suspicion? a) "She seems to be breathing a little fast." b) "Her cry seems to be pretty strong." c) "My water broke quite a while before I actually delivered her." d) "She hasn't had a fever."
c) "My water broke quite a while before I actually delivered her." Explanation: Prolonged or premature rupture of membranes increases a neonate's risk for sepsis. A weak cry or lack of smile or facial expression may be present with sepsis. A significant increase in breathing rate (tachypnea) or increased work of breathing evidenced by nasal flaring, grunting, and a retraction is noted with sepsis. Neonates with sepsis do not have a fever. In fact, they may have below-normal temperature.
A nurse is assessing a neonate with sepsis. The nurse understands that most commonly the cause involves which of the following? a) Protozoa b) Enterovirus c) Bacteria d) Herpes virus
c) Bacteria Explanation: 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 young patient arrives at the clinic with a rash on the trunk and flexor surfaces of the extremities. The mother 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 physician diagnoses the child with erythema infectiosum. The nurse tells the mother that this is also known as which of the following? a) Pityriasis rosea b) Enterovirus c) Fifth disease d) Rosacea
c) Fifth disease Explanation: 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.
The nurse is caring for a 14-year-old girl who fears she might have a sexually transmitted infection. Which of the following would the nurse expect to assess if the adolescent has trichomoniasis? a) Lesions on the vulva b) Flu-like symptoms c) Green vaginal discharge d) Urinary incontinence
c) Green vaginal discharge Explanation: Symptoms of trichomoniasis include a yellow, green, or gray vaginal discharge with a foul odor. Urinary incontinence is not indicative of trichomoniasis, but dysuria is. Syphilis is associated with flu-like symptoms Lesions on the vulva are a sign of venereal warts.
The nurse is teaching a group of parents about head lice. Which of the following statements is essential to include during the presentation? a) Discourage the children from going to sleepovers. b) Wash the bed linens in hot water to kill the lice. c) Head lice are becoming very resistant to treatment. d) Send your child to school even if you suspect head lice, but have the school nurse check the child.
c) Head lice are becoming very resistant to treatment. Explanation: The accurate advice is that head lice are becoming resistant to treatment. Children with head lice do not need to stay home, but parents should follow school policies regarding whether children are allowed in school until they are nit-free. Children should be allowed to participate in sleepovers, preferably bringing their own pillows. Head lice do not survive long once they have fallen off. Most children can be treated effectively without treating their bedding and clothing.
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) Legs b) Arms c) Neck d) Stomach
c) Neck Explanation: Tetanus progresses in a descending fashion to other muscle groups, causing spasms of the neck, arms, legs, and stomach.
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) Gonorrhea b) Pertussis c) Pinworm d) Lyme disease
c) Pinworm Explanation: 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 practitioner suspects that a child has scarlet fever based on which of the following assessment findings? a) An enanthematous rash b) White exudate on the tonsils c) Red, strawberry tongue d) Severity of the sore throat
c) Red, strawberry tongue Explanation: 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 nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which of the following best describes erythema? a) Small, circumscribed, solid elevation of the skin b) Discolored skin spot not elevated at the surface c) Redness of the skin produced by congestion of the capillaries d) Small elevation of epidermis filled with a viscous fluid
c) Redness of the skin produced by congestion of the capillaries Explanation: Erythema is redness of the skin produced by congestion of the capillaries.
Which of the following should be included in the teaching plan for a child with varicella? a) Administer aspirin for fever. b) Place the child in a warm bath for skin discomfort. c) Remind the child not to scratch the lesions. d) Utilize salt solutions to assist in healing oral lesions.
c) Remind the child not to scratch the lesions. Explanation: The teaching plan for varicella should include that the child not scratch the lesions. 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. The child should avoid citrus, spicy, or salty foods.
A 6-month-old baby boy is brought to the doctor's office with a high fever. The physician diagnoses the child as having a viral infection of some kind and recommends acetaminophen to reduce the fever. After 3 days, the mother returns with the child. The fever is gone, but a rash of discrete, rose-pink macules approximately 2 to 3 mm and flat with the skin surface appears. Which condition should the nurse suspect? a) Rubella (German measles) b) Chickenpox (Varicella) c) Roseola d) Measles (Rubeola)
c) Roseola Explanation: Roseola begins with a high fever; after 3 or 4 days, the fever falls abruptly and a distinctive rash of discrete, rose-pink macules approximately 2 to 3 mm in size and flat with the skin surface appears. With rubella, after the 1 to 5 days of prodromal signs, a discrete pink-red maculopapular rash begins on the face, then spreads downward to the trunk and extremities. On the third day, the rash disappears. Measles feature Koplik's spots (small, irregular, bright-red spots with a blue-white center point), which appear on the buccal membrane. Chickenpox is marked by a low-grade fever, malaise, and, in 24 hours, the appearance of a distinctive rash. Varicella lesions first begin as a macula, then progress rapidly within 6 to 8 hours to a papule, then a vesicle that becomes umbilicated and then forms a crust.
A nurse is providing care to an infant who develops roseola during hospitalization. The nurse would institute which of the following infection control precautions. a) Airborne b) Droplet c) Standard d) Contact
c) Standard Explanation: If an infant develops roseola infantum in the hospital, the nurse would follow standard precautions. There is no need for airborne, droplet, or contact precautions.
An adolescent girl and her caregiver present at the pediatricians office. The adolescent complains of severe abdominal pain. A diagnosis of pelvic inflammatory disease is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. Which of the following actions by the nurse would be most appropriate? a) Take the caregiver to a private room and tell her that the child's diagnosis can only come from sexual activity. b) Contact the necessary authorities to report a suspected case of sexual abuse. c) Take the child to a private room and interview her regarding her sexual history and partners. d) 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.
c) Take the child to a private room and interview her regarding her sexual history and partners. Explanation: 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.
A young girl arrives at the emergency room after being bitten by a neighbor's dog. The mother is in a panic because she fears 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. Which of the following would most strongly indicate a risk for rabies infection in this client? a) The fact that there have been no other reported instances in the area b) The fact that the dog was properly immunized for rabies c) The fact that the dog was unprovoked when he bit the girl d) The fact that the dog belonged to a neighbor
c) The fact that the dog was unprovoked when he bit the girl Explanation: 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 child hospitalized with pertussis. Which of the following nursing interventions would be the highest priority for this child? a) The nurse will administer antibiotics. b) The nurse will monitor caloric intake. c) The nurse will administer oxygen. d) The nurse will encourage bed rest.
c) The nurse will administer oxygen. Explanation: The major complication of pertussis (whooping cough) is pneumonia and respiratory complications. Oxygen, bed rest, and monitor for airway obstruction are nursing interventions. The highest priority is administering oxygen to maintain adequate oxygenation of cells.
An 11-year-old girl arrives at the doctor's office with fever, a sore throat, chills, and malaise. A throat culture indicates scarlet fever. Which other symptom should the nurse notice in this patient that clearly indicates scarlet fever? a) There is pain along the jawline just in front of the ear lobe b) Fever blisters on the lips c) The tongue has a white or red "strawberry" appearance d) Vesicles that become purulent, ooze, and form honey-colored crusts
c) The tongue has a white or red "strawberry" appearance Explanation: A "strawberry tongue" is a hallmark symptom of scarlet fever and helps to differentiate the disease from other rashes or pharyngeal infections. Pain along the jawline in front of the ear lobe indicates mumps. Vesicles that become purulent, ooze, and form honey-colored crusts are associated with impetigo. Fever blisters on the lips are caused by a herpes simplex infection.
When developing the plan of care for a 5-year-old boy with Rocky Mountain spotted fever, the nurse integrates knowledge of this infection as being caused by which of the following? a) Animal bite b) Contact with contaminated sports equipment c) Infection with group A streptococcus d) Bite of a tick
d) Bite of a tick Explanation: 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.
It is summer time, and the mother of a 6-year-old boy tells the nurse that the mosquitoes in their neighborhood are terrible this year. She says she has heard of cases of West Nile virus in the area and asks the nurse what she can do to protect her son from it. Which of the following should the nurse recommend to the mother? a) Have the son dress in light-colored clothing b) Instruct the son to stay inside from 11 am to 3 pm c) Avoid using mosquito repellants that contain DEET d) Drain any standing water in the yard
d) Drain any standing water in the yard Explanation: Parents can help prevent the spread of West Nile disease by adhering to the "5D's": Instruct children to stay inside between Dusk and Dawn (not 11 am to 3 pm) when mosquitoes are most prevalent. Drain standing water so there are few opportunities for mosquitoes to breed. Dress should include long pants and long sleeves when outside (not light-colored clothing). Apply mosquito repellant that contains DEET (use a concentration not over 30% and apply only once a day. Don't place it on children's hands so they don't ingest it or use with infants under 2 months of age).
A nurse is preparing a presentation for parents about common childhood infectious diseases. Which of the following would the nurse include as being caused by a tick bite? Select all that apply. a) Scabies b) Ascariasis c) Psittacosis d) Lyme disease e) Rocky Mountain Spotted Fever
d) Lyme disease e) Rocky Mountain Spotted Fever Explanation: 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 3-year-old girl was in the hospital for a week following open heart surgery. By the end of the week, she had contracted an infection. The nurse recognizes this type of infection as which of the following? a) Fungal infection b) Bacterial infection c) Viral infection d) Nosocomial infection
d) Nosocomial infection Explanation: Nosocomial or health care-associated infections (HAI) are infections which are contracted while in a hospital or other health care setting. Children younger than 2 years, 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 are at highest risk for contracting such an infection. The infection could be viral, bacterial, or fungal, but not enough information is provided in the scenario to determine this.
When the physician looks in a child's mouth during a sick-visit exam, the mother exclaims: "Her tongue is bright red! It was not like that yesterday." The physician would most likely order which medication based on the probable diagnosis of scarlet fever? a) Acetaminophen to decrease the throat pain b) Steroids to decrease the inflammation c) Erythromycin to prevent the spread to siblings d) Penicillin to prevent acute glomerulonephritis
d) Penicillin to prevent acute glomerulonephritis Explanation: 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.
