Tissue integrity/infection/vaccines

What preventative measure should be taught to parents of a toddler to decrease the incidence of ear infections? A. Wean the toddler from a bottle B. Encourage the parent to smoke outside the home C. Give the toddler a decongestant before bedtime D. Have the child's hearing checked

A

Which vaccination helps protect children from epiglottis? A. HIB B. DTAP C. Varicella D. PCV

A

Which would be the nurse's best response if a mother asks if her baby still needs the Hib vaccine because he already had Hib? A. "Yes, it is recommended that the baby still get the Hib vaccine." B. "No, if he has had Hib, he will not need to receive the vaccine." C. "Let me take a nasal swab first; if it is negative, he will receive the Hib vaccine." D. "The physician will order a blood test, and depending on results, your child may need the vaccine."

A The infant needs the Hib vaccine to ensure protection against many serious infections caused by Hib, such as bacterial meningitis, bacterial pneumonia, epiglottitis, septic arthritis, and sepsis. The infant needs the Hib vaccine to ensure protection against many serious infections caused by Hib, such as bacterial meningitis, bacterial pneumonia, epiglottitis, septic arthritis, and sepsis. A nasal swab is used to diagnose a respiratory syncytial virus (RSV) infection, which is unrelated to a Hib infection.A blood test does not diagnose previous Hib infection in a healthy child.

A 4-month-old infant comes to the clinic for a well-infant checkup. Immunizations she should receive are DTaP (diphtheria, tetanus, acellular pertussis) and IPV (inactivated poliovirus vaccine). She is recovering from a cold but is otherwise healthy and afebrile. Her older sister has cancer and is receiving chemotherapy. Nursing considerations should include which? A. DTaP and IPV can be safely given. B. DTaP and IPV are contraindicated because she has a cold. C. IPV is contraindicated because her sister is immunocompromised. D. DTaP and IPV are contraindicated because her sister is immunocompromised.

A These immunizations can be given safely. Serious illness is a contraindication. A mild illness with or without fever is not a contraindication. These are not live vaccines, so they do not pose a risk to her sister.

What should be included in teaching a parent about the management of small red macules and vesicles that become pustules around the childs mouth and cheek? A. Keep the child home from school for 24 hours after initiation of antibiotic treatment. B. Clean the rash vigorously with Betadine three times a day. C. Notify the physician for any itching. D. Keep the child home from school until the lesions are healed

A To prevent the spread of impetigo to others, the child should be kept home from school for 24 hours after treatment is initiated. Good hand washing is imperative in preventing the spread of impetigo. The lesions should be washed gently with a warm soapy washcloth three times a day. Washcloth should not be shared with other members of the family. Itching is common and does not necessitate medical treatment. Rather, parents should be taught to clip the childs nails to prevent maceration of the lesions. The child may return to school 24 hours after initiation of antibiotic treatment.

The nurse is preparing to admit a 2-year-old child with rubella (German measles). Which clinical manifestations of rubella should the nurse expect to observe? (Select all that apply.) A. Sore throat B. Conjunctivitis C. Koplik spots D. Lymphadenopathy E. Discrete, pinkish red maculopapular exanthema

A, B, D, E The clinical manifestations of rubella include a sore throat; conjunctivitis; lymphadenopathy; and a discrete, pinkish red maculopapular exanthema. Koplik spots occur in measles but not rubella.

What disease processes require airborne precautions? (Select all that apply.) A. Measles B. Varicella Pertussis Meningitis Tuberculosis

A, B, E In addition to Standard Precautions, use airborne precautions for patients known or suspected to have serious illnesses transmitted by airborne droplet nuclei. Examples of such illnesses include measles, varicella (including disseminated zoster), and tuberculosis. Pertussis and meningitis require droplet precautions.

The clinic nurse is reviewing the immunization guidelines for hepatitis B. Which are true of the guidelines for this vaccine? (Select all that apply.) A. The hepatitis B vaccination series should be begun at birth. B. The adolescent not vaccinated at birth does not have a need to be vaccinated. C. Any child not vaccinated at birth should receive two doses at least 4 months apart. D. An unimmunized 10-year-old child should receive three doses administered 4 weeks apart.

A, D Current immunization guidelines for hepatitis B vaccination recommend beginning the hepatitis B vaccine series at birth or, in unimmunized children, as soon as possible. Children younger than 11 years of age may be vaccinated with a three-dose series, administered 4 weeks apart. Children 11 years and older may receive the two-dose adult formulation given at least 4 months apart.

The nurse is reviewing a list of allowable immunizations which was developed by the parents of a child with leukemia. Which immunizations will the nurse to correct from the parents' lists? (Select all that apply.) A. Measles B. Mumps C. Rubella D. Varicella E. Hepatitis B

ABCD The child must not receive any live virus vaccines. Hepatitis B is the only immunization from the list that is not a live virus

The school nurse assesses a high school age student with a reddened and edematous right eye, with clear discharge with purulent streaks. The student reports that the eye is itchy. What statements will the nurse include when assessing the student? (Select all that apply.) A. "Do you wear contact lenses?" B. "Stay here until I can contact a family member." C. "Who have you been around in your classes today?" D. "You will need to be seen by a health care provider." E. "How many family members do you have in your household?" F. "You must find out what you are allergic to as soon as possible."

ABCDE The child has classic symptoms of conjunctivitis, which is highly contagious. Conjunctivitis is not related to an allergy. The purulent streaks indicate there may be an infection and treatment by a health care provider is indicated. The family members and close contacts are at risk for contracting conjunctivitis.

A 2-year-old is brought to the emergency department for fever and ear pain.The parent reports the child has had many ear infections and that polyethylene tubes have been recommended, but the parent cannot afford surgery. The child is diagnosed with bilateral otitis media. The toddler is carrying a baby bottle full of juice, and the parent is carrying a pack of cigarettes. Which preventive measures could be taught to the parent to decrease the incidence of ear infections? Select all that apply. A. Wean the toddler from the bottle. B. Give the toddler a decongestant before bedtime. C. Encourage the parent to smoke outside the house. D. Counsel the parent to change his shirt and wash his hands after smoking. E. Have the child's hearing checked.

ACD Most toddlers are weaned from the bottle at about 12 to 15 months. Children who continue to drink from a bottle while lying down have a higher incidence of colds and ear infections. Giving the toddler a decongestant before bedtime is not recommended because the primary problem is obstruction of the eustachian tube due to intrinsic or extrinsic causes. Decongestants thicken and make passage of fluid out of the middle ear more difficult. Smoking outside the house is recommended as a way to prevent exposure of secondhand smoke to children, but the smoke still clings to the parents' clothing and hands and continues to be a source of exposure. Smokers should change their shirts and wash hands before handling a child to help prevent exposure to smoke. Following treatment for otitis media, it is important to have the child's hearing checked because drainage from the middle ear may persist beyond the days of treatment. It will not prevent recurrence of the otitis media.

The nurse is providing care to a child with a white blood cell count of 1.025 cell/mm³. What measures will the nurse take to decrease the risk for infection? (Select all that apply.) A. Assist with daily hygiene with an antimicrobial soap. B. Include fresh strawberries in the lunch menu. C. Replace the water in the pitcher every 4 hours. D. Encourage the addition of a green-leafy salad with supper. E. Offer a toothbrush and toothpaste after every meal and at bedtime.

ACE :Reduce environmental risks of infection by eliminating fresh fruits and vegetables. Use an antimicrobial soap with daily hygiene. Change water frequently to eliminate bacterial growth in standing water. Keep teeth clean by brushing after every meal and before bed.

Which is an example of active immunity? A. Prenatal B. Live vaccine C. Monoclonol antibodies D. IVIG

B

Pertussis vaccination should begin at which age? A. Birth B. 2 months C. 6 months D. 12 months

B The acellular pertussis vaccine is recommended by the American Academy of Pediatrics beginning at age 6 weeks. Infants are at greater risk for complications of pertussis. The vaccine is not given after age 7 years, when the risks of the vaccine become greater than those of pertussis. The first dose is usually given at the 2-month well-child visit. Infants are highly susceptible to pertussis, which can be a life-threatening illness in this age group.

When giving instructions to a parent whose child has scabies, what should the nurse include? A. Treat all family members if symptoms develop. B. Be prepared for symptoms to last 2 to 3 weeks. C. Carefully treat only areas where there is a rash. D. Notify practitioner so an antibiotic can be prescribed.

B The mite responsible for the scabies will most likely be killed with the administration of medications. It will take 2 to 3 weeks for the stratum corneum to heal. That is when the symptoms will abate. Initiation of therapy does not wait for clinical symptom development. All individuals in close contact with the affected child need to be treated. Permethrin, a scabicide, is the preferred treatment and is applied to all skin surfaces.

A mother requests that her child receive the varicella vaccine at the 9 month well-child checkup. The nurse tells the mother the following: A. Children who are vaccinated will likely develop a mild case of the disease B. The vaccine cannot be given at that visit C. The vaccine will be administered after the physician examines the child to make sure he is well enough D. A booster vaccination will be needed at 18 months of age

B The nurse should not give the vaccine. The varicella vaccine is not usually administered prior to 1 year of age.

What immunization is recommended for all newborns? A. Hepatitis A vaccine B. Hepatitis B vaccine C. Hepatitis C vaccine D. Hepatitis A, B, and C vaccines

B Universal vaccination for hepatitis B is recommended for all newborns. Hepatitis A vaccine is recommended for infants starting at 12 months. No vaccine is currently available for hepatitis C

The nurse is preparing to administer eardrops to a 2-year-old. What is the proper procedure for administering this medication? A. Pull the pinna up and back. B. Pull the pinna down and back. C. Pull the pinna up and forward. D. Pull the pinna down and forward.

B Up until a child is 3-year-old, the proper procedure for administering eardrops is by pulling the pinna down and back to straighten the ear canal.

A nurse is instructing parents on treatment of pediculosis (head lice). Which should the nurse include in the teaching plan? Select all that apply. A. Bedding should be washed in warm water and dried on a low setting. B. After treating the hair and scalp with a pediculicide, shampoo the hair with regular shampoo. C. Retreat the hair and scalp with a pediculicide in 7 to 10 days. D. Items that cannot be washed should be dry cleaned or sealed in plastic bags for 2 to 3 weeks. E. Combs and brushes should be boiled in water for at least 10 minutes.

C, D, E An over-the-counter pediculicide, permethrin 1% (Nix, Elimite, Acticin), kills head lice and eggs with one application and has residual activity (i.e., it stays in the hair after treatment) for 10 days. Nix Creme Rinse is applied to the hair after it is washed with a conditioner-free shampoo. The product should be rinsed out after 10 minutes. The hair should not be shampooed for 24 hours after the treatment. Even though the kill rate is high and there is residual action, retreatment should occur after 7 to 10 days. Combs and brushes should be boiled or soaked in antilice shampoo or hot water [greater than 60 C (140 F)] for at least 10 minutes. Advise parents to wash clothing (especially hats and jackets), bedding, and linens in hot water and dry at a hot dryer setting.

A 4-month-old client comes into the clinic for a well visit. Which vaccine will the nurse prepare? A. TDaP B. HPV C. Varicella D. DTaP

D

A patient is experiencing testicular pain and inflammation. Which is most probable? A. Chicken pox B. Measles C. Meningitis D. Mumps

D

A patient presents with bilateral clear drainage from the eyes and itching. Which is most probable A. Viral conjunctivitis B. Exposure to foreign body C. Bacterial Conjuctivits D. Allergic conjunctivitis

D

Approximately, how long does maternal IgG provide protection for the newborn? A. Up to 2-4 weeks after birth B. Up to 6 months after birth C. Up to 1 year after birth D. Up to 3 months after birth

D

The nurse is preparing vaccines for a 4-year-old. Which will the nurse NOT include? A. DTaP B. Varicella C. MMR D. Prevnar

D

Which symptom is NOT a clinical manifestation of mumps? A. Fever B. Headache C. Testicular pain D. Runny nose

D

Which type of precautions are used for varicella? A. Standard B. Droplet C. Contact D. Airborne

D

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

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

An infant with respiratory syncytial virus (RSV) is being admitted to the hospital. The nurse should plan to place the infant on which precaution? A. Enteric B. Airborne C. Droplet D. Contact

D A patient with RSV is placed on contact precautions. The transmission of RSV is by contact of secretions, not by droplets or airborne. Enteric precautions are not required for RSV.

A child has been diagnosed with scabies. Which statement by the parent indicates understanding of the nurses teaching about scabies? A. The itching will stop after the cream is applied. B. We will complete extensive aggressive housecleaning. C. We will apply the cream to only the affected areas as directed. D. Everyone who has been in close contact with my child will need to be treated.

D Because of the length of time between infestation and physical symptoms (30 to 60 days), all persons who were in close contact with the affected child need treatment. Families need to know that although the mite will be killed, the rash and the itch will not be eliminated until the stratum corneum is replaced, which takes approximately 2 to 3 weeks. Aggressive housecleaning is not necessary, but surface vacuuming of heavily used rooms by a person with crusted scabies is recommended. The prescribed cream should be thoroughly and gently massaged into all skin surfaces (not just the areas that have a rash) from the head to the soles of the feet.

The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like the childs younger brother had when he was an infant. The nurse should base a response on which information? A. Meningitis rarely occurs during infancy. B. Often a genetic predisposition to meningitis is found. C. Vaccination to prevent all types of meningitis is now available. D. Vaccinations to prevent pneumococcal and Haemophilus influenzae type B meningitis are available.

D H. influenzae type B meningitis has been virtually eradicated in areas of the world where the vaccine is administered routinely. Bacterial meningitis remains a serious illness in children. It is significant because of the residual damage caused by undiagnosed and untreated or inadequately treated cases. The leading causes of neonatal meningitis are the group B streptococci and Escherichia coli organisms. Meningitis is an extension of a variety of bacterial infections. No genetic predisposition exists. Vaccinations are not available for all of the potential causative organisms.

Which is the correct method to instill eardrops in a 5-year-old? A. Pull the pinna of the ear downward and back for instillation. B. Place cotton tightly in the ear after instillation C. Have the child remain upright after instillation. D. Pull the pinna of the ear upward and back for instillation.

D Pull the pinna down and back for a child younger than age 3 years. Placing the cotton in the ear tightly would be painful. The cotton could act as a wick and absorb the medication preventingits instillation. It will not help in the administration of the eardrops. Having the child stay in an upright position after instillation does not affect administration of the eardrops. The correct way to administer eardrops in a child older than 3 years of age is to pull the pinna up and back, the same as for an adult.

Secondary prevention for cognitive impairment includes what activity? A. Genetic counseling B. Avoidance of prenatal rubella infection C. Preschool education and counseling services D. Newborn screening for treatable inborn errors of metabolism

D Secondary prevention involves activities that are designed to identify the condition early and initiate treatment to avert cerebral damage. Inborn errors of metabolism such as hypothyroidism, phenylketonuria, and galactosemia can cause cognitive impairment. Genetic counseling and avoidance of prenatal rubella infections are examples of primary prevention strategies to preclude the occurrence of disorders that can cause cognitive impairment. Preschool education and counseling services are examples of tertiary prevention. These are designed to include early identification of conditions and provision of appropriate therapies and rehabilitation services.

An infants parents ask the nurse about preventing otitis media (OM). What information should be provided? A. Avoid tobacco smoke. B. Use nasal decongestants. C. Avoid children with OM. D. Bottle- or breastfeed in a supine position.

A Eliminating tobacco smoke from the childs environment is essential for preventing OM and other common childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other symptoms of upper respiratory tract infection. Children should be fed in a semivertical position to prevent OM.

A child comes to the school nurse complaining of itching. Further assessment reveals that the child has impetigo. What action should the nurse take? A. Send the child home with the parents to see the health care provider before returning to school. B. Send the child home with the parents and report this to the health department. C. Cover the lesion with a dry gauze dressing and send the child back to class. D. Wash the lesion with antimicrobial soap, air-dry, and send the child back to class.

A Impetigo is a staphylococcal infection and is transmitted by person-to-person contact. The child should be sent home with a note to the parents explaining the condition. Option B is not necessary because this is not a public health hazard. Option C slows the healing process and can contribute to spread of the infection. The lesions should be washed with soap and water, topical ointment applied, and left open to the air to dry. This will occur at the child's home.

What does impetigo ordinarily results in? A. No scarring B. Pigmented spots C. Atrophic white scars D. Slightly depressed scars

A Impetigo tends to heal without scarring unless a secondary infection occurs.

Which is usually the only symptom of pediculosis capitis (head lice)? A. Itching B. Vesicles C. Scalp rash D. Localized inflammatory response

A Itching is generally the only manifestation of pediculosis capitis (head lice). Diagnosis is made by observation of the white eggs (nits) on the hair shaft. Vesicles, scalp rash, and localized inflammatory response are not symptoms of head lice.

A 4 year old cancer patient is scheduled to receive vaccinations . Which vaccine will the pt not receive? A. Dtap B. MMR C. Polio

B

A patient presents with a flat, red, systemic rash with fever and malaise. Which is more probable? A. Impetigo B. Measles C. Scabies D. Chicken pox

B

The nurse identifies Koplik spots on a pediatric client. The nurse understands that this is a sign of which condition? A. Rubella B. Rubeola C. Mumps D. Varicella

B

When providing education at the WIC clinic, which disease will the RN advise pregnant moms to avoid? A. Rubeola B. Rubella C. Mumps D. Pertussis

B

Which vaccine protects against paralysis and subsequent death? A. Dtap B. IPV C. Tdap D. HIB

B

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

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

The mother of a newborn asks the nurse when the infant will receive the first hepatitis B immunization. Which is the nurse's best response? A. "Babies receive the hepatitis B vaccine only if their mother is hepatitis B-positive." B. "The first dose of the hepatitis B vaccine will be given prior to discharge today." C. "The first dose of hepatitis B vaccine is given at 1 year of age." D. "Babies receive their first hepatitis B vaccine at 6 months of age."

B Babies born to mothers positive for hepatitis B receive the first dose of hepatitis B vaccine within 12 hours of delivery. The first dose of hepatitis B vaccineis recommended between birth and 2 months. In most hospitals, newborns are given the vaccine prior to discharge. The first dose of hepatitis B vaccine is recommended between birth and 2 months. In most hospitals, newborns are given the vaccine prior to discharge. The first dose of hepatitis B vaccine is recommended between birth and 2 months. In most hospitals, newborns are given the vaccine prior to discharge.

The clinic nurse is reviewing the newly received lab reports. The report from an 8-year-old indicates chlamydial conjunctivitis. What is the nurse's next action? A. Have the parents bring the child in for further examination. B. Alert the proper authorities of possible sexual abuse. C. Ask the health care provider to call in a prescription for the child. D. Assess the child's chart to determine if immunizations are up-to-date.

B Chlamydial conjunctivitis outside of the neonatal period is suspect of child abuse. Nurses are mandatory reporters and must report this finding. No further examination is needed with this laboratory finding. The health care provider can prescribe the appropriate treatment, which is the next step. Chlamydial conjunctivitis is not impacted my immunizations; the infection is spread by contact.

Which methods results in primary prevention of communicable disease? A. Strict isolation B. Immunizations C. Early diagnosis D. Treatment of disease

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

A mother requests that her child receive the varicella vaccine at the 9-month well- child checkup. The nurse tells the mother that: A. Children who are vaccinated will likely develop a mild case of the disease. B. The vaccine cannot be given at that visit. C. The vaccine will be administered after the physician examines the child. D. A booster vaccination will be needed at 18 months of age.

B It is possible for children to develop a mild rash after receiving the varicella vaccine. However, the varicella vaccine is not usually administered prior to 1 year of age. The nurse should not give the vaccine. The varicella vaccine is not usually administered prior to 1 year of age unless there are extenuating circumstances. The varicella vaccine is not usually administered prior to 1 year of age. The recommendation is that a second dose be administered at 4 to 6 years of age

During routine screening at a school clinic, an otoscope examination of a child's ear reveals a tympanic membrane that is pearly gray, slightly bulging, and not movable. Based on these findings, what action should the nurse take? A. No action is required because this is an expected finding for a school-aged child. B. Ask if the child has had a cold, runny nose, or any ear pain lately. C. Send a note home advising parents to have the child evaluated by a health care provider. D. Call the parents and have them take the child home from school for the rest of the day.

B More information is needed to interpret these findings. The tympanic membrane is normally pearly gray, not bulging, and moves when a client blows against resistance or when a small puff of air is blown into the ear canal. Because these findings are not completely normal, further assessment of history and related signs and symptoms are needed to interpret the findings accurately. Based on the data obtained from the otoscope examination, options A, C, and D are not indicated.

The nurse is caring for a child with erythema multiforme (Stevens-Johnson syndrome). What local manifestations does the nurse expect to assess in this child? (Select all that apply.) A. Papular urticaria B. Erythematous papular rash C. Lesions absent in the scalp D. Lesions enlarge by peripheral expansion E. Firm papules that may be capped by vesicles

B, C, D Local manifestations of erythema multiforme include an erythematous popular rash, lesions involving most skin surfaces except the scalp and lesions that enlarge by peripheral expansion. Papular urticaria and firm papules capped by vesicles are characteristics of an insect bite.

The clinic nurse is assessing a child with bacterial conjunctivitis (pink eye). Which assessment findings should the nurse expect? (Select all that apply.) A. Itching B. Swollen eyelids C. Inflamed conjunctiva D. Purulent eye drainage E. Crusting of eyelids in the morning

B, C, D, E The assessment findings in bacterial conjunctivitis include swollen eyelids, inflamed conjunctiva, purulent eye drainage, and crusting of eyelids in the morning. Itching is seen with allergic conjunctivitis but not with bacterial conjunctivitis

The nurse is performing an otoscopic examination on a child. Which are normal findings the nurse should expect? (Select all that apply.) A. Ashen gray areas B. A well-defined light reflex C. A small, round, concave spot near the center of the drum D. The tympanic membrane is a nontransparent grayish color E. A whitish line extending from the umbo upward to the margin of the membrane

B, C, E Normal findings include the light reflex and bony landmarks. The light reflex is a fairly well- defined, cone-shaped reflection that normally points away from the face. The bony landmarks of the eardrum are formed by the umbo, or tip of the malleus. It appears as a small, round, opaque, concave spot near the center of the eardrum. The manubrium (long process or handle) of the malleus appears to be a whitish line extending from the umbo upward to the margin of the membrane. The tympanic membrane should be light pearly pink or gray and translucent, not nontransparent. Ashen gray areas indicate signs of scarring from a previous perforation.

The nurse obtains a N-95 mask and prepares to transport a pt to a negative pressure room. What is the patients diagnosis? A. Hepatitis A B. Rotavirus C. Chicken pox D. Tetanus

C

Which serious reaction should the nurse be alert for when administering vaccines? A. Fever B. Skin irritation C. Allergic reaction D. Pain at injection site

C Each vaccine administration carries the risk of an allergic reaction. The nurse must be prepared to intervene if the child demonstrates signs of a severe reaction. Mild febrile reactions do occur after administration. The nurse includes management of fever in the parent teaching. Local skin irritation may occur at the injection site after administration. Parents are informed that this is expected. The injection can be painful. The nurse can minimize the discomfort with topical analgesics and nonpharmacologic measures.

A child comes to the clinic for diphtheria, pertussis, and tetanus (DTaP) and inactivated poliovirus vaccines. The child does not appear ill but has a temperature of 101°F (38.3°C). The nurse should take which action? A. Withhold the vaccines and reschedule when the child is afebrile. B. Administer acetaminophen (Tylenol) and give the vaccines. C. Give the vaccines and instruct the parent to give acetaminophen (Tylenol) every 4 hours as needed. D. Have the health-care provider order an antibiotic and give the vaccine.

C Immunizations can be given when the child has a low-grade fever as long as the child is not ill appearing. Diagnose the problem before giving the vaccine. Just giving the acetaminophen (Tylenol) would not allow a diagnosis to be made, as it may mask symptoms. Immunizations can be given when the child has a low-grade fever as long as the child is not ill appearing. The nurse would not want to give an antibiotic until a bacterial infection was diagnosed.

Which causal agent would produce purulent discharge from the eyes, crusting, and swollen eyelids in a child? A. Virus B. Allergy C. Bacteria D. Foreign body

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

The nurse is preparing to administer a measles, mumps, rubella, and varicella (MMRV) vaccine. Which is a contraindication associated with administering this vaccine? A. The child has recently been exposed to an infectious disease. B. The child has symptoms of a cold but no fever. C. The child is having intermittent episodes of diarrhea. D. The child has a disorder that causes a deficient immune system.

D The MMRV (measles, mumps, rubella, and varicella) vaccine is an attenuated live virus vaccine. Children with deficient immune systems should not receive the MMRV vaccine because of a lack of evidence of its safety in this population. Exposure to an infectious disease, symptoms of a cold, or intermittent episodes of diarrhea are not contraindications to receiving a live vaccine.

What immunization should not be given to a child receiving chemotherapy for cancer? A. Tetanus vaccine B. Inactivated poliovirus vaccine C. Diphtheria, pertussis, tetanus (DPT) D. Measles, mumps, rubella (MMR)

D The vaccine used for MMR is a live virus and can cause serious disease in immunocompromised children. The tetanus vaccine, inactivated poliovirus vaccine, and DPT are not live vaccines and can be given to immunosuppressed children. The immune response is likely to be suboptimum, so delaying vaccination is usually recommended.

A mother tells the nurse that she does not want her infant immunized because of the discomfort associated with injections. What should the nurse explain? A. This cannot be prevented. B. Infants do not feel pain as adults do. C. This is not a good reason for refusing immunizations. D. A topical anesthetic can be applied before injections are given.

D To minimize the discomfort associated with intramuscular injections, a topical anesthetic agent can be used on the injection site. These include EMLA (eutectic mixture of local anesthetic) and vapor coolant sprays. Pain associated with many procedures can be prevented or minimized by using the principles of atraumatic care. Infants have neural pathways that will indicate pain. Numerous research studies have indicated that infants perceive and react to pain in the same manner as do children and adults. The mother should be allowed to discuss her concerns and the alternatives available. This is part of the informed consent process.