356: infectious disease
An adolescent is seen in the health care clinic with complaints of chronic fatigue. On physical examination, the nurse notes swollen lymph nodes, and laboratory test results indicate the presence of Epstein-Barr virus (mononucleosis). The nurse provides instruction regarding care of the adolescent. Which statement made by the mother indicates an understanding of the care measures? a) "I will call the doctor if my child has abdominal or left shoulder pain." b) "I need to keep my child on bed rest for 3 weeks to discourage physical activity." c)"I will notify the health care provider if my child is still feeling tired in 1 week." d) "I need to isolate my child so that the respiratory infection is not spread to others."
a) "I will call the doctor if my child has abdominal or left shoulder pain." The mother needs to be instructed to notify the health care provider (HCP) if abdominal pain, especially in the left upper quadrant, or left shoulder pain occurs because this may indicate splenic rupture. Children with enlarged spleens are also instructed to avoid contact sports until splenomegaly resolves. Bed rest is not necessary, and children usually self-limit their activity. No isolation precautions are required, although transmission can occur via saliva, close intimate contact, or contact with infected blood. The child may still feel tired in 1 week as a result of the virus.
The nurse provides instructions to the mother of a child with mumps regarding respiratory precautions, and the mother asks the nurse about the length of time required for the respiratory precautions. The nurse should make which statement to the mother? a) "Precautions are not necessary once the swelling appears." b) "Precautions are not necessary before the swelling begins." c) "Precautions are indicated during the period of communicability." d) "Precautions are indicated for 20 days following the onset of parotid swelling."
c) "Precautions are indicated during the period of communicability." Mumps is transmitted via direct contact with or droplet spread from an infected person. Droplet precautions are indicated during the period of communicability (immediately before and after swelling begins); therefore, all other options are incorrect.
An infant receives a diphtheria, tetanus, and acellular pertussis (DTaP) immunization at a well-baby clinic. The parent returns home and calls the clinic to report that the infant has developed swelling and redness at the site of injection. Which intervention should the nurse suggest to the parent? a) Monitor the infant for a fever. b) Bring the infant back to the clinic. c) Apply a hot pack to the injection site. d) Apply a cold pack to the injection site.
d) Apply a cold pack to the injection site. On occasion, tenderness, redness, or swelling may occur at the site of the DTaP injection. This can be relieved with cold packs for the first 24 hours, followed by warm or cold compresses if the inflammation persists. Bringing the infant back to the clinic is unnecessary. Option 1 may be an appropriate intervention, but is not specific to the subject of the question, a localized reaction at the injection site. Hot packs are not applied and can be harmful by causing burning of the skin.
A 12-month-old child with human immunodeficiency virus infection is currently immunocompromised. The nurse determines that the immunization needs of this child include which action? a) Withholding the inactivated polio vaccine b) Recommending against any influenza vaccinations c) Administering the measles-mumps-rubella (MMR) vaccine d) Delaying the administration of the varicella virus vaccine until the child is not immunocompromised
d) Delaying the administration of the varicella virus vaccine until the child is not immunocompromised Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. The immunocompromised child with human immunodeficiency virus (HIV) infection should not receive live vaccines. With both the varicella and the MMR vaccinations, live vaccines are given. Once the child's immune status improves, these vaccinations can then be given. The correct option is chosen because the varicella vaccination would be delayed until the child is not immunocompromised. The inactivated polio vaccine is not a live virus, so it can be administered. The MMR vaccine would not be administered at this time. Influenza vaccinations do not typically involve live viruses, so the child could receive these vaccinations.
A child is sent to the school nurse by the teacher. On assessment of the child the nurse notes the presence of a rash. The nurse suspects that the child has erythema infectiosum (fifth disease) based on which assessment finding? a) A discrete rose-pink maculopapular rash on the trunk b) A highly pruritic, profuse macule-to-papule rash on the trunk c) Erythema on the face, giving a "slapped cheeks" appearance d) A discrete pinkish-red maculopapular rash on the arms and trunk
c) Erythema on the face, giving a "slapped cheeks" appearance The classic rash of erythema infectiosum, or fifth disease, affects the face. The discrete rose-pink maculopapular rash is the rash of exanthema subitum (roseola). The highly pruritic, profuse macule-to-papule rash is the rash of varicella (chickenpox). The discrete pinkish-red maculopapular rash is the rash of rubella (German measles).
A child diagnosed with scarlet fever is being cared for at home. The home health nurse performs an assessment on the child and checks for which clinical manifestations of this disease? Select all that apply. a) Pastia's sign b) Koplik's spots c) White strawberry tongue d) Edematous and beefy-red pharynx e) Petechial red, pinpoint spots on the soft palate f) Small red spots with a bluish-white center and a red base located on the buccal mucosa
a, c, d a) Pastia's sign c) White strawberry tongue d) Edematous and beefy-red pharynx Pastia's sign describes a rash seen in scarlet fever that will blanch with pressure except in areas of deep creases and the folds of joints. The tongue initially is coated with a white furry covering, with red projecting papillae (white strawberry tongue). By the fourth to fifth day, the white strawberry tongue sloughs off, leaving a red swollen tongue (strawberry tongue). The pharynx is edematous and beefy red. Koplik's spots are associated with rubeola (measles). These are small red spots with a bluish-white center and a red base located on the buccal mucosa. Petechial red, pinpoint spots occurring on the soft palate are characteristic of rubella (German measles).
The clinic nurse is assessing a child who is scheduled to receive a live virus vaccine (immunization). What are the general contraindications associated with receiving a live virus vaccine? Select all that apply. a) The child has symptoms of a cold. b) The child had a previous anaphylactic reaction to the vaccine. c) The mother reports that the child is having intermittent episodes of diarrhea. d) The mother reports that the child has not had an appetite and has been fussy. e) The child has a disorder that caused a severely deficient immune system. f) The mother reports that the child has recently been exposed to an infectious disease.
b, e b) The child had a previous anaphylactic reaction to the vaccine. e) The child has a disorder that caused a severely deficient immune system. The general contraindications for receiving live virus vaccines include a previous anaphylactic reaction to a vaccine or a component of a vaccine. In addition, live virus vaccines generally are not administered to individuals with a severely deficient immune system, individuals with a severe sensitivity to gelatin, or pregnant women. A vaccine is administered with caution to an individual with a moderate or severe acute illness, with or without fever. Options 1, 3, 4, and 6 are not contraindications to receiving a vaccine.
A child is scheduled to receive inactivated poliovirus vaccine (IPV), and the nurse who is preparing to administer the vaccine reviews the child's record. The nurse questions the administration of IPV if which is documented in the child's record? a) Recent recovery from a cold b) A history of frequent respiratory infections c) A history of anaphylactic reaction to neomycin d) A local reaction at the site of injection of a previous IPV
c) A history of anaphylactic reaction to neomycin IPV contains neomycin. A history of anaphylactic reaction to neomycin is considered a contraindication to IPV. The presence of a minor illness such as the common cold is not a contraindication. In addition, a history of frequent respiratory infections is not a contraindication to receiving a vaccine. A local reaction to an immunization is not a contraindication to receiving a vaccine.
The nurse should expect to administer the first dose of the measles, mumps, and rubella (MMR) vaccine at which age? a) 2 years b) 4 years c) 12 months d) 22 months
c) 12 months The first dose of the measles, mumps, and rubella vaccine should be administered at 12 to 15 months of age. A second dose is administered at 4 to 6 years of age.
A child is seen in the health care clinic, and the nurse suspects the presence of pinworm infection (enterobiasis). The nurse instructs the mother as to how to obtain a cellophane tape rectal specimen. Which statement by the mother indicates an understanding of the correct procedure to obtain the specimen? a) "I need to collect the specimen after I give my child a bath." b) "I need to collect the first bowel movement of the day and place it in a sealed container." c) "I need to place a piece of transparent cellophane tape lightly over the anal area as soon as my child awakens and bring it to the clinic for examination." d) "I need to place a piece of transparent cellophane tape lightly over the anal area after my child has a bowel movement and bring it to the clinic for examination."
c) "I need to place a piece of transparent cellophane tape lightly over the anal area as soon as my child awakens and bring it to the clinic for examination." Diagnosis of pinworm is confirmed by direct visualization of the worms. Parents can view the sleeping child's anus with a flashlight. The worm is white, thin, and about ½ to1 inch (1.3 to 2.5 cm) long, and it moves. A simple technique, the cellophane tape slide method, is used to capture worms and eggs. Transparent tape is lightly touched to the anus and then applied to a slide for examination. The best specimens are obtained as the child awakens, before toileting or bathing.
Several children have contracted rubeola (measles) in a local school, and the school nurse conducts a teaching session for the parents of the schoolchildren. Which statement made by a parent indicates a need for further teaching regarding this communicable disease? a) "Small blue-white spots with a red base may appear in the mouth." b) "The rash usually begins on the face and spreads downward toward the feet." c) "The disease can be spread to others from 10 days before any sign of the disease appears to 15 days after the rash appears." d) "Respiratory symptoms such as a profuse runny nose, cough, and fever occur before the development of a rash."
c) "The disease can be spread to others from 10 days before any sign of the disease appears to 15 days after the rash appears." The communicable period for rubeola ranges from 4 days before to 5 days after the rash appears, mainly during the prodromal stage. All other options are accurate descriptions of rubeola, so they would not indicate a need for further teaching. The small blue-white spots found in this communicable disease are called Koplik's spots. The incorrect option describes the incubation period for rubella, not rubeola.
A child is seen in a health care clinic, and a diagnosis of chickenpox is confirmed. The mother expresses concern for two other children at home and asks the nurse if the child is infectious to the other children. Which response by the nurse is most appropriate? a) "The infectious period occurs after the lesions begin." b) "The infectious period begins with the onset of the rash." c) "The infectious period is not known, and it is possible that the children may develop the chickenpox within the next 2 weeks." d) "The infectious period begins 1 to 2 days before the onset of the rash and ends about 5 days after the onset of the lesions and crusting of the lesions."
d) "The infectious period begins 1 to 2 days before the onset of the rash and ends about 5 days after the onset of the lesions and crusting of the lesions." The infectious period of chickenpox is 1 to 2 days before the onset of the rash to about 5 days after the onset of the lesions and the crusting of the lesions. The remaining options are inaccurate statements.
The home health nurse visits a child with infectious mononucleosis and provides home care instructions to the parents. Which instruction should the nurse give to the parents? a) Maintain the child on bed rest for 2 weeks. b) Maintain respiratory precautions for 1 week. c) Notify the health care provider (HCP) if the child develops a fever. d) Notify the HCP if the child develops abdominal pain or left shoulder pain.
d) Notify the HCP if the child develops abdominal pain or left shoulder pain. Infectious mononucleosis is caused by Epstein-Barr virus. The parents need to be instructed to notify the HCP if abdominal pain, especially in the left upper quadrant, or left shoulder pain occurs because this may indicate splenic rupture. Children with enlarged spleens also are instructed to avoid contact sports until splenomegaly resolves. Bed rest is unnecessary, and children usually self-limit their activity. Respiratory precautions are not required, although transmission can occur via direct intimate contact or contact with infected blood. Fever is treated with acetaminophen or ibuprofen per HCP preference.
The clinic nurse prepares to administer a measles, mumps, and rubella (MMR) vaccine to a 5-year-old child. The nurse should administer this vaccine by which method? a) Subcutaneously in the gluteal muscle b) Intramuscularly in the deltoid muscle c) Subcutaneously in the outer aspect of the upper arm d) Intramuscularly in the anterolateral aspect of the thigh
c) Subcutaneously in the outer aspect of the upper arm MMR vaccine is administered subcutaneously in the outer aspect of the upper arm. The gluteal muscle is not recommended for injections. MMR vaccine is not administered by the intramuscular route.
The nurse provides home care instructions to the parents of a child hospitalized with pertussis who is in the convalescent stage and is being prepared for discharge. Which statement by a parent indicates a need for further instruction? a) "We need to encourage our child to drink fluids." b) "Coughing spells may be triggered by dust or smoke." c) "Vomiting may occur when our child has coughing episodes." d) "We need to maintain droplet precautions and a quiet environment for at least 2 weeks."
d) "We need to maintain droplet precautions and a quiet environment for at least 2 weeks." Pertussis is transmitted by direct contact or respiratory droplets from coughing. The communicable period occurs primarily during the catarrhal stage. Respiratory precautions are not required during the convalescent phase. Options 1, 2, and 3 are accurate components of home care instructions.
The nurse is providing anticipatory guidance to the mother of a 10-month-old child. The mother asks how soon her daughter will be able to receive the chickenpox (varicella) vaccine. What is the best nursing response? a) "She will receive it today." b) "She can receive it when she is 12 months old." c) "She can receive it any time before her first birthday." d) "She will receive it before entry into kindergarten, at 4 to 6 years of age."
b) "She can receive it when she is 12 months old." The varicella vaccination is recommended to be administered when the child is between 12 and 18 months of age; therefore, the remaining options are incorrect.
The home care nurse provides instructions regarding basic infection control to the parent of an infant with human immunodeficiency virus (HIV) infection. Which statement, if made by the parent, indicates the need for further instruction? a) "I will clean up any spills from the diaper with diluted alcohol." b) "I will wash baby bottles, nipples, and pacifiers in the dishwasher." c) "I will be sure to prepare foods that are high in calories and high in protein." d) "I will be sure to wash my hands carefully before and after caring for my infant."
a) "I will clean up any spills from the diaper with diluted alcohol." HIV is transmitted through blood, semen, vaginal secretions, and breast milk. The mother of an infant with HIV should be instructed to use a bleach solution for disinfecting contaminated objects or cleaning up spills from the child's diaper. Alcohol would not be effective in destroying the virus. Options 2, 3, and 4 are accurate instructions related to basic infection control.
An infant is brought to the clinic for his third diphtheria-tetanus toxoid-acellular pertussis vaccination (DTaP). The mother reports that the infant developed a 99.4°F (37.4°C) temperature after the last DTaP. Which action is most appropriate? a) Withhold the vaccination. b) Administer the vaccination. c) Draw blood for a pertussis titer. d) Notify the health care provider.
b) Administer the vaccination. The vaccination should be given. Mild fever after the DTaP is not uncommon, and the vaccination would not be withheld for that reason. A vaccination is withheld for true contraindications such as a previous anaphylactic reaction or sensitivity to a product in the vaccination. Drawing blood for determination of a pertussis titer would not be indicated. It is not necessary to notify the health care provider about this side effect.
A child is receiving a series of the hepatitis B vaccine and arrives at the clinic with his parent for the second dose. Before administering the vaccine, the nurse should ask the child and parent about a history of a severe allergy to which substance? a) Eggs b) Penicillin c) Sulfonamides d) A previous dose of hepatitis B vaccine or component
d) A previous dose of hepatitis B vaccine or component A contraindication to receiving the hepatitis B vaccine is a previous anaphylactic reaction to a previous dose of hepatitis B vaccine or to a component (aluminum hydroxide or yeast protein) of the vaccine. An allergy to eggs, penicillin, and sulfonamides is unrelated to the contraindication to receiving this vaccine.
A child with rubeola (measles) is being admitted to the hospital. In preparing for the admission of the child, the nurse should plan to place the child on which precautions? a) Enteric b) Airborne c) Protective d) Neutropenic
b) Airborne Rubeola is transmitted via airborne particles or direct contact with infectious droplets. Airborne droplet precautions are required, and persons in contact with the child should wear masks. The child is placed in a private room if hospitalized, and the hospital room door remains closed. Gowns and gloves are unnecessary, but standard precautions are used. Articles that are contaminated should be bagged and labeled. Special enteric precautions and protective (neutropenic) isolation are not indicated in rubeola.
A child seen in the clinic is found to have rubeola (measles), and the mother asks the nurse how to care for the child. The nurse should tell the mother to implement which action? a) Keep the child in a room with dim lights. b) Give the child warm baths to help prevent itching. c) Allow the child to play outdoors because sunlight will help the rash. d) Take the child's temperature every 4 hours and administer 1 baby aspirin for fever.
a) Keep the child in a room with dim lights. A nursing consideration in rubeola is eye care. The child usually has photophobia, so the nurse should suggest that the parent keep the child out of brightly lit areas. Warm baths and sunlight will aggravate itching. Additionally, the child needs to rest. Children with viral infections are not to be given aspirin because of the risk of Reye's syndrome.
A mother brings her 6-year-old child to the clinic because the child has developed a rash on the trunk and scalp. The mother reports that the child has had a low-grade fever, has not felt like eating, and has been tired. The child is diagnosed with chickenpox. The mother inquires about the communicable period associated with chickenpox, and the nurse bases the response on which statement? a) The communicable period is unknown. b) The communicable period ranges from 2 weeks or less to 4 weeks. c) The communicable period is 10 days before the onset of symptoms to 15 days after the rash appears. d) The communicable period is 1 to 2 days before the onset of the rash to 6 days, when crusts have formed.
d) The communicable period is 1 to 2 days before the onset of the rash to 6 days, when crusts have formed. Chickenpox is transmitted via direct contact, droplet (airborne) spread, and contaminated objects. The communicable period for chickenpox is 1 to 2 days before the onset of the rash to 6 days after the first crop of vesicles, when crusts have formed. In roseola, the communicable period is unknown. A communicable period ranging from 2 weeks or less to 4 weeks describes diphtheria. A communicable period of 10 to 15 days describes rubella.
The nurse is caring for a hospitalized child with a diagnosis of measles (rubeola). In preparing to care for the child, which supplies should the nurse bring to the child's room to prevent transmission of the virus? a) Mask and gloves b) Gown and gloves c) Goggles and gloves d) Gown, gloves, and goggles
a) Mask and gloves Rubeola is transmitted via airborne particles or direct contact with infectious droplets. Respiratory isolation is required, and a mask should be worn by those in contact with the child. Gloves are also worn as necessary to prevent contact with infectious droplets. Gowns and goggles are not specifically indicated for care of the child with rubeola. Any articles that are contaminated should be bagged and labeled.
The nurse is caring for a child with a diagnosis of roseola. The nurse provides instructions to the mother regarding prevention of the transmission to siblings and other household members. Which instruction should the nurse provide? a) Isolate the child from others for 2 weeks because the virus is transmitted by breathing and coughing. b) Wash sheets and towels used by the child separately in bleach to prevent spread of the infection to others. c) Have the child use a separate bathroom for urination and bowel movements to prevent the spread of infection. d) Avoid allowing the children to share drinking glasses or eating utensils because the disease is transmitted through saliva.
d) Avoid allowing the children to share drinking glasses or eating utensils because the disease is transmitted through saliva. Roseola is transmitted via saliva, so others should not share drinking glasses or eating utensils. The remaining options are not accurate instructions regarding the prevention of the transmission of roseola.
A child with acquired immunodeficiency syndrome is hospitalized for the treatment of Pneumocystis jiroveci pneumonia. The child will be receiving nebulizer treatments at home when discharged. The nurse instructs the mother regarding the maintenance of the nebulizer equipment. What should the nurse tell the mother to do? a) Boil the nebulizer pieces for 15 minutes after each treatment. b) Clean the nebulizer pieces with warm water after each treatment and allow to air dry. c) Clean the nebulizer pieces after each treatment with one-fourth strength bleach and water. d) Clean the mouthpiece with alcohol after each use, and soak in alcohol for 30 minutes at the end of each day.
b) Clean the nebulizer pieces with warm water after each treatment and allow to air dry. Nebulizer pieces are cleaned with warm water after each treatment and allowed to air dry. They are soaked in white vinegar and water for 30 minutes at the end of each day. The instructions in the remaining options are inaccurate and would damage the nebulizer equipment.
A child is scheduled to receive immunizations. The child's mother reports to the nurse that the child has been receiving long-term immunosuppressive therapy. The nurse prepares the scheduled immunizations knowing that which vaccine is contraindicated? a) Hepatitis B b) MMR (measles-mumps-rubella) c) Hib (Haemophilus influenzae type b) d) DTaP (diphtheria-tetanus-acellular pertussis)
b) MMR (measles-mumps-rubella) Known altered immunodeficiency from long-term immunosuppressive therapy is a contraindication to MMR immunization because a live vaccine is given. The vaccines identified in the remaining options are not live vaccines and can be administered.
The nursing student is assigned to administer immunizations to children in a clinic. The student should question whether to administer immunizations to a child with which condition? a) A cold b) Otitis media c) Mild diarrhea d) A severe febrile illness
d) A severe febrile illness A severe febrile illness is a reason to delay immunization but only until the child has recovered from the acute stage of the illness. Minor illness, such as a cold, otitis media, or mild diarrhea, is not a contraindication to immunization.
The mother of a 6-year-old child arrives at a clinic because the child has been experiencing itchy, red, and swollen eyes. The nurse notes a discharge from the eyes and sends a culture to the laboratory for analysis. Chlamydial conjunctivitis is diagnosed. On the basis of this diagnosis, the nurse determines that which requires further investigation? a) Possible trauma b) Possible sexual abuse c) Presence of an allergy d) Presence of a respiratory infection
b) Possible sexual abuse Conjunctivitis is an inflammation of the conjunctiva. A diagnosis of chlamydial conjunctivitis in a child who is not sexually active should signal the health care provider to assess the child for possible sexual abuse. Trauma, allergy, and infection can cause conjunctivitis, but the causative organism is not likely to be Chlamydia.
A child hospitalized with pertussis is in the convalescent stage, and the nurse is preparing the child for discharge. The nurse has provided instructions to the parents for home care of the child. Which statement by a parent indicates a need for further teaching? a) "It is important that my child drinks plenty of fluids." b) "A quiet environment helps to prevent episodes of coughing spells." c) "We need to teach the other members of the family how to use good hand washing techniques to prevent the spread of infection." d) "I need to make sure that the child is isolated from the other children for at least 2 weeks to prevent the spread of the virus to them.
d) "I need to make sure that the child is isolated from the other children for at least 2 weeks to prevent the spread of the virus to them." Pertussis is transmitted by direct contact or respiratory droplets from coughing. The infectious period occurs during the catarrhal stage (from the first to second week until the fourth week). Respiratory isolation is not required during the convalescent stage.
A parent brings her 4-month-old infant to a well-baby clinic for immunizations. The child is up to date with the immunization schedule. The nurse should prepare to administer which immunizations to this infant? a) Varicella, hepatitis B vaccine (HepB) b) Diphtheria, tetanus, acellular pertussis (DTaP); measles, mumps, rubella (MMR); inactivated poliovirus vaccine (IPV) c) MMR, Haemophilus influenzae type b (Hib), DTaP d) DTaP, Hib, IPV, pneumococcal vaccine (PCV), rotavirus vaccine (RV)
d) DTaP, Hib, IPV, pneumococcal vaccine (PCV), rotavirus vaccine (RV) DTaP, Hib, IPV, PCV, and RV are administered at 4 months of age. DTaP is administered at 2, 4, and 6 months of age; at 15 to 18 months of age; and at 4 to 6 years of age. Hib is administered at 2, 4, and 6 months of age and at 12 to 15 months of age. IPV is administered at 2, 4, and 6 months of age and at 4 to 6 years of age. PCV is administered at 2, 4, and 6 months of age and at 12 to 15 months of age. The first dose of MMR vaccine is administered at 12 to 15 months of age; the second dose is administered at 4 to 6 years of age (if the second dose was not given by 4 to 6 years of age, it should be given at the next visit). The first dose of HepB is administered at birth, the second dose is administered at 1 month of age, and the third dose is administered at 6 months of age. Varicella-zoster vaccine is administered at 12 to 15 months of age and again at 4 to 6 years of age.
The mother of a preschooler who attends day care calls a clinic nurse and tells the nurse that the child is constantly scratching the perianal area and that the area is irritated. The nurse suspects the possibility of pinworm infection (enterobiasis) and instructs the mother to obtain a rectal specimen by a tape test. At what time should the nurse tell the mother to obtain the specimen? a) After bathing b) After toileting c) When the child is put to bed d) In the morning, when the child awakens
d) In the morning, when the child awakens Diagnosis of pinworm infection is confirmed by direct visualization of the worms. Parents can view the sleeping child's anus with a flashlight. The worm is white, thin, about ½ to 1 inch (1.3 to 2.5 cm) long, and moves. A simple technique, the tape test, is used to capture worms and eggs. Transparent tape is lightly touched to the anus and then applied to a slide for microscopic examination. The best specimens are obtained as the child awakens, before toileting or bathing.
