Peds Exam 2: Infectious Disease

A child seen in the clinic is found to have rubeola (measles) and the mother asks the nurse how to care for the child. Which instruction should the nurse provide to the mother? 1.Keep the child in a room with dim lights. 2.Give the child warm baths to help prevent itching. 3.Allow the child to play outdoors because sunlight will help the rash. 4.Take the child's temperature every 4 hours and administer 1 baby aspirin for fever.

1.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. Children with viral infections are not to be given aspirin because of the risk of Reye's syndrome. Warm baths and the sun will aggravate itching. In addition, the child needs to rest

The nurse is caring for a 4-month-old infant with respiratory syncytial virus (RSV). Several clients are being admitted to the unit and assignments are being made. The nurse should question being assigned which newly admitted clients? Select all that apply. 1.The 6-month old with bronchopulmonary dysplasia 2.The 11-month-old client with diarrhea 3.The 16-year-old client taking antibiotics 4.The 1-year-old client taking corticosteroids 5.The 15-year-old with bone marrow suppression

1.The 6-month old with bronchopulmonary dysplasia 4.The 1-year-old client taking corticosteroids Clients with respiratory syncytial virus (RSV) should not be cared for by nurses who are also assigned to clients at high risk for RSV infection. RSV is most dangerous in children between 2 and 7 months of age. Older children and adults do not become as seriously ill. Therefore, the nurse should question being assigned the 6-month-old with bronchopulmonary dysplasia who is more susceptible to serious problems with respiratory infection because the client is between 2 and 7 months of age and already has serious respiratory issues. The 1-year-old taking corticosteroids may have a decreased immune system and be more at risk for serious problems associated with RSV infection; thus, the nurse should question this assignment also. Although the 15-year-old client with bone marrow suppression is at a greater risk for infection and ideally would not be assigned to the nurse taking care of a client with RSV, because of the anatomy of the client's lungs, an infection with RSV would not be as detrimental to this client as it would to an infant with immunosuppression. The 11-month-old with diarrhea and the 16-year-old taking antibiotics are not at as high of a risk of adverse effects to RSV infection.

A nursing student is asked to discuss human immunodeficiency virus (HIV) during a clinical conference. The nursing student should include which correct item in the discussion? 1.HIV primarily attacks the hematological system. 2.HIV virus attacks the immune system by destroying T lymphocytes. 3.Most newborns of HIV-positive women test positive for HIV virus. 4.In HIV, the B cells are depleted and cannot signal T4 cells to form protective antibodies.

2.HIV virus attacks the immune system by destroying T lymphocytes. The virus attacks the immune system by destroying T lymphocytes. Children born to HIV-positive women test positive for HIV antibody, not HIV virus. This is actually a measure of maternal antibody and not indicative of true infection. T4 cells are depleted in number and cannot signal B cells to form protective antibodies to fight off the invading virus.

A child with rubeola (measles) is being admitted to the hospital. When preparing for the admission of the child, which precautions should be implemented? Select all that apply. 1.Enteric 2.Contact 3.Airborne 4.Protective 5.Neutropenic

2.Contact 3.Airborne Rubeola is transmitted via airborne particles or direct contact with infectious droplets. Airborne precautions and contact precautions are required; a mask and gloves are worn by those who come in contact with the child. Gowns and gloves are not indicated. Articles that are contaminated should be bagged and labeled. Options 1, 4, and 5 are not indicated for rubeola

Several children have contracted measles (rubeola) in a local school, and the nurse provides information to the mothers of the children about this communicable disease. Which statement by a mother indicates a need for further teaching? 1."The disease is caused by a virus." 2."We will watch for the complication of otitis media." 3."The symptoms increase in severity after the rash appears." 4."Small, irregular red spots with a minute, bluish white center are seen on buccal mucosa before the rash appears."

3."The symptoms increase in severity after the rash appears." Symptoms gradually increase in severity until second day after rash appears, when they begin to subside. Options 1, 2, and 4 are accurate descriptions of rubeola. Option 3 is not true for the rubeola disease.

An infant is suspected to be human immunodeficiency virus (HIV) positive, and the nurse provides information to the parents about the care of their infant. Which indicates to the nurse that the parents need further teaching about the care of their HIV-positive infant? 1.The parents ask about a prescription for an antiretroviral medication. 2.The parents are able to verbalize signs and symptoms of failure to thrive. 3.The parents plan to use rice cereal to help with watery stools when they occur. 4.The parents state they will not allow anyone with a cold to hold and kiss the baby.

3.The parents plan to use rice cereal to help with watery stools when they occur. If an infant is having diarrhea, the parents need to seek medical attention because this could be the beginning of an opportunistic infection. Self-treatment is not encouraged. Asking for antiretroviral therapy, understanding signs and symptoms of failure to thrive, and being protective of an immunocompromised infant are evidence of understanding the needs of the infant.

The nurse is reviewing instructions to a parent of a 6-year-old on how to prevent influenza. Which statement by the parent indicates a need for further teaching? 1."I will get a flu shot and I will have my child get a flu shot too." 2."I will avoid having my child come into contact with sick children." 3."I will have my child wash her hands frequently during the flu season." 4."I will not let my child play with other children who have the flu unless they are taking acetaminophen.

4."I will not let my child play with other children who have the flu unless they are taking acetaminophen. Children who have influenza should be kept home and away from other children until they are fever-free without the use of antipyretics. Influenza may be prevented with the annual vaccine, by avoiding other children who are sick, and with frequent hand washing

Several children have contracted rubeola (measles) in a local school, and the school nurse conducts a teaching session for the parents of the school children. Which statement, if made by a parent, indicates a need for further teaching regarding this communicable disease? 1."Small blue-white spots with a red base may appear in the mouth." 2."The rash usually begins centrally and spreads downward to the limbs." 3."Respiratory symptoms such as a very runny nose, cough, and fever occur before the development of a rash." 4."The communicable period ranges from 10 days before the onset of symptoms to 15 days after the rash appears."

4."The communicable period ranges from 10 days before the onset of symptoms 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 (catarrhal) stage. Options 1, 2, and 3 are accurate descriptions of rubeola. The small blue-white spots found in this communicable disease are called Koplik spots. Option 3 describes the incubation period for rubella, not rubeola.

Which is an important nursing consideration when caring for a child with herpetic gingivostomatitis (HGS)? a. Apply topical anesthetics before eating. b. Drink from a cup, not a straw. c. Wait to brush teeth until lesions are sufficiently healed. d. Explain to parents how this is sexually transmitted.

ANS: A Treatment for HGS is aimed at relief of pain. Drinking bland fluids through a straw helps avoid painful lesions. Mouth care is encouraged with a soft toothbrush. HGS is usually caused by herpes simplex virus type 1, which is not associated with sexual transmission.

A nurse is interpreting the results of a tuberculin skin test (TST) on an adolescent who is HIV positive. Which induration size indicates a positive result for this child 48 to 72 hours after the test? a. 5 mm³ b. 10 mm³ c. 15 mm³ d. 20 mm³

A

An infant with a congenital heart defect is receiving palivizumab (Synagis). Based on the nurse's knowledge of medication, the purpose of this medication is to A. prevent respiratory syncytial virus (RSV) infection. B. make isolation of the infant with RSV unnecessary. C. prevent secondary bacterial infection. D .decrease toxicity of antiviral agents.

A. Prevent respiratory syncytial virus (RSV) infection. Palivizumab is a monoclonal antibody specifically used in the prevention of RSV. Monthly administration is expected to prevent infection with RSV. The goal of this drug is prevention of RSV. It will not affect the need to isolate the child if RSV develops. Palivizumab is specific to RSV, not bacterial infections. Palivizumab will have no effect on antiviral agents.

The most important prevention method for the spread of any communicable disease is A. hand washing. B. immunizations as secondary prevention. C. use of appropriate broad spectrum antibiotics. D. isolation from infectious agents.

A. hand washing. Hand washing is the single most important prevention method for the spread of any communicable disease. Immunizations are considered to be a form of primary prevention. Use of appropriate broad spectrum antibiotics are not considered effective against all communicable diseases. Isolation from infectious agents may not be a realistic option.

The nurse is concerned with the prevention of communicable disease. Primary prevention results from A. immunizations. B. early diagnosis. C. strict isolation. D. treatment of disease.

A. immunizations. Communicable diseases are prevented through immunizations, which constitute 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.

The nurse is planning care for an adolescent with AIDS. Which is the priority nursing goal? a. Preventing infection b. Preventing secondary cancers c. Restoring immunologic defenses d. Identifying source of infection

ANS: A Because the child is immunocompromised in association with HIV infection, the prevention of infection is paramount. Although certain precautions are justified in limiting exposure to infection, these must be balanced with the concern for the child's normal developmental needs. Preventing secondary cancers is not currently possible. Current drug therapy is affecting the disease progression; although not a cure, these drugs can suppress viral replication, preventing further deterioration. Case finding is not a priority nursing goal.

A nurse is interpreting the results of a tuberculin skin test (TST) on an adolescent who is HIV positive. Which induration size indicates a positive result for this child 48 to 72 hours after the test? a. 5 mm b. 10 mm c. 15 mm d. 20 mm

ANS: A Clinical evidence of a positive TST in children receiving immunosuppressive therapy, including immunosuppressive doses of steroids or who have immunosuppressive conditions, including HIV infection is an induration of 5 mm. Children younger than 4 years of age: (a) with other medical risk conditions, including Hodgkin disease, lymphoma, diabetes mellitus, chronic renal failure, or malnutrition; (b) born or whose parents were born in high-prevalence (TB) regions of the world; (c)frequently exposed to adults who are HIV infected, homeless, users of illicit drugs, residents of nursing homes, incarcerated or institutionalized, or migrant farm workers; and (d) who travel to high-prevalence(TB) regions of the world are positive when the induration is 10 mm. Children 4 years of age or older without any risk factors are positive when the induration is 20 mm.

The nurse is conducting a staff in-service on appearance of childhood skin conditions.Lymphangitis ("streaking") is frequently seen in which condition? a. Cellulitis b. Folliculitis c. Impetigo contagiosa d. Staphylococcal scalded skin

ANS: A Lymphangitis is frequently seen in cellulitis. If it is present, hospitalization is usually required for parenteral antibiotics. Lymphangitis is not associated with folliculitis, impetigo, or staphylococcal scalded skin.

The school nurse is informed that a child with human immunodeficiency virus (HIV) will be attending school soon. Which is an important nursing intervention? a. Carefully follow universal precautions. b. Determine how the child became infected. c. Inform the parents of the other children. d. Reassure other children that they will not become infected.

ANS: A Universal precautions are necessary to prevent further transmission of the disease. It is not the role of the nurse to determine how the child became infected. Informing the parents of other children and reassuring children that they will not become infected is a violation of the child's right to privacy.

A young child with human immunodeficiency virus (HIV) is receiving several antiretroviral drugs. What is the purpose of these drugs? a. Cure the disease b. Delay disease progression c. Prevent spread of disease d. Treat Pneumocystis carinii pneumonia

ANS: B Although not a cure, these antiviral drugs can suppress viral replication, preventing further deterioration of the immune system and delaying disease progression. At this time, cure is not possible. These drugs do not prevent the spread of the disease. P. carinii prophylaxis is accomplished with antibiotics.

The nurse is teaching nursing students about normal physiologic changes in the respiratory system of toddlers. Which best describes why toddlers have fewer respiratory tract infections as they grow older? a. The amount of lymphoid tissue decreases. b. Repeated exposure to organisms causes increased immunity. c. Viral organisms are less prevalent in the population. d. Secondary infections rarely occur after viral illnesses.

ANS: B Children have increased immunity after exposure to a virus. The amount of lymphoid tissue increases as children grow older. Viral organisms are not less prevalent, but older children have the ability to resist invading organisms. Secondary infections after viral illnesses include Mycoplasma pneumoniae and group A b-hemolytic streptococcal infections.

Which consideration is the most important in managing tuberculosis (TB) in children? a. Skin testing annually b. Pharmacotherapy c. Adequate nutrition d. Adequate hydration

ANS: B Drug therapy for TB includes isoniazid, rifampin, and pyrazinamide daily for 2 months and two or three times a week for the remaining 4 months. Pharmacotherapy is the most important intervention for TB.

Which term best describes the identification of the distribution and causes of disease, injury, or illness? a. Nursing process b. Epidemiologic process c. Community-based statistics d. Mortality and morbidity statistics

ANS: B Epidemiology is the science of population health applied to the detection of morbidity and mortality in a population. It identifies the distribution and causes of diseases across a population. Nursing process is a systematic problem-solving approach for the delivery of nursing care. Morbidity and mortality statistics, along with natal rates, may provide an objective picture of a community's health status.

Nursing strategies to improve the growth and development of the child with human immunodeficiency virus (HIV) infection should include what? a. Provide only those foods that the child feels like eating. b. Fortify foods with nutritional supplements to maximize quality of intake. c. Weigh the child and measure height and muscle mass on a daily basis. d. Provide high-fat and high-calorie meals and snacks to meet body requirements for growth.

ANS: B HIV infection often leads to marked failure to thrive and multiple nutritional deficiencies. Nutritional management may be difficult because of recurrent illness, diarrhea, and other physical problems. The nurse should implement intensive nutritional interventions if the childs growth begins to slow or weight begins to decrease. Fortifying foods with nutritional supplements will maximize quality of intake. The child does not need to be weighed daily, and high-fat meals and snacks should not be encouraged.

A nurse is assessing a child and notes Koplik spots. In which of these communicable diseases are Koplik spots present? a. Rubella b. Measles (rubeola) c. Chickenpox (varicella) d. Exanthema subitum (roseola)

ANS: B Koplik spots are small irregular red spots with a minute, bluish white center found on the buccal mucosa 2 days before systemic rash. Rubella occurs with rash on the face, which rapidly spreads downward.Varicella appears with highly pruritic macules, followed by papules and vesicles. Roseola is seen with rose-pink macules on the trunk, spreading to face and extremities.

What is most important in the management of cellulitis? a. Burow solution compresses b. Oral or parenteral antibiotics c. Topical application of an antibiotic d. Incision and drainage of severe lesions

ANS: B Oral or parenteral antibiotics are indicated depending on the extent of the cellulitis. Warm water compresses may be indicated for limited cellulitis. The antibiotic needs to be administered systemically. Incision and drainage of severe lesions presents a risk of spreading infection or making the lesion worse.

Which immunization should be given with caution to children infected with human immunodeficiency virus (HIV)? a. Influenza b. Varicella c. Pneumococcal d. Inactivated poliovirus (IPV)

ANS: B The children should be carefully evaluated before being given live viral vaccines such as varicella, measles, mumps, and rubella. The child must be immunocompetent and not have contact with other severely immunocompromised individuals. Influenza, pneumococcal, and inactivated poliovirus (IPV) are not live vaccines.

Treatment for herpes simplex virus (type 1 or 2) includes which? a. Corticosteroids b. Oral griseofulvin c. Oral antiviral agent d. Topical or systemic antibiotic

ANS: C Oral antiviral agents are effective for viral infections such as herpes simplex. Corticosteroids, antibiotics, and griseofulvin (an antifungal agent) are not effective for viral infections

Which is caused by a virus that primarily infects a specific subset of T lymphocytes,the CD4+T cells? a. Wiskott-Aldrich syndrome b. Idiopathic thrombocytopenic purpura c. Acquired immunodeficiency syndrome (AIDS) d. Severe combined immunodeficiency disease

ANS: C AIDS is caused by the human immunodeficiency virus (HIV), which primarily attacks the CD4+T cells. Wiskott-Aldrich syndrome, idiopathic thrombocytopenic purpura, and severe combined immunodeficiency disease are not viral illnesses.

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

ANS: 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.

Which frequency is recommended for childhood skin testing for tuberculosis (TB) using the Mantoux test? a. Every year for all children older than 2 years b. Every year for all children older than 10 years c. Every 2 years for all children starting at age 1 year d. Periodically for children who reside in high-prevalence regions

ANS: D Children who reside in high-prevalence regions for TB should be tested every 2 to 3 years. Annual testing is not necessary. Testing is not necessary unless exposure is likely or an underlying medical risk factor is present.

A nurse has completed a teaching session for adolescents regarding lymphoid tissue growth. Which statement, by the adolescents, indicates understanding of the teaching? a. The tissue reaches adult size by age 1 year. b. The tissue quits growing by 6 years of age. c. The tissue is poorly developed at birth. d. The tissue is twice the adult size by ages 10 to 12 years.

ANS: D Lymphoid tissue continues growing until it reaches maximal development at ages 10 to 12 years, which is twice its adult size. A rapid decline in size occurs until it reaches adult size by the end of adolescence. The tissue reaches adult size at 6 years of age but continues to grow. The tissue is well developed at birth.

The majority of children in the United States with human immunodeficiency virus (HIV) infection acquired the disease by which means? a. Through sexual contact b. From a blood transfusion c. By using intravenous (IV) drugs d. Perinatally from their mothers

ANS: D More than 90% of the children with HIV under 13 years who were reported to the Centers for Disease Control and Prevention acquired the infection during the perinatal period. With intervention, the number of children infected can be decreased. Sexual contact and IV drug use are the leading causes of infection in the 14- to 19-year age group. This number is less than the number of cases in the under 13-year age group. Transfusion has accounted for 3% to 6% of all pediatric acquired immunodeficiency syndrome cases to date. Before 1985 and routine screening of donated blood products, children with hemophilia were at great risk from pooled plasma products

The nurse is teaching a nursing student about standard precautions. Which statement made by the student indicates a need for further teaching? a. "I will use precautions when I give an infant oral care." b. "I will use precautions when I change an infant's diaper." c. "I will use precautions when I come in contact with blood and body fluids." d. "I will use precautions when administering oral medications to a school-age child."

ANS: D Standard precautions involve the use of barrier protection (personal protective equipment [PPE]), such as gloves, goggles, a gown, or a mask, to prevent contamination from (1) blood; (2) all body fluids, secretions, and excretions except sweat, regardless of whether they contain visible blood; (3) nonintact skin; and (4) mucous membranes. Precautions should be taken when giving oral care, when changing diapers, and when coming in contact with blood and body fluids. Further teaching is needed if the student indicates the need to use precautions when administering an oral medication to a school-age child.

What is cellulitis often caused by? a. Herpes zoster b. Candida albicans c. Human papillomavirus d. Streptococcus or Staphylococcus organisms

ANS: D Streptococci, staphylococci, and Haemophilus influenzae are the organisms usually responsible for cellulitis. Herpes zoster is the virus associated with varicella and shingles. C. albicans is associated with candidiasis, or thrush. Human papillomavirus is associated with various types of human warts.

The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which intervention should be included in the child's care? (Select all that apply.) a. Place in a mist tent. b. Administer antibiotics. c. Administer cough syrup. d. Encourage the child to drink 8 ounces of formula every 4 hours. e. Cluster care to encourage adequate rest. f. Place on noninvasive oxygen monitoring.

ANS: D, E, F Hydration is important in children with RSV bronchiolitis to loosen secretions and prevent shock. Clustering of care promotes periods of rest. The use of noninvasive oxygen monitoring is recommended.Mist tents are no longer used. Antibiotics do not treat illnesses with viral causes. Cough syrup suppresses clearing of respiratory secretions and is not indicated for young children.

What is described as the time interval between early manifestations of a disease and the overt clinical syndrome? A. Incubation period B. Prodromal period C. Desquamation period D. Period of communicability

B. Prodromal period The prodromal period is defined as the symptoms that occur between early manifestations of the disease and overt clinical symptoms. The incubation period is the time from exposure to the appearance of the first symptom. The desquamation period refers to the shedding of skin when applicable for a syndrome or disorder. The period of communicability describes the period when the child is infectious.

Which method should the student nurse use to apply the principles of cough etiquette in the clinical setting to prevent the potential spread of infection? A. Wearing a surgical mask for all patient contacts even if the student nurse has not overt clinical symptoms of having a cold. B. Maintaining a perimeter of 10 feet from patient and visitors when coughing. C. Using tissues when coughing to catch secretions. D. Covering the nose when coughing.

C. Using tissues when coughing to catch secretions. Using a tissue when coughing to catch secretions is recommended. One does not have to wear a surgical mask if they do not have any cold type symptoms in the clinical environment unless the patient is neutropenic. Maintaining a space of 3 feet or more is recommended whereas 10 feet would be excessive. Covering one's mouth is recommended when coughing whereas the nose should be covered during sneezing.

Lymphoid tissues such as lymph nodes are: a. Adult size by age 1 year. b. Adult size by age 13 years. c. Half their adult size by age 5 years. d. Twice their adult size by age 10 to 12 years.

D (Lymph nodes increase rapidly and reach adult size at approximately age 6 years. They continue growing until they reach maximal development at age 10 to 12 years, which is twice their adult size. A rapid decline in size occurs until they reach adult size by the end of adolescence.)

The nurse is assessing a child with herpetic gingivostomatitis. The nurse wears gloves when examining the lesions. This nursing action is A. unnecessary because the virus is sexually transmitted. B. unnecessary because the virus is not easily spread. C. necessary only if the nurse touches his or her own mouth after touching the child's mouth. D. necessary because virus can easily enter breaks in the skin.

D. necessary because virus can easily enter breaks in the skin. HSV easily enters breaks in the skin and can cause herpetic whitlow on the fingers. Herpetic gingivostomatitis is usually caused by herpes simplex virus (HSV) HSV 2 is usually transmitted through sexual activity. Gloves are always necessary because the virus is easily spread.