PEDS immunizations, lead poisoning

An infant age 4 months comes to the clinic for a well-infant check-up. 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 include which of the following? 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.

ANS: 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.

The single parent of a child who has just been diagnosed with chickenpox tells the nurse that she cannot afford to stay home with the child and miss work. The parent asks the nurse if some medication will shorten the course of the illness. Which of the following is the most appropriate nursing intervention? a. Describe the role of varicella-zoster immune globulin to treat chickenpox. b. Discuss the risks and benefits of acyclovir to treat chickenpox. c. Explain that no medication will shorten the course of the illness. d. Reassure the parent that it is not necessary to stay home with the child.

ANS: B Acyclovir is effective in reducing the number of lesions; shortening the duration of fever; and decreasing itching, lethargy, and anorexia. Varicella-zoster immune globulin is given only to high-risk children. Acyclovir lessens the severity of chickenpox. It is important for the parent to stay with the child to monitor fever.

A significant secondary prevention nursing activity for lead poisoning is: a. chelation therapy. b. screening children for blood lead levels. c. removing lead-based paint from older homes. d. questioning parents about ethnic remedies containing lead.

ANS: B Screening children for lead poisoning is an important secondary prevention activity. Screening does not prevent the initial exposure of the child to lead. It can lead to identification and treatment of children who are exposed. Chelation therapy is treatment, not prevention. Removing lead-based paints from older homes before children are affected is primary prevention. Questioning parents about ethnic remedies containing lead is part of the assessment to determine the potential source of lead.

Pertussis vaccination should begin at which age? a. Birth b. 2 months c. 6 months d. 12 months

ANS: 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. The infant is highly susceptible to pertussis, which can be a life-threatening illness in this age-group.

Which muscle is contraindicated for the administration of immunizations in infants and young children? a. Deltoid b. Dorsogluteal c. Ventrogluteal d. Anterolateral thigh

ANS: B The dorsogluteal site is avoided in children because of the location of nerves and veins. The deltoid is recommended for 12 months and older. Ventrogluteal and anterolateral thigh sites can safely be used for the administration of vaccines to infants.

The nurse is concerned with the prevention of communicable disease. Primary prevention results from which of the following? a. Hand washing b. Strict isolation c. Immunizations d. Early diagnosis

ANS: C Primary prevention rests almost exclusively with immunizations. Hand washing and isolation are control measures to prevent the spread of disease. Early diagnosis assists in instituting appropriate therapy when available and in preventing spread to others.

Which of the following is an important nursing consideration when a child is hospitalized for chelation therapy to treat lead poisoning? a. Maintain bed rest. b. Maintain isolation precautions. c. Keep accurate record of intake and output. d. Institute measures to prevent skeletal fracture.

ANS: C The iron chelates are excreted though the kidneys. Adequate hydration is essential. Periodic measurement of renal function is done. Bed rest is not necessary. Often the chelation therapy is done on an outpatient basis. The chelation therapy is not infectious or dangerous. Isolation is not indicated. Skeletal weakness does not result from high levels lead.

Acyclovir (Zovirax) is given to children with chickenpox to: a. minimize scarring. b. prevent aplastic anemia. c. prevent spread of the disease. d. decrease the number of lesions.

ANS: D Acyclovir decreases the number of lesions; shortens duration of fever; and decreases itching, lethargy, and anorexia. Treating pruritus and discouraging itching minimizes scarring. Aplastic anemia is not a complication of chickenpox. Strict isolation until vesicles are dried prevents spread of disease.

The school nurse sees a 14-year-old child who presents with fatigue and a nagging cough of three weeks' duration that has become productive with thick mucus and is much worse at night. The school nurse suspects pertussis (whooping cough), because vaccine protection wanes in 5-10 years. What is the school nurse's first nursing action? A) Isolate the child and contact the parents. B) Report the case to the Centers for Disease Control and Prevention (CDC). C) Encourage fluids to prevent dehydration. D) Provide emotional support to parents.

Answer: A Isolation is necessary to prevent the disease from spreading to classmates by aerosolized droplet infection. The case is not reportable until a positive culture is returned. The remaining interventions are important, but are not the first nursing action, because the entire school population might be at risk.

Which of the following situations increase risk of lead poisoning in children? a. playing in the park with heavy traffic and with many vehicles passing by b. playing sand in the park c. playing plastic balls with other children d. playing with stuffed toys at home

Answer: A Lead poisoning may be caused by inhalation of dusk and smoke from leaded gas. It may also be caused by lead-based paint, soil, water (especially from plumbings of old houses).

A mother of a 3-year-old hospitalized with lead poisoning asks the nurse to explain the treatment for her daughter. The nurse's explanation is based on the knowledge that lead poisoning is treated with: A. Gastric lavage B. Chelating agents C. Antiemetics D. Activated charcoal

Answer: B Chelating agents are used to treat the client with poisonings from heavy metals such as lead and iron. Answers A and D are used to remove noncorrosive poisons; therefore, they are incorrect. Answer C prevents vomiting; therefore, it is an incorrect response.

Which of the following nursing interventions should be implemented for a client with influenza? a) instructing family members not to visit the client until the fever declines b) instructing family members or visitors to wear surgical mask before entering the client's room c) instructing family members that there are no special precautions needed when caring for the client d) instructing family members to wear gown and gloves before entering the client's room

Answer: B Influenza requires droplet precaution. Healthcare workers and family members should wear surgical mask when entering client's room to ensure prevention of contamination.

The nurse concludes that a parent of an otherwise healthy child with varicella (chickenpox) has an accurate understanding of the disease when the parent states which of the following? A) "I will take my child to our primary care provider to request acyclovir." B) "I will send my child back to school when all the lesions are dry and crusted over." C) "I will give my child acetaminophen 120 mg three times a day for the duration of the illness." D) "I will take my child to our primary care provider to request antibiotics."

Answer: B Varicella is no longer contagious when all the lesions are dry. Acetaminophen should be used when the child has a fever, not three times per day, every day, during the illness. Antibiotics are not effective against viruses. Acyclovir is an antiviral, but it is recommended for immunocompromised children, not healthy children and adolescents.