RICCI Peds Review Exam 2 - Chapter 37 + 47

Match the vector-borne illness with the means of infection - Rickettsialpox

MOUSE MITE BITE

Place the stage of an infectious disease in the proper order 1. Convalescence 2. Illness 3. Incubation 4. Prodromal

3 - 4 - 2 - 1

A ____ rash is often an early sign of a graft-versus-host disease that is developing in response to a bone marrow or stem cell transplant.

MACULOPAPULAR

Primary immune deficiencies such as SCID and Wiskott-Aldrich syndrome are cured only by ____ or stem cell transplantation.

BONE MARROW

The malar rash of SLE resembles the shape of a ____

BUTTERFLY

____ is the movement of white blood cells to an inflames or infected area of the body in response to chemicals released by neutrophils, monocytes, and the suffering tissue.

CHEMOTAXIS

Match the vector-borne illness with the means of infection - Scabies

CLOSE PROLONGED CONTACT

Explain the postexposure prophylaxis after an animal bite

CONCURRENT USE OF PASSIVE AND ACTIVE USE OF IMMUNOPROPHYLAXIS IS RECOMMENDED. REGIMEN OF IMMUNE GLOBULIN AND FIVE DOSES OF RABIES VACCINE SHOULD BE GIVEN OVER A 28 DAY PERIOD (DAY 1, 3, 7, 14, 28). THE FIRST DOSE OF RABIES VACCINE SHOULD BE GIVEN AS SOON AS POSSIBLE. RABIES IMMUNE GLOBULIN IS INFLITRATED INTO AND AROUND THE WOUND WITH ANY REMAINING VOLUME ADMINISTERED IM AT A SITE DISTANT TO THE RABIES INOCULATION. THE HUMAN RABIES VACCINE IS ADMINISTERED IM INTO THE ANTEROLATERAL THIGH OR DELTOID DEPENDING ON THE AGE AND SIZE OF THE CHILD.

Match the medication with the appropriate indication - NSAIDS

JUVENILE IDIOPATHIC ARTHRITIS (JIA)

Why are skin test responses (PPD for TB detection) diminished until about 1 year of age?

DELAYED HYPERSENSITIVITY REACTIONS ARE MEDIATED BY T-CELLS RATHER THAN ANTIBODIES. AN INFANT'S SKIN TREST RESPONSE IS DIMINISHED MOST LIKELY DUE TO THE INFANT'S DECREASED ABILITY TO PRODUCE AN INFLAMMATORY RESPONSE.

Explain the role of fever in a child with an infection.

FEVER IS A PROTECTIVE MECHANISM THE BODY USES TO FIGHT INFECTION. ELEVATED TEMPERATURE ENHANCES VARIOUS COMPONENTS OF IMMUNE RESPONSE. FEVER CAN SLOW THE GROWTH OF BACTERIA AND VIRUSES AND CAN INCREASE NEUTROPHIL PRODUCTION AND T-CELL PROLIFERATION. STUDIES SHOW THAT ANTI-PYRETICS MAY PROLONG ILLNESS. ANOTHER CONCERN IS THAT REDUCING FEVER MAY MASK SIGNS OF SERIOUS BACTERIAL ILLNESS.

Match the medication with the appropriate indication - Protease inhibitors

HIV, PART OF 3-DRUG REGIMEN

Acetaminophen and ____ administered at the appropriate dose and interval, are safe and effective for reducing fever in children.

IBUPROFEN

Match the vector-borne illness with the means of infection - Roundworm

INGESTED FECAL MATTER

Fever can increase the production of ____ and slow the growth of bacteria and viruses.

NEUTROPHILS

HIV infects the CD4 cells, also known as the ____ cells.

T-HELPER

What is the complement in relation to the immune system?

THE COMPLEMENT SYSTEM IS A SERIES OF BLOOD PROTEINS WHOSE ACTION IS TO AUGMENT THE WORK OF ANTIBODIES BY ASSISTING WITH DESTRUCTION OF BACTERIA, PRODUCTION OF INFLAMMATION, AND REGULATION OF IMMUNE REACTIONS.

Match the vector-borne illness with the means of infection - Pediculosis pubis

RAT FLEA FECES

B cells use ____ to attack specific foreign substances.

ANTIBODIES

For most children only allergies to fish, shellfish, tree nuts, and ____ persist into adulthood.

PEANUTS

Monocytes use ____ as a means to eliminate pathogens.

PHAGOCYTOSIS

The trigger of prostaglandins to increase the body's temperature set point is caused by ____

PYROGENS

Match the medication with the appropriate indication - Cyclosporine A

ANTIREJECTION IN RENAL TRANSPLANTS

Place the following anaphylaxis treatment priorities in the proper sequencing 1. Administration of corticosteroids. 2. Injection of intramuscular epinephrine. 3. Administration of intravenous diphenhydramine 4. Assessment of airway and support of the airway, breathing, and circulation

4 - 2 - 3 - 1

What is avascular necrosis and what group of patients are at an increased risk of developing this complication?

AVASCULAR NECROSIS IS AN ADVERSE EFFECT OF LONG-TERM USE OT HIGH DOSES OF CORTICOSTERIODS, CAUSING TISSUE DAMAGE TO A JOINT DUE TO LACK OF BLOOD SUPPLY TO THE JOINT. A CHILD RECEIVING LONG-TERM OR HIGH-DOSE CORTICOSTEROIDS AS TREATMENT (THINK SLE) IS AT INCREASED RISK.

In systemic lupus erythematosus (SLE), autoantibodies react with the child's ____ to form immune complexes.

SELF-ANTIGENS

Explain sepsis, what is septic shock?

SEPSIS IS A RESPONSE TO INFECTION RESULTING FROM BACTERIA (MOST COMMON), FUNGI, VIRUSES, PARASITES. CAN LEAD TO SEPTIC SHOCK, WHICH RESULTS IN HYPOTENSION, LOW BLOOD FLOW, AND MULTISYSTEM ORGAN FAILURE (MSOF). SEPTIC SHOCK IS A MEDICAL EMERGENCY AND PATIENTS ARE USUALLY ADMITTED TO AN ICU.

Match the medication with the appropriate indication - Methotrexate

SEVERE POLYARTICULAR JUVENILE IDIOPATHIC ARTHRITIS (JIA)

Match the medication with the appropriate indication - Cyclophosphamide

SEVERE SLE

Which laboratory test for HIV requires serial testing? Why?

THE ELISA METHO DETECTS ONLY ANTIBODIES SO RESULT MAY REMAIN NEGATIVE FOR SEVERAL WEEKS UP TO 6 MONTHS (FALSE NEGATIVE). A FALSE POSITIVE RESULT MAY OCCUR WITH AUTOIMMUNE DISEASE.

Discuss what is meant by the statement "Children acquire HIV infection either vertically or horizontally."

VERTICALLY IS STERILE, MEANS THE DISEASE WAS TRANSMITTED PERINATALLY, EITHER IN UTERO, OR THROUGH BREAST MILK. TRANSMITTION HORIZONTALLY IS NONSTERILE, VIA HIV CONTAMINATED NEEDLES, SEXUAL CONTACT, OR MUCH LESS COMMON, BLOOD PRODUCT TRANSMISSION

A nurse is providing dietary interventions for a 12-year old girl with a shellfish allergy. Which response indicates a need for further teaching? a. "He will likely outgrow this" b. "He must avoid lobster and shrimp" c. "We must order carefully when dining out" d. "Wheezing is a sign of a severe reaction"

a. "He will likely outgrow this"

A young girl has been diagnosed with juvenile idiopathic arthritis (JIA) and has been prescribed methotrexate. Which statements by the child's parents indicate that adequate learning has occurred? SELECT ALL THAT APPLY a. "We'll need to bring her back in for some laboratory tests after she starts methotrexate" b. "She can take methotrexate with yogurt or chocolate milk" c. "She may start feeling better by next week" d. "Swimming sounds like a good exercise for her" e. "A warm bath before bed might help her sleep better"

a. "We'll need to bring her back in for some laboratory tests after she starts methotrexate" d. "Swimming sounds like a good exercise for her" e. "A warm bath before bed might help her sleep better"

Which child needs to be seen immediately in the physician's office? a. 10-month old with a fever and petechiae who is grunting b. 2-month old with a slight fever and irritability after getting immunizations the previous day c. 4-month old with a cough, elevated temperature, and wetting 8 diapers every 24 hours d. 8 -month old who is restless, irritable, and afebrile

a. 10-month old with a fever and petechiae who is grunting

A nurse in the emergency department is examining an 18-month old with lip edema, urticaria, stridor, and tachycardia. The nurse immediately suspects: a. Severe polyarticular juvenile idiopathic arthritis b. Anaphylaxis c. Systemic lupus erythematosus d. Severe combined immunodeficiency

b. Anaphylaxis

A nurse is conducting a physical examination of a 12-year old girl with suspected systemic lupus erythematosus (SLE). How would the nurse best interview the girl? a. "Do you notice any wheezing when you breathe or a runny nose?" b. "Do you have any shoulder pain or abdominal tenderness?" c. "Have you noticed any new bruising or different color patterns on your skin?" d. "Have you noticed any hair loss or redness on your face?"

d. "Have you noticed any hair loss or redness on your face?"

The nurse is assessing with a complex medical history that includes fatigue, Raynaud's, anemia, and photosensitivity. The nurse should anticipate that this child may require which treatment? a. Antiretroviral therapy b. IVIG c. Phototherapy d. Corticosteroids

d. Corticosteroids

The nurse is caring for a child with juvenile idiopathic arthritis (JIA). There is involvement of five or more small joints it is affecting the body symmetrically. This tells the nurse which information about the child? a. Has polyarticular JIA b. Has systemic JIA c. Has pauciarticular JIA d. Is at risk for anaphylaxis

a. Has polyarticular JIA

The student nurse is discussing the plan of care for a child admitted to the hospital for treatment of an infection. Which action should be taken FIRST? a. Obtain blood cultures b. Initiate antibiotic therapy c. Obtain urine specimen for analysis d. Initiate intravenous therapy

a. Obtain blood cultures

Name 5 risk factors for sepsis that are related to pregnancy and labor.

a. PREMATURE OR PROLONGED RUPTURE OF MEMBRANES b. DIFFICULT BIRTH c. MATERNAL INFECTION OR FEVER, INCLUDING STI'S d. RESUSCITATION AND INVASIVE PROCEDURES e. GBS + VAGINOSIS

The nurse at an outpatient facility is obtaining a blood specimen from a 9-year-old girl. Which technique would MOST likely be used? a. Puncturing a vein on the dorsal side of the hand b. Administering sucrose prior to beginning c. Accessing an indwelling venous access device d. Using an automatic lancet on the heel

a. Puncturing a vein on the dorsal side of the hand

The nurse is administering a chicken pox vaccination to a 12-month old girl. Which concern is unique to varicella? a. This disease can reactivate years later and cause shingles b. Vitamin A is indicated for children younger than 2 years c. Dehydration is caused by mouth lesions d. Children with this disease need to avoid pregnant women

a. This disease can reactivate years later and cause shingles

The child has a peanut allergy and accidently ate food that contained peanuts. Which clinical manifestations of anaphylaxis should the nurse expect to find? SELECT ALL THAT APPLY a. The child's pulse is 52 beats per minute b. The child states that his tongue feels "too big" for his mouth c. The child has hives on his face and trunk d. The child states that he might "throw up" e. The child states that he might faint

b. The child states that his tongue feels "too big" for his mouth c. The child has hives on his face and trunk d. The child states that he might "throw up" e. The child states that he might faint

The nurse is taking a health history for an 8-yar-old who is hospitalized. Which is a risk factor for sepsis in a hospitalized child? a. Maternal infection or fever b. Use of immunosuppressant drugs c. Lack of juvenile immunizations d. Resuscitation or invasive procedures

b. Use of immunosuppressant drugs

The pediatric nurse knows that there a number of anatomic and physiologic differences between children and adults. Which statemen about the immune system of infants and young children is true? a. Children have an immature immune response b. Cellular immunity is not functional in children c. Children have an increased inflammatory response d. Passive immunity overlaps immunization

a. Children have an immature immune response

The nurse is reviewing the assessment data from a 4-year old admitted to the hospital for management of early onset sepsis. Which finding supports the diagnosis? a. The child is unhappy about having to stay in bed b. The child's tympanic temperature is 98.9F (37.11C) c. The child is hypotensive d. The child is irritable

d. The child is irritable

The nurse is preparing to administer acetaminophen to a 4-year-old girl to provide comfort to the child. Which precaution is specific to antipyretics? a. Check for medicine allergies b. Take the entire course of medication c. Ensure proper dose and interval d. Warn of possible drowsiness

c. Ensure proper dose and interval

The nurse is caring for a 10-year old child with a skin rash. The nurse should include which intervention to manage the associate pruritis? a. Encourage warm baths b. Apply hot compresses c. Press the pruritic area (press, do not scratch) d. Rub powder on the pruritic area

c. Press the pruritic area (press, do not scratch)

A nurse is caring for an infant whose mother is HIV+ the nurse knows that which diagnostic test result will be positive, even if the child is not infected with the virus? a. Erythrocyte sedimentation rate b. Immunoglobulin electrophoresis c. Polymerase chain reaction test - PCR d. Enzyme-linked immunosorbent assay - ELISA

d. Enzyme-linked immunosorbent assay - ELISA

Match the vector-borne illness with the means of infection - Endemic typhus

SEXUAL CONTACT

Describe the nursing management of mumps. SYMPTOM MANAGEMENT

SYMPTOM MANAGEMENT. ACETAMINOPHEN FOR FEVER MANAGEMENT. NARCOTIC ANALGESICS MAY BE REQUIRED FOR PAIN MANAGEMENT. ORAL FLUIDS TO PREVENT DEHYDRATION. IF ORCHITIS (INFLAMMATION OF THE TESTES) IS PRESENT ICE PACKS AND GENTLE SUPPORT OF THE RESTICLES MAY BE NECESSITATED. HOSPITALIZED CHILDREN SHOULD BE CONFINED TO RESPIRAOTRY ISOLATION. CONSIDERED NO LONGER CONTAGIOUS AFTER 9 DAYS FOLLOWING THE ONDET OF PAROTID SWELLING.

The nurse is providing instructions to the parents of a child with severe peanut allergy. Which statement by the parents indicated a need for further teaching about the use of an epinephrine auto-injector? a. "We must massage the area for 10 seconds after administration" b. "We must make sure that the black tip pointed downward" c. "The epinephrine auto-injector should be jabbed into the upper arm" d. "The epinephrine auto-injector must be help firmly for 10-seconds"

c. "The epinephrine auto-injector should be jabbed into the upper arm"

A 10-year-old girl with long hair is brought into the emergency room because she began acting irritable, reported a headache, and was very sleepy. Which question is the MOST appropriate for the nurse to ask the parents? a. "Has she done this before?" b. "How long has she been acting like this?" c. "What were you prior to her beginning to feel sick" d. "What medications is she currently taking?"

c. "What were you prior to her beginning to feel sick"

The nurse is providing teaching for the parents of a child with a latex allergy. The nurse tells the client to avoid which food? a. Blueberries b. Pumpkins c. Bananas d. Pomegranates

c. Bananas

The nurse is providing education to the parents of a 5-year old with a fever. Which statements indicate the need for further instruction? SELECT ALL THAT APPLY a. "Fever has many therapeutic properties" b. "I can administer two baby aspirin tablets to my child ever 4-6 hours for fever" c. "Sponging my child with cold water can be a soothing way to manage the fever" d. "I should use a cooling fan in my child's room to keep the fever down" e. "Ibuprofen has been shown to be more beneficial than acetaminophen when managing a fever"

b. "I can administer two baby aspirin tablets to my child ever 4-6 hours for fever" c. "Sponging my child with cold water can be a soothing way to manage the fever" d. "I should use a cooling fan in my child's room to keep the fever down"

The nurse is providing teaching about food substitutions when cooking for the child with an allergy to eggs. Which response indicates a need for further teaching? a. "I must not feed my child eggs in any form" b. "I can use the egg white when baking, but not the yolk" c. "1 tsp yeast and ¼ cup warm water is a substitute in baked goods" d. "1 tsp baking powder equals one egg in a recipe"

b. "I can use the egg white when baking, but not the yolk"

A 6-year-old boy is suspected of having late-stage Lyme disease. Which assessment should the nurse use to produce findings supporting this concern? a. Inspecting for erythema migraines b. Asking the child if his knees hurt c. Observing for facial palsy d. Examining for conjunctivitis

b. Asking the child if his knees hurt

The nurse is assessing children in a physician's office. Who may have a primary immunodeficiency? SELECT ALL THAT APPLY. a. Child diagnoses with 6 episodes of acute otitis media during the previous year b. Child with oral thrush that is unresolved with treatment c. Child admitted to the hospital three times within the last year with pneumonia d. Child diagnosed with a severe case of acute sinusitis during the last year e. Child who has taken antibiotic for the last 3 months without evidence of clearing of the infection

b. Child with oral thrush that is unresolved with treatment c. Child admitted to the hospital three times within the last year with pneumonia e. Child who has taken antibiotic for the last 3 months without evidence of clearing of the infection

The nurse is preparing to administer the child's dose of IVIG. Which actions should the nurse take? SELECT ALL THAT APPLY. a. Prepare to administer the medication into ventrogluteal site as an IM injection b. Take baseline vital signs and monitor vitals during the infusion c. Prepare to give acetaminophen to the child d. Prepare to give diphenhydramine to the child e. Mix the medication with the child's IV antibiotics

b. Take baseline vital signs and monitor vitals during the infusion c. Prepare to give acetaminophen to the child d. Prepare to give diphenhydramine to the child

The nurse is caring for a 6-month old boy with Wiskott-Aldrich syndrome. The nurse teaches the parents which of the following? a. "Don't use a tub bath for daily cleansing" b. "Don't encourage a pacifier due to possible oral malformation" c. "Do not insert anything into the rectum" d. "Do not use a sponge bath for light cleaning"

c. "Do not insert anything into the rectum"

A 10-year-old boy has an unknown infection and will need to provide a urine specimen for sensitivity. To assure that the sensitivity results are accurate, which step is MOST important? a. Ensure that the specimen is obtained from proper area b. Collect three specimens on three different days c. Use aseptic technique when obtaining the specimen d. Obtain specimen before antibiotics are given

d. Obtain specimen before antibiotics are given

The nurse is preparing to administer IVIG for a child who has not had an IVIG infusion in over 10 weeks. The nurse knows to first: a. Begin infusing slowly increasing to prescribed rate b. Assess for adverse reaction c. Obtain baseline physical assessment d. Premedicate with acetaminophen and diphenhydramine

d. Premedicate with acetaminophen and diphenhydramine

The nurse is caring for a 5-year old girl with scarlet fever. Which intervention will most likely be part of her care? a. Exercising both standard and droplet precautions b. Palpating for and noting enlarged lymph nodes c. Monitoring for changes in respiratory status d. Teaching proper administration of penicillin V

d. Teaching proper administration of penicillin V