Peds Exam 2 - Immunizations and Common Childhood Illnesses

The nurse is caring for a toddler in the clinic setting. The parent reports the child has begun having development and behavioral problems and "never slows down." What is the best response by the nurse?"

"Is the child exposed to lead sources, such as paint, contaminated soil, or dust?"

Which statement by the parent lets the nurse know that teaching about antibiotics prescribed 3 times a day for the child with strep throat has been effective?

"It is important to give my child the full course of antibiotics."

A pregnant client tells her nurse that a friend of hers recently gave birth to an infant who was found to have congenital heart disease. She asks the nurse whether there is anything she can do to reduce the risk of this type of condition occurring in her baby. What information should the nurse mention to this client?

"Make sure you are fully immunized."

The nurse is providing education to the parents of a child diagnosed with pinworms. Which statement is most important for the nurse to include in the teaching?

"Make sure your child washes hands before eating."

How is strep treated?

10 days of PCN

How many negative cultures are required before release of a patient with Diphtheria?

2-3

Which type of immunity is long lasting immunity when the body is stimulated to form its own defense?

Active

The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education?

"I hate to think that I will need to be worried about my child having seizures for the rest of his life."

The public health nurse is discussing immunizations with a group of caregivers of infants. One of the mothers asks the nurse why the child will need immunizations. Which statement would be the most appropriate for the nurse to make to this mother?

"The infant is born with immunity to some diseases, but those immunities decrease over the first year of life."

A child is diagnosed with varicella. The parent states the child is "just miserable" and wants to know how best to make the child feel more comfortable. Which instruction(s) would the nurse give this parent? Select all that apply.

"You can administer acetaminophen to help with fever and pain." "Keep only light clothing on your child." "Keep your child's fingernails short so scratching will not disturb vesicles." "Place the child in a soothing tepid bath."

The nurse is discussing vaccination for Haemophilus influenzae type B (Hib) with the mother of a 6-month-old child. Which comment provides the most compelling reason to get the vaccination?

"Young children are especially susceptible to these bacteria."

Three children in a family, ages 7 months, 4 years, and 9 years, have been tested for lead poisoning. The two younger children have test results reflecting elevated lead levels and they will be undergoing treatment. The mother questions why her younger children were not "spared" as their older sibling was. What response by the nurse is most correct?

"Younger children are often impacted because of their play behaviors place them on the floors and they often put things into their mouths."

What is the incubation period for Mono?

30-50 days

How old does patient have to be to be able to use throat lozenges?

4 years old

Which assessment finding by the nurse would warrant immediate action?

A child with periorbital cellulitis reports changes in vision and pain with eye movement.

What is the antidote for acetaminophen?

Acetylcysteine (Mucomyst)

_____ is a protein molecule produced by B lymphocytes to fight an antigen

Antibody

_______ is a live or inactivated substance capable of producing an immune response.

Antigen

Which labs should be done for patients who were bitten by a snake?

CBC, platelets, coagulation, electrolytes, renal panel

Which vaccines should an 4-6 year old receive?

DTaP, IPV, MMR, Varicella

The 4-year-old due for the DTaP, IVP, MMR, and varicella vaccines has a runny nose, slight cough, and temperature of 99° F (37.2° C). What should be the response of the nurse?

Do the well-child exam and give the immunizations that are due.

How is Mono diagnosed?

Monospot antibody test

Which OTC medication cannot be given after T&A for risk of increased bleeding?

Motrin

Which medication can be given after T&A?

Tylenol

Which vaccines are considered live?

Varicella, MMR, Influenza, Rubella, Hepatitis A

What is the treatment for pinworms?

Vermox taken once then again in 2 weeks

How can contact dermatitis be treated?

calamine lotion, topical steroid gels, oatmeal bath, steroid injection

If strep is left untreated, what could result?

cardiac and renal issues

Peritonsillar abscesses may cause which symptom?

change in voice or "trismus"

What is the treatment for anaphylaxis?

epinephrine

What is important to consider when treating patients with Pertussis?

have emergency equipment ready and on standby

How are ulcers prevented in patients with poliovirus?

keep body in proper alignment

Which type of vaccines cannot be given to immunosupressed patients?

live

Which organ is severely affected by acetaminophen overdose?

liver

What is important to know about Rubella (German Measles)?

should disappear in 3 days in the same order that it began

What are interventions for acne?

using a mild cleanser, avoid scrubbing and picking, hygiene

What is the needle gauge and length for IM injections?

20-23 gauge, 1-1 1/2 inch needle

What is the needle gauge and length for SQ injections?

25-29 gauge, 3/8-5/8 inch needle

How long should mono patients avoid alcohol for?

3 months

A health care provider has prescribed cephalexin 30 mg/kg PO daily in 4 divided doses for a child diagnosed with impetigo. The child weighs 30 lb (14 kg). How many milligrams should the child receive each day?

420

When is it okay for a child to receive the influenza vaccine?

6 months, then annually

Which lead level is considered good?

<10

At which lead level should EDTA be administered to bind lead and clear it from the blood vessels?

>45

The nurse is caring for a child immediately following a tonsillectomy. The child requests something to drink. Which action by the nurse is best?

Give the child a few ice chips to consume.

If a patient who is allergic to eggs gets the flu vaccine, what could happen?

Gullian Barre syndrome

Which immunizations should a child receive at birth?

Hepatitis B

Which immunization should a child receive at 2 months old?

Hepatitis B, Rotavirus, DTaP, Hib, PCV, IPV

Which immunizations should a child receive at 6 months old?

Hepatitis B, Rotavirus, DTaP, Hib, PCV, IPV, Flu

Which diseases require droplet precautions?

Hib, Rubella, Pertussis, Mumps, Pneumonia, Influenza, Meningitis

A nursing instructor is describing the progression of signs and symptoms associated with varicella from earliest to latest. Place the signs and symptoms below in the sequence that the instructor would describe them.

Low-grade fever Macular rash Papular rash Vesicle formation Crusting

______ is protection from diseases in a "borrowed" sense

Passive

How is lice treated?

Permethrin 1% shampoo, use once to comb out and remove lice then again in a week when eggs hatch

By which route is the Varicella vaccine given?

SQ

What route is the MMR vaccine given?

SQ

What route is the Polio vaccine given?

SQ, IM

After you get the chickenpox, you are at risk for later developing what?

Shingles

The nurse has received the morning report on a group of pediatric clients. Which pediatric client will the nurse see first?

a child reporting dark brown urine and a fine sandpaper rash

What does activated charcoal do to a patient who has been poisoned?

absorbs the toxins in the stomach

What is the treatment for lead poisoning?

administer O2, treat anemia, monitor I&Os, monitor kidney function

Diphtheria may cause lymphadenitis. What should we be concerned about when this sxs occurs?

airway obstruction

What are the symptoms of pinworms?

anal itching, restlessness, fussiness

Eczema is very commonly seen with which other condition?

asthma

Which people should especially get the flu vaccine?

asthma, DM, sickle cell, chronic diseases

What is patient teaching for patients with Strep?

avoid citrus, soft diet, cold or warm drinks, cough drops, warm salt water, popsicles

Which population is affected by Roseola?

babies 6 months-3 years

Hib may lead to which complications?

bacterial meningitis, epiglottitis, infections of the blood, bone, heart, and joints

Which allergies should the nurse be aware of when giving the hepatitis vaccines?

baker's yeast

How is Hep B transmitted?

blood, body fluids, sex, childbirth, human bite

What age of children does Hib affect?

children under 5

What is a sign that a patient has hemorrhaging after a T&A?

constant swallowing or not swallowing at all

A nursing instructor is teaching the students about the standard and transmission-based precautions. What type of precautions require placing a client in an isolated room with limited access, wearing gloves during contact with the client and all body fluids or contaminated items, wearing two layers of protective clothing, and avoiding sharing equipment between clients?

contact precautions

How is Mononucleosis transmitted?

contact with fluids

What are the late signs of lead poisoning?

convulsions

Shingles lesions appear along the ______ of the skins.

dermatones

Scarletina fever is characterized by which symptoms?

diffuse sandpaper rash, peeling skin, strep infection

How can we prevent lice from spreading?

don't share hats and brushes

Why is it important that patients with Mono do not participate in contact sports for 4-6 weeks?

due to the possibility of a ruptured spleen

Where is tetanus found?

dust, soil, animal feces, salt and freshwater, intestinal tract of humans and animals

What are interventions for cellulitis?

elevate HOB, warm compresses, elevate affected extremity

What are the methods of treatment for poisonings?

emesis, ipecac syrup, gastric lavage, activated charcoal

How often is a tetanus shot needed?

every 10 years, unless a dirty injury occurs

What are symptoms of Roseola?

fevere 102-105 degrees, then macular rash

What allergies should you be aware of when administering the MMR vaccine?

gelatin, neomycin

In what order should you doff PPE?

gloves, gown, goggles, mask

Venom of snakes causes which symptoms?

hemolysis and tissue necrosis

What is the hallmark sign of impetigo?

honey colored crusts

What is patient education for T&A procedure?

hydrate, no orange or red drinks, no milk, no nose blowing or clearing throat, soft diet, cold liquids

What constitutes anaphylaxis?

if more than 1 body system is affected

Which patients should not receive live vaccines?

immunosuppressed or patients with high fever, wheezing, pregnant women, or patients on steroids

When should patients be instructed to get the flu vaccine?

in the fall

What are the symptoms of contact dermitis?

itching and redness, possible vesicles

Which order do lesions progress in the chickenpox virus?

macules, papules, vesicles, bust/ crust

The nurse approaches a client room and notes a sign stating the client is on droplet precautions. Which personal protective equipment (PPE) will the nurse use for this client?

mask with face shield

What are common complications of Measles?

mastoiditis, ear infections, pneumonia, seizures, brain damage, laryngitis, encephalitis, bronchiolitis

The nurse determines that it is necessary to implement airborne precautions for children with which infection?

measles

Which diseases require airborne precautions?

measles, chickenpox, tuberculosis

The rotavirus vaccine may cause which symptom?

mild diarrhea

What are the symptoms of poliovirus?

paralysis, nerve weakness, death

What type of infection is giardia?

parasitic

What are the symptoms of Pertussis?

paroxysmal cough, whooping cough, inflammation of mucous membranes of head and throat, tearing of eyes, fever

What is the hallmark sign of strep?

petechiae in throat

What is the leading cause of bacterial meningitis?

pneumococcal infections

What may cause contact dermatitis?

poison ivy, sumac or oak

What are early signs of lead poisoning?

poor fine motor skills

Which child(ren) will the nurse avoid immunizing with a live-virus vaccine? Select all that apply.

preschool-age child receiving radiation therapy toddler with a severe acute illness

What is the primary symptom of scabies?

pruritis

What are symptoms of eczema?

red patches with vesicles, exudate, crusts, pigment changes

When should lotion be applied for patients with eczema?

right after shower/ bath

A 6-month-old boy is brought to the doctor's office with a high fever. The physician diagnoses the child as having a viral infection of some kind and recommends acetaminophen to reduce the fever. After 3 days, the mother returns with the child. The fever is gone, but a rash of discrete, rose-pink macules approximately 2 to 3 mm and flat with the skin surface appears. Which condition should the nurse suspect?

roseola

The mother of a 4-month-old refuses for her baby to be "stuck" when immunized. What immunization will the nurse administer under these restrictions?

rotavirus

While enrolled in a geography course, a student nurse learns that diarrheal illness is deadly for large numbers of infants in Third World countries. What vaccine will this nursing student identify as part of the solution to this problem?

rotavirus (RV)

Which illnesses require contact precautions?

scabies, lice, impetigo, HSV, STDs, C. diff, CF, RSV, Meningitis

What are possible complications of pneumococcal infections?

sepsis, meningitis, ear infections, sinusitis, pneumonia, otitis media

What is the hallmark symptom of rotavirus?

severe diarrhea

What are symptoms of Hepatitis B?

severe ongoing liver damage, fatigue, malaise, jaundice, HA, N/V

What is the hallmark sign of Erythema Infectiosum (5ths Disease)?

slapped cheeks and lacy red rash

Why is it important that pregnant women get the TDaP vaccine?

so that the child is protected from Pertussis when they are born

What time of year is Pertussis seen most often?

spring and summer

What are the symptoms of tetanus?

stiffness, diminished reflexes, sardonic grin, fractures d/t stiffness

Strawberry tongue may be a symptom of which type of infection?

streptococcal

What is the most common sign of Mumps?

swelling of the parotid gland

Which type of reaction does a black widow bite cause?

systemic, malaise, sweating, N/V

What is contagious about poison ivy, sumac or oak?

the oils

How is strep diagnosed?

throat culture

What is the incubation period of an illness?

time between exposure and symptom onset

What symptom can a brown recluse bite cause?

tissue necrosis

What may doctors suggest if repeated strep infections occur?

tonsillectomy and adenoidectomy

The nurse is caring for a child with a skin disorder. The child presented with papules that progressed to vesicles with a honey-colored exudate. What treatment would the nurse expect to be ordered to treat this disorder? Select all that apply.

topical mupirocin ointment cool compresses to assist in removing crusts on vesicles regular hygiene measures

If MMR vaccine is given to a patient who is allergic to Neomycin, what adverse effect may result?

Arthritis

Which type of active immunity is obtained from getting the vaccine for a disease process?

Artificial

Which type of passive immunity is giving an injection of immunoglobulins (IVIG) aka purified blood?

Artificial

The nurse is obtaining a throat culture from a child. The nurse would include which action(s) to obtain this specimen? Select all that apply.

Educate the child and parent about the procedure. Wash hands and don gloves. Swab the pharyngeal and tonsillar area. Use a tongue blade to depress the tongue.

Which interventions will the nurse include when caring for a child with an infectious disorder? Select all that apply.

Ensure immunization status is current. Use appropriate personal protective equipment. Provide information about disease transmission. Educate the child and family about infection control.

Which forms of hepatitis have vaccines?

Hep A and Hep B

Which medication is saved for severe cystic acne?

Isotrentinoin (Acutane)

Which acne treatment may cause depression and suicidal ideations?

Isotretinoin

What is the hallmark of Measles (Rubeola)?

Koplik spots

Which type of passive immunity is a mom breastfeeding her baby?

Natural

which type of active immunity is obtained by catching a disease?

Natural

What route is the Rotavirus vaccine given?

Orally

How is tetanus treated?

PCN, Valium for spasms

Which immunizations should a child receive at 4 months old?

Rotavirus, DTaP, Hib, PCV, IPV

Which acne treatment may bleach clothing and hair?

Topical Benzoyl Peroxide

How can Hep A be transmitted?

fecal, food, water

What is the treatment of scabies?

promethium 5% cream

What is the primary mode of transmission for giardia?

unfiltered/ contaminated water

How long is Roseola contagious?

until fever and rash disappear

How long are patients with Varicella contagious?

until the last lesion busts open and crusts over

How is a spider bite treated?

valium, antivenom, ice

The nurse is doing discharge teaching for a child who has had a tonsillectomy. The nurse tells the client and family that the child should have plenty of fluids. In addition, the nurse would explain to the child's caregiver that the child may:

vomit dark, old blood, but the caregiver should call the clinic if the child has bleeding between the fifth and seventh days postoperatively.