Chapt 39 Nursing Care of the Child with Communicable Disease

A neonate is brought to the emergency department by her mother because she "just doesn't look right." The neonate is suspected of having sepsis. Which statement by the mother would help to confirm this suspicion? a) "She seems to be breathing a little fast." b) "Her cry seems to be pretty strong." c) "She hasn't had a fever." d) "My water broke quite a while before I actually delivered her."

"My water broke quite a while before I actually delivered her." Prolonged or premature rupture of membranes increases a neonate's risk for sepsis. A weak cry or lack of smile or facial expression may be present with sepsis. A significant increase in breathing rate (tachypnea) or increased work of breathing evidenced by nasal flaring, grunting, and a retraction is noted with sepsis. Neonates with sepsis do not have a fever. In fact, they may have below-normal temperature.

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 of the following statements would be the most appropriate statement for the nurse to make to this mother? a) "Infants are unable to develop antibodies to protect them from diseases so they must be immunized." b) "The antibodies the fetus gets from the mother are in the placenta, so after birth they are no longer available to the infant." c) "The infant is born with immunity to some diseases, but those immunities decrease over the first year of life." d) "The immunities that the infant is born with are not for the same diseases they will be immunized against."

"The infant is born with immunity to some diseases, but those immunities decrease over the first year of life." During fetal life, the mother's antibodies cross the placenta, giving the fetus a temporary immunity against certain diseases. This immunity is present at birth and decreases during the first year of life. In the meantime, the infant begins developing antibodies to fight against pathogens and disease. In addition, during the first year of life immunizations are started to help the infant develop protection against certain diseases. (less)

A group of grade-school children is going camping. As a school nurse, you would offer them which advice to prevent Lyme disease? a) "Don't approach strange animals outside the campsite." b) "Don't drink water from mountain streams while hiking." c) "Don't touch any bush without knowing what kind it is." d) "Wear jeans tucked inside your socks when in the woods."

"Wear jeans tucked inside your socks when in the woods." Lyme disease is prevented by measures to reduce the possibility of tick bites.

A child is diagnosed with early disseminated Lyme disease. The nurse informs the parents the child will most likely receive antibiotic therapy for which length of time? a) 10 to 14 days b) 14 to 18 days c) 7 to 10 days d) 14 to 28 days

14 to 28 days For early disseminated or late Lyme disease, intravenous penicillin or ceftriaxone is used for 14 to 28 days. Early Lyme disease is treated for 14 to 21 days; treatment for Rocky Mountain Spotted Fever is usually 7 to 10 days.

A nurse is assessing a child with a tick-borne disease. Which of the following would indicate to the nurse that the child has developed ehrlichiosis and not Rocky Mountain Spotted Fever? a) Headache b) Fever c) Absence of rash d) Malaise

Absence of rash Both Rocky Mountain Spotted Fever and ehrlichiosis are manifested by fever, headache, and malaise. However, there is rarely a rash with ehrlichiosis, which helps to differentiate it from Rocky Mountain Spotted Fever.

The nurse is caring for an adolescent diagnosed with genital herpes. The drug of choice for treating genital herpes is which of the following? a) Acyclovir b) Penicillin c) Griseofluvin d) Rocephin

Acyclovir The drug acyclovir (zovirax) is useful in relieving or suppressing the symptoms of genital herpes

A 3-week-old infant is diagnosed with pertussis. Which antimicrobial agent would the nurse expect the physician to prescribe? a) Trimethoprim-sulfamethoxazole b) Erythromycin c) Clarithromycin d) Azithromycin

Azithromycin The macrolides (erythromycin, azithromycin, and clarithromycin) are the drugs of choice for pertussis in children over 6 months of age. Azithromycin and clarithromycin are not FDA approved for use in infants younger than 6 months; however, infants younger than 1 month old should be treated with azithromycin because erythromycin is associated with increased risk of infantile hypertrophic pyloric stenosis. Trimethoprim-sulfamethoxazole is an alternative antibiotic for children who cannot tolerate erythromycin.

A 13-year-old boy who recently immigrated to the United States from India is found to be infected by a strain of the poliovirus. After initial symptoms of fever, headache, nausea, vomiting and abdominal pain subside, the virus proceeds to his central nervous system. Which of the following would be the best intervention for this client at this point? a) Salicylic acid solution b) Bed rest, analgesia, and application of moist hot packs c) Vaccination d) Antibiotics

Bed rest, analgesia, and application of moist hot packs Treatment for poliomyelitis is bed rest with analgesia and moist hot packs to relieve pain. Vaccination would be too late, at this point, as the infection has already occurred. Antibiotics would be ineffective as this is a viral, not a bacterial, infection. Salicylic acid solution is used to treat warts.

A child is diagnosed with an enterovirus infection. Which type of infection control precaution would be most important for the nurse to use? a) Droplet b) Standard c) Contact d) Airborne

Contact For the child with an enterovirus infection, contact precautions are used during the illness. Standard precautions are followed at all times and are appropriate for any child. Droplet precautions would be used for a child infected with pertussis. Airborne precautions would be indicated for the child with varicella.

A group of nursing students are reviewing the functions of white blood cells. The students demonstrate an understanding of the information when they identify which white blood cell as responsible for combating allergic disorders? a) Eosinophils b) Monocytes c) Neutrophils d) Lymphocytes

Eosinophils Eosinophils function to combat allergic disorders and parasitic infestations. Neutrophils function to combat bacterial infections. Lymphocytes function to combat viral infections. Monocytes function to combat severe infections.

A young patient arrives at the clinic with a rash on the trunk and flexor surfaces of the extremities. The mother informs the nurse that the rash started a day before on the exterior surfaces of the extremities; 2 days before, the child had a really bad rash on the face. The physician diagnoses the child with erythema infectiosum. The nurse tells the mother that this is also known as which of the following? a) Pityriasis rosea b) Fifth disease c) Enterovirus d) Rosacea

Fifth disease Erythema infectiosum is also known as "fifth disease." It starts with a fever, headache, and malaise. One week later, a rash appears on the face. A day later, the rash appears on the extensor surfaces of the extremities. One more day later, the rash appears on the trunk and flexor surfaces of the extremities.

The nurse is caring for a 14-year-old girl who fears she might have a sexually transmitted infection. Which of the following would the nurse expect to assess if the adolescent has trichomoniasis? a) Urinary incontinence b) Green vaginal discharge c) Lesions on the vulva d) Flu-like symptoms

Green vaginal discharge Symptoms of trichomoniasis include a yellow, green, or gray vaginal discharge with a foul odor. Urinary incontinence is not indicative of trichomoniasis, but dysuria is. Syphilis is associated with flu-like symptoms Lesions on the vulva are a sign of venereal warts.

Nursing students are learning about the infectious process. They correctly identify the first stage of an infectious disease to be which of the following? a) Prodromal period b) Illness period c) Incubation period d) Convalescent period

Incubation period The incubation period is the first stage of the infectious disease. It is the time between the invasion of an organism and the onset of symptoms of infection.

A child is brought to the clinic with fever, cough, and coryza. The nurse inspects the child's mouth and observes what look like tiny grains of white sand with red rings. The nurse documents this as which of the following? a) Slapped cheek appearance b) Nits c) Lymphadenopathy d) Koplik spots

Koplik spots Koplik spots are bright red spots with blue-white centers appearing primarily on the buccal mucosa and indicate rubeola (measles). They are often described as tiny grains of white sand surrounded by red rings. Lymphadenopathy is used to document enlargement of the lymph nodes. Slapped cheek appearance refers to the erythematous flushing associated with fifth disease. Nits refer to the adult eggs of pediculosis.

The appearance of which hallmark clinical manifestation occurs in measles? a) Koplik spots b) Fever c) Cough d) Conjunctivitis

Koplik spots The hallmark of measles is the appearance of Koplik spots. Other typical symptoms include fever, conjunctivitis, and a cough.

A 7-year-old patient with an earache comes to the clinic. The child's mother reports that 1 day ago the patient had a fever and headache and did not want to play. When the nurse asks where it hurts, the patient points to the jawline in front of the earlobe. What does the nurse expect the diagnosis to be for this patient? a) Fifth disease b) Mumps c) Measles d) Mononucleosis

Mumps Mumps begin with a fever, headache, anorexia, and malaise. Within 24 hours an earache occurs. When pointing to the site of pain, however, the child points to the jawline just in front of the earlobe.

A child is brought to the emergency department by his parents. The parents report that he stepped on a rusty nail about a week and a half ago. The child is complaining of cramping in his jaw and some difficulty swallowing. The nurse suspects tetanus. When assessing the child, the nurse would be alert to which muscle groups being affected next? a) Legs b) Stomach c) Neck d) Arms

Neck Tetanus progresses in a descending fashion to other muscle groups, causing spasms of the neck, arms, legs, and stomach.

When the physician looks in a child's mouth during a sick-visit exam, the mother exclaims: "Her tongue is bright red! It was not like that yesterday." The physician would most likely order which medication based on the probable diagnosis of scarlet fever? a) Penicillin to prevent acute glomerulonephritis b) Acetaminophen to decrease the throat pain c) Erythromycin to prevent the spread to siblings d) Steroids to decrease the inflammation

Penicillin to prevent acute glomerulonephritis A "strawberry tongue" is a classic sign of scarlet fever. Penicillin is prescribed to prevent the complications of acute glomerulonephritis and rheumatic fever associated with beta-hemolytic group A streptococcal infections.

Which of the following begins as an upper respiratory illness and progresses to a persistent cough characterized by an inspiratory whoop? a) TB b) Sepsis c) HIV d) Pertussis

Pertussis Pertussis, also known as whooping cough, begins as an upper respiratory illness and progresses to a persistent cough characterized by an inspiratory whoop. TB is not characterized by an inspiratory whoop. Sepsis and HIV are not associated with an inspiratory whoop.

A nurse practitioner suspects that a child has scarlet fever based on which of the following assessment findings? a) Red, strawberry tongue b) White exudate on the tonsils c) An enanthematous rash d) Severity of the sore throat

Red, strawberry tongue The characteristic assessment finding that distinguishes scarlet fever from other disorders is the appearance of the red, strawberry tongue. Sore throat, an enanthematous and exanthematous rash, and white exudate on the tonsils are also seen with scarlet fever, but it is the strawberry tongue that helps to confirm the diagnosis.

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which of the following best describes erythema? a) Small elevation of epidermis filled with a viscous fluid b) Small, circumscribed, solid elevation of the skin c) Discolored skin spot not elevated at the surface d) Redness of the skin produced by congestion of the capillaries

Redness of the skin produced by congestion of the capillaries Erythema is redness of the skin produced by congestion of the capillaries.

A child is diagnosed with group A streptococcal pharyngitis. The nurse would teach the parents to be alert for signs and symptoms of which of the following? a) Scarlet fever b) Osteomyelitis c) Impetigo d) Pneumonia

Scarlet fever Group A streptococcal pharyngitis can progress to scarlet fever with the rash appearing in about 12 hours after the onset of the disease. Group A streptococcal pharyngitis is not associated with pneumonia. Impetigo is a group A strep infection involving the skin. Osteomyelitis can occur with an infection by group B streptococcus.

A 6-year-old child is brought to the clinic by his parents. The parents state, "He had a sore throat for a couple of days and now his temperature has been over 102°F. He has this rash on his face and chest that looks like sunburn but feels really rough." Which of the following would the nurse suspect? a) Diphtheria b) Scarlet fever c) Pertussis d) Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA)

Scarlet fever Scarlet fever typically is associated with a sore throat, fever greater than 101°F, and the characteristic rash on the face, trunk, and extremities that looks like sunburn but feels like sandpaper. CAMRSA is typically manifested by skin and tissue infections. Diphtheria is characterized by a sore throat and difficulty swallowing but fever is usually below 102°F. Airway obstruction is apparent. Pertussis is characterized by cough and cold symptoms that progress to paroxysmal coughing spells along with copious secretions.

A nurse is providing care to an infant who develops roseola during hospitalization. The nurse would institute which of the following infection control precautions. a) Contact b) Airborne c) Droplet d) Standard

Standard If an infant develops roseola infantum in the hospital, the nurse would follow standard precautions. There is no need for airborne, droplet, or contact precautions.

One method of preventing communicable diseases in children is to administer vaccines to stimulate the development of antibodies. Which of the following best describes what occurs in the child when vaccines are given? a) The child develops a passive immunity. b) The child develops an active immunity. c) The child becomes a carrier of the disease. d) The child becomes a host for the disease.

The child develops an active immunity. When a vaccine is given, active immunity occurs which then stimulates the development of antibodies to destroy infective agents without causing the disease.

The nurse is caring for a child diagnosed with Haemophilus Influenzae type B. Which of the following nursing interventions would be the highest priority in the prevention of complications seen with this disorder? a) The nurse will monitor for seizure activity. b) The nurse will monitor fluid intake. c) The nurse will administer antibiotics. d) The nurse will elevate the head of the bed.

The nurse will administer antibiotics. A serious complication of Haemophilus Influenzae type B is meningitis. Antibiotics are administered to treat the bacterium infection caused by Haemophilus Influenzae type B.

The nurse is caring for a child hospitalized with pertussis. Which of the following nursing interventions would be the highest priority for this child? a) The nurse will administer oxygen. b) The nurse will monitor caloric intake. c) The nurse will administer antibiotics. d) The nurse will encourage bed rest.

The nurse will administer oxygen. The major complication of pertussis (whooping cough) is pneumonia and respiratory complications. Oxygen, bed rest, and monitor for airway obstruction are nursing interventions. The highest priority is administering oxygen to maintain adequate oxygenation of cells.

The nurse is caring for a 10-year-old boy with diphtheria. Which of the following would the nurse institute as a tier 2 precaution? a) Use of a protective mask b) Use of a protective face shield c) Negative air pressure ventilation d) Use of a protective gown

Use of a protective mask : Use of a protective mask if within 3 feet of the child is a tier 2 precaution with diphtheria, which is transmitted through contact with droplets. Use of a protective gown is a tier 2 precaution for contact transmission. Negative air pressure ventilation is a tier 2 precaution for airborne transmission. Face shields are part of tier 1 precautions against contaminated splashes.

Which of the following would you expect to observe about the rash associated with chickenpox (varicella)? a) Noticeable crusts but no pruritus b) Dark red color (red hen marks) c) Various stages of lesions present at the same time d) Dark red, macular, very pruritic lesions

Various stages of lesions present at the same time Chickenpox lesions appear "in waves," so many stages of lesions are present at the same time.

After teaching nursing students about childhood exanthems, the instructor determines that the teaching was successful when the students identify which of the following as the primary cause? a) Bacteria b) Viruses c) Parasites d) Fungi

Viruses Most childhood exanthems are caused by viruses.

Parents usually ask when their child can return to school after having chickenpox. The correct answer would be a) as soon as all lesions are crusted. b) as soon as the temperature is normal. c) 10 days after the initial lesions appear. d) not until all lesions have completely faded.

as soon as all lesions are crusted. Chickenpox lesions are infectious until they crust.

A child in the clinic has a fever and reports a sore neck. Upon assessment the nurse finds a swollen parotid gland. The nurse suspects which of the following infectious diseases? a) scabies b) mumps c) whooping cough d) measles

mumps Mumps is an infectious disease with a primary symptom of a swollen parotid gland.

A nurse is preparing a presentation for parents about common childhood infectious diseases. Which of the following would the nurse include as being caused by a tick bite? Select all that apply. a) Lyme disease b) Scabies c) Rocky Mountain Spotted Fever d) Ascariasis e) Psittacosis

• Lyme disease • Rocky Mountain Spotted Fever Infectious diseases caused by tick bites include Lyme disease and Rocky Mountain Spotted Fever. Psittacosis is transmitted to children by birds. Ascariasis is a roundworm infection. Scabies is a parasitic infection caused by a female mite.

A nurse is assessing a child with a tick-borne disease. Which of the following would indicate to the nurse that the child has developed ehrlichiosis and not Rocky Mountain Spotted Fever? a) Malaise b) Fever c) Absence of rash d) Headache

Absence of rash Both Rocky Mountain Spotted Fever and ehrlichiosis are manifested by fever, headache, and malaise. However, there is rarely a rash with ehrlichiosis, which helps to differentiate it from Rocky Mountain Spotted Fever.

The parent of a child with mumps calls the clinic to find out how long the child needs to stay home from school. The nurse would instruct the parent to allow the child to return to school at which time? a) After 9 days from the onset of swelling b) Within 3 days of starting antiviral therapy c) Usually 7 days after the last lesion appears d) In about 5 days, once the lesions crust

After 9 days from the onset of swelling In the home, educate the family to keep the child with mumps from attending school or daycare until 9 days after the onset of swelling. Mumps involves swelling of the salivary glands; no lesions are present. Therapy for mumps is primarily supportive; antiviral agents are not used.

The rash in roseola is pruritic. Which of the following measures would you teach the father to provide comfort? a) Discuss with the child the importance of not scratching lesions. b) Dress the child warmly to bring out the rash so that it fades quickly. c) Apply cool compresses to the skin to stop local itching. d) Administer infant aspirin every 4 hours as necessary for comfort.

Apply cool compresses to the skin to stop local itching. Cool compresses can minimize pruritus. Aspirin should not be given with increased temperature (flu-like symptoms).

When developing the plan of care for a 5-year-old boy with Rocky Mountain spotted fever, the nurse integrates knowledge of this infection as being caused by which of the following? a) Animal bite b) Infection with group A streptococcus c) Contact with contaminated sports equipment d) Bite of a tick

Bite of a tick Rocky Mountain spotted fever is a tick-borne infection. Rabies is due to the bite of an animal. Community-acquired methicillin-resistant Staphylococcus aureus is transmitted through direct person-to-person contact, respiratory droplets, blood, or sharing of personal items and touching surfaces or items contaminated with methicillin-resistant S. aureus. Scarlet fever is an infection resulting from group A streptococcus.

Which of the following is a symptom of neonatal sepsis? a) Hyperglycemia b) Hypertension c) Bradycardia d) Increased urine output

Bradycardia Symptoms of neonatal sepsis are bradycardia or tachycardia, hypotension, decreased urine output, and hypoglycemia.

A chief danger of scarlet fever is that children may develop a) local areas of skin necrosis. b) acute glomerulonephritis. c) liver destruction. d) respiratory obstruction.

acute glomerulonephritis. Because this is a streptococci-based infection, there is a chance the child will develop rheumatic fever or glomerulonephritis following the illness.

The nurse is caring for a 6-year-old boy with mumps. Which of the following statements by the child would cause the nurse to suspect the boy is experiencing a complication of mumps? a) "My knees are sore and stiff." b) "I keep coughing up mucus." c) "Please talk a little louder." d) "I feel wobbly when I walk."

"Please talk a little louder." Complications of mumps include meningoencephalitis with seizures and auditory neuritis, which can result in deafness. Joint complaints, which might suggest arthritis, are a complication of erythema infectiosum. Difficulty walking, which might suggest cerebellar ataxia, is a complication of chickenpox. Coughing, which might suggest bronchopneumonia, is a complication of rubeola.

A nurse is assessing a child who was recently adopted from a foreign country and has not yet received any immunizations. The child has a high fever, rhinitis, and sore throat. The nurse also notes small, irregular, bright red spots on the buccal membrane. Which of the following would the nurse suspect? a) Rubella b) Variola c) Rubeola d) Varicella

Rubeola Small, irregular, bright red spots on the buccal membrane suggest Koplik's spots and, together with the child's other assessment findings, suggest rubeola. Koplik spots distinguish the disease because none of the other exanthems has this finding. Rubella is characterized by a low-grade fever, mild cough, sore throat, and red maculopapular rash. Varicella is characterized by a low-grade fever, malaise, and rash that begins as a macule and progresses to a papule and then a vesicle. Variola is characterized by chills, fever, headache, vomiting, and the appearance of a rash and high fever after 3 to 4 days.

Parents bring their 9-year-old child to the clinic for a well-child visit. They are concerned because several children in the neighborhood have developed Lyme disease and asks for suggestions on what to do to reduce their child's risk. Which of the following would be appropriate for the nurse to suggest? Select all that apply. a) Contacting the health care provider if there is any area of inflammation that might be a bite. b) Dressing the child in dark clothing when going outdoors. c) Removing ticks by rubbing them away from the skin with a credit card. d) Inspecting the skin closely for ticks after the child plays in wooded areas. e) Wearing protective clothing when playing in wooded areas.

• Wearing protective clothing when playing in wooded areas. • Inspecting the skin closely for ticks after the child plays in wooded areas. • Contacting the health care provider if there is any area of inflammation that might be a bite. The nurse should teach the parents to have the child wear protective clothing and dress the child in light clothing when playing in wooded areas or going outdoors. The parents should inspect the child's skin closely for ticks after being outside in wooded areas and if any ticks are found, remove them with a tweezer, not rub them with a credit card. The parents also should be instructed to contact their health care provider if they notice any area of inflammation that might be a tick bite.

An 11-year-old girl arrives at the doctor's office with fever, a sore throat, chills, and malaise. A throat culture indicates scarlet fever. Which other symptom should the nurse notice in this patient that clearly indicates scarlet fever? a) There is pain along the jawline just in front of the ear lobe b) Fever blisters on the lips c) The tongue has a white or red "strawberry" appearance d) Vesicles that become purulent, ooze, and form honey-colored crusts

The tongue has a white or red "strawberry" appearance A "strawberry tongue" is a hallmark symptom of scarlet fever and helps to differentiate the disease from other rashes or pharyngeal infections. Pain along the jawline in front of the ear lobe indicates mumps. Vesicles that become purulent, ooze, and form honey-colored crusts are associated with impetigo. Fever blisters on the lips are caused by a herpes simplex infection.

A 15-year-old boy visits his primary care physician's office with fever, headache, and malaise, along with complaints of pain on chewing and pain in the jawline just in front of the ear lobe. The boy asks his mother to leave the exam room for a minute and then tells the nurse that he is also experiencing testicular pain and swelling. The nurse recognizes that this client most likely has which of the following conditions? a) Herpes zoster b) Poliomyelitis c) Infectious mononucleosis d) Mumps

Mumps Initial symptoms of mumps include fever, headache, anorexia, and malaise. Within 24 hours, pain on chewing and an "earache" occurs. When the child points to the site of the earache, however, the child points, not to the ear, but to the jawline just in front of the ear lobe, the site of the parotid gland. By the next day, the gland appears swollen and feels tender; the ear becomes displaced upward and backward. Boys may also develop testicular pain and swelling (orchitis). None of the other conditions listed matches the symptoms indicated.

A nursing instructor is teaching the students about the standard and transmission-based precautions. What type of precautions requires placing a patient in an isolated room with limited access, wearing gloves during contact with the patient and all body fluids or contaminated items, wearing two layers of protective clothing, and avoiding sharing equipment between patients? a) Droplet precautions b) Standard precautions c) Airborne precautions d) Contact precautions

Contact precautions Contact precautions means placing the patient in an isolation room with limited access, wearing gloves during contact with the patient and all body fluids, wearing two layers of protective clothing, limiting movement of the patient from the room, and avoiding sharing equipment between patients

A 5-year-old girl catches the flu from a friend at daycare after the friend sneezed and wiped mucus on a toy that the girl played then with. In this case, which of the following is the portal of exit in the chain of infection? a) Upper respiratory excretion b) The friend c) The 5-year-old girl d) Toy

Upper respiratory excretion The portal of exit is the route by which an organism leaves an infected child's body to be spread to others. Organism can be carried out of the body by upper respiratory excretions, feces, vomitus, saliva, urine, vaginal secretions, blood, or lesion secretions. The friend would be the reservoir, which is the container or place in which an organism grows and reproduces. The toy would be the means of transmission. The 5-year-old girl would be the susceptible host.

A 6-month-old boy develops roseola. When obtaining information from his father, which of the following information would you expect him to report? a) The infant is lethargic and not interested in playing. b) The infant's temperature fell when the rash appeared. c) The infant's temperature rose at the same time as the rash appeared. d) The rash is a mixture of papules and pustules.

The infant's temperature fell when the rash appeared. The mark of roseola is that the rash appears as the initial temperature decreases.

The nurse is caring for a 16-year-old child with a diagnosis of acquired immunodeficiency syndrome (AIDS). Which of the following goal has the highest priority for this child? a) Improving nutrition b) Preventing spread of infection c) Maintaining skin integrity d) Promoting comfort

Preventing spread of infection Major goals for the child include maintaining the highest level of wellness possible by preventing infection and the spread of the infection. Because the adolescent has the belief that nothing can hurt him or her, and also because of the increasing rate of sexual activity in this age group which often involves multiple partners, the highest priority is teaching and preventing the spread of the infection. Othe goals include maintaining skin integrity, minimizing pain, improving nutrition, alleviating social isolation, and diminishing a feeling of hopelessness. The primary goal for the family is improving coping skills and helping the teen cope with the illness.

A 6-month-old baby 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? a) Roseola b) Rubella (German measles) c) Measles (Rubeola) d) Chickenpox (Varicella)

Roseola Roseola begins with a high fever; after 3 or 4 days, the fever falls abruptly and a distinctive rash of discrete, rose-pink macules approximately 2 to 3 mm in size and flat with the skin surface appears. With rubella, after the 1 to 5 days of prodromal signs, a discrete pink-red maculopapular rash begins on the face, then spreads downward to the trunk and extremities. On the third day, the rash disappears. Measles feature Koplik's spots (small, irregular, bright-red spots with a blue-white center point), which appear on the buccal membrane. Chickenpox is marked by a low-grade fever, malaise, and, in 24 hours, the appearance of a distinctive rash. Varicella lesions first begin as a macula, then progress rapidly within 6 to 8 hours to a papule, then a vesicle that becomes umbilicated and then forms a crust.

A group of camp nurses is discussing various types of tick bites. One of the nurses states that deer ticks are carried by white-footed mice and white-tailed deer, and can carry the organism that causes which of the following diseases? a) Gonorrhea b) Lyme disease c) Rheumatic fever d) Acquired immunodeficiency syndrome

Lyme disease Deer ticks, carried by white-footed mice and white-tailed deer, can carry the organism that causes lyme disease.