chapter 43 maternal
A child is diagnosed with group A streptococcal pharyngitis. The nurse would teach the parents to be alert for signs and symptoms of: osteomyelitis. scarlet fever. impetigo. pneumonia.
Correct response: scarlet fever. Explanation: 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 hospitalized child develops herpangina. Which of the following infection control precautions would the nurse expect to institute? Select all that apply. standard precautions droplet precautions contact precautions airborne precautions
Correct response: standard precautions contact precautions Explanation: If a child is hospitalized and develops herpangina, an infection caused by coxsackievirus A, the nurse would institute standard and contact precautions.
When developing the plan of care for a 5-year-old boy with Rocky Mountain spotted fever, the nurse knows the cause of the illness is: an animal bite. the bite of a tick. contact with contaminated sports equipment. infection with group A streptococcus.
Correct response: the bite of a tick. Explanation: Rocky Mountain spotted fever is a tick-borne infection. Rabies is due to the bite of an animal. Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is transmitted through direct person-to-person contact, respiratory droplets, blood, or sharing of personal items and touching surfaces or items contaminated with MRSA. Scarlet fever is an infection resulting from group A streptococcus.
The nurse is performing a physical examination on a 9-year-old boy who has experienced a tick bite on his lower leg and is suspected of having Lyme disease. Which assessment finding would the nurse expect to find? Swelling in the neck Confusion and anxiety Hypersalivation Ring-like rash on lower leg
orrect response: Ring-like rash on lower leg Explanation: A ring-like rash at the site of the tick bite is characteristic for Lyme disease. Swelling in the neck is a symptom of mumps. Confusion, anxiety, and hypersalivation are symptoms of rabies.
The parents ask the nurse how to prevent their child from becoming sick. Which response by the nurse is most appropriate? "Clean your bathroom and kitchen when they look dirty." "Handwashing is an effective way to prevent infection." "A daily multi-vitamin will boost the immune system." "Remind your child to cover the mouth when coughing." SUBMIT ANSWER
Correct response: "Handwashing is an effective way to prevent infection." Explanation: Proper handwashing is the best method to reduce chances of acquiring an infection. Although multivitamins may help provide the body with needed nutrients and covering a cough can prevent the spread of infection to others, neither of these will directly prevent the child from contracting an infectious disorder. Parents should be educated that bacteria and viruses are not visible and the bathroom and kitchen should be cleaned on a routine basis to avoid bacterial/viral transmission.
After teaching nursing students about childhood exanthems, the instructor determines that the teaching was successful when the students identify what as the primary cause? Fungi Viruses Parasites Bacteria
Correct response: Viruses Explanation: Most childhood exanthems are caused by viruses.
The nurse is caring for a child admitted to the hospital for sepsis. Which assessment finding is the most concerning? apical heart rate 120 beats per minute urine output of 10 ml over 3 hours white blood cell count 18,000/mm3 oral temperature 102.3°F (39°C)
Correct response: urine output of 10 ml over 3 hours Explanation: Children with sepsis will show alteration in temperature, heart rate, respiratory rate, and white blood cell count. Septic shock with organ dysfunction is more serious and can be manifested by decreased urine output.
Which of the following is the drug of choice for multidrug-resistant strains of infection? trimethoprim/sulfamethoxazole clindamycin vancomycin erythromycin
Correct response: vancomycin Explanation: Vancomycin is the drug of choice for serious infections involving multiple drug-resistant strains. Sensitive strains respond to most antibiotics including erythromycin and clindamycin. Most community-acquired MRSA infections can be treated on an outpatient basis with trimethoprim/sulfamethoxazole or clindamycin.
The nurse is caring for an adolescent diagnosed with genital herpes. The drug of choice for treating genital herpes is: acyclovir griseofluvin ceftriaxone penicillin
correct response: acyclovir Explanation: The drug acyclovir is useful in relieving or suppressing the symptoms of genital herpes.
The nurse is caring for a child admitted to the hospital for sepsis. Which assessment finding is the most concerning? urine output of 10 ml over 3 hours oral temperature 102.3°F (39°C) white blood cell count 18,000/mm3 apical heart rate 120 beats per minute
Correct response: urine output of 10 ml over 3 hours Explanation: Children with sepsis will show alteration in temperature, heart rate, respiratory rate, and white blood cell count. Septic shock with organ dysfunction is more serious and can be manifested by decreased urine output.
When providing care for a child with herpes zoster (shingles), the parents ask the nurse how the child contracted this infectious disorder. Which response by the nurse is most appropriate? "Herpes zoster is a reactivation of a previous varicella zoster infection." "Your child must have been exposed to someone with herpes zoster." "Handwashing is an effective way to prevent the spread of infectious disorders." "Children who are immunocompromised are more likely to contract shingles."
Correct response: "Herpes zoster is a reactivation of a previous varicella zoster infection." Explanation: Herpes zoster (shingles) is reactivation of the latent varicella zoster (chickenpox) infection that occurs during times of immunosuppression and aging. Although it is possible to contract the varicella zoster virus from a person with herpes zoster or varicella zoster, a child diagnosed with herpes zoster has already been exposed to varicella zoster. Handwashing will not directly prevent herpes zoster.
Parents of a child who has been diagnosed with tinea capitis ask how the child got the infection. Which of the following would the nurse explain as the most likely cause? bite of a tick not properly washing hands using a friend's comb puncture wound with a rusty object
Correct response: using a friend's comb Explanation: Tinea capitis or head lice is commonly transmitted when children share personal items such as combs, brushes, or other personal objects. Lyme disease and Rocky Mountain Spotted Fever are transmitted by a tick bite. Tetanus is transmitted through a puncture wound with a contaminated object. Helminthic infections are often transmitted by not properly washing hands.
When the nurse is instructing on disease transmission, which is noted as the smallest infectious agent known? bacteria fungus virus yeast
Correct response: virus Explanation: Viruses are the smallest infectious agents known, so small they cannot be seen through an ordinary microscope.
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? "After applying this special cream, leave it on for about 8 to 10 hours." "Be sure your child wears shoes at all times." "Make sure your child washes hands before eating." "Seal the child's clothing in a plastic bag for at least 10 days."
Correct response: "Make sure your child washes hands before eating." Explanation: The most effective measure to prevent pinworms or a recurrence is good hand hygiene, especially after using the bathroom and before eating. Sealing the child's clothing in a plastic bag is appropriate for pediculosis capitis. Having the child wear shoes at all times is helpful in preventing hookworm. Use of a cream that remains on for a specified time is associated with scabies.
Infectious mononucleosis ("mono") is caused by which of the following? Epstein-Barr virus Microsporum canis Treponema pallidum Streptococcal bacterium
Correct response: Epstein-Barr virus Explanation: Infectious mononucleosis ("mono") is caused by the Epstein-Barr virus, one of the herpes virus groups. The organism is transmitted through saliva.
The nurse is reviewing a pediatric client's laboratory results. An elevation in which type of cells indicates that white blood cells are actively involved with phagocytosis? Select all that apply. neutrophils basophils lymphocytes monocytes eosinophils
Correct response: neutrophils monocytes Explanation: The cells chiefly responsible for phagocytosis are neutrophils. Monocytes serve as backup cells for phagocytosis. Eosinophils are involved with parasitic infections, while basophils increase with inflammation. Lymphocytes are involved with the immune response.
The parents of a 5-year-old have just found out that their child has head lice. Which statement by the parents would support the nursing diagnosis of deficient knowledge? "We'll have to get that special shampoo." "Everybody in the house will need to be checked." "That explains his complaints of itching on his neck." "I can't believe it. We're not unclean, poor people."
Correct response: "I can't believe it. We're not unclean, poor people." Explanation: Head lice is not an indication of poor hygiene or poverty. It occurs in all socioeconomic groups. Thus, the parents' statement about being unclean and poor reflects a lack of knowledge about the infection. A pediculicide is used to wash the hair to treat the infestation. Household contacts need to be examined and treated if affected. Extreme pruritus is the most common symptom, with nits or lice especially behind the ears or at the nape of the neck.
Nursing students are learning about the body's response to infection. Which of the following statements made by a student indicates an understanding of the job of pus in an infection? "Pus indicates that the infection has entered the bloodstream." "Pus can never be good for the body." "Pus indicates that phagocytosis is occurring." "Pus indicates that the infection is getting worse."
Correct response: "Pus indicates that phagocytosis is occurring." Explanation: The action of phagocytes on organisms produces pus. Many people think the presence of pus indicates a worsening infection. More likely, it indicates phagocytosis and that the infection is resolving.
A toddler has a fever. The parent calls the clinic wanting to know the appropriate dosage of acetaminophen to give the child. The parents say the child weighs 26 lb (11.8 kg). What is the lowest dose the nurse would instruct the parent to administer to the child? 165 mg 118 mg 130 mg 177 mg
Correct response: 118 mg Explanation: The normal range for the dosage of acetaminophen is 10 to 15 mg/kg. The child weighs 11.8 kg. Using the lowest dose at 10 mg/kg, the child would need 118 mg. At 12 mg/kg, the dose would be 142 mg. At 14 mg/kg, the dose would be 165 mg. The highest dose at 15 mg/kg would equal 177 mg.
A nursing instructor has presented a class on the stages of an infectious disease to a group of students and asks the students to place the stages in their proper sequence from beginning to end. Place the stages in their proper sequence. 1Convalescence 2Incubation 3Illness 4Prodrome
Correct response: Incubation Prodrome Illness Convalescence Explanation: An infectious disease begins with incubation, then progresses to the prodrome stage, then to illness, and finally to convalescence.
A child is diagnosed with scarlet fever. The nurse is reviewing the child's medical record, expecting which medication to be prescribed for this child? Doxycycline Penicillin V Acyclovir Ibuprofen
Correct response: Penicillin V Explanation: Penicillin V is the antibiotic of choice for the treatment of scarlet fever. Ibuprofen is used to treat fever. Acyclovir is used to treat viral infections. Doxycycline, a tetracycline, is the drug of choice for treating Rocky Mountain spotted fever.
The nurse is caring for a child diagnosed with hepatitis B. Which system is most likely to have complications from this diagnosis? cardiovascular gastrointestinal neurologic respiratory
Correct response: gastrointestinal Explanation: Complications of hepatitis B can be fatal; in particular, issues related to the liver and chronic conditions are concerns.
The nurse is discussing medications to be given to a child who has been diagnosed with oral candidiasis (thrush). Which medication would most likely be prescribed for the child? aspirin acetaminophen ampicillin nystatin
Correct response: nystatin Explanation: Application of nystatin to the oral lesions every 6 hours is an effective treatment for oral candidiasis (thrush). Treatment for diaper rash caused by Candida albicans is nystatin ointment or cream applied to the affected area.
The most common complication of varicella is: scarring. pneumonia. secondary bacterial infections. encephalitis.
orrect response: secondary bacterial infections. Explanation: Varicella starts with lesions that appear first on the scalp, face, trunk, and then extremities. The lesions begin as macules then develop into papules and finally clear, fluid-filled vesicles. These lesions are intensely pruritic. The most common complication of varicella is secondary bacterial infection caused by the child scratching the lesions. Other complications include pneumonia, scarring, and encephalitis.
A nursing instructor is teaching students about childhood infectious diseases. Which of the following would the instructor identify as the cause of warts in children? rubella virus herpes virus papillomavirus coxsackievirus
Correct response: papillomavirus Explanation: Warts, one of the most common dermatologic diseases in children, are caused by the papillomavirus.
The nurse is caring for a child diagnosed with hand-foot-mouth disease. When educating the family about this disease, which education by the nurse is most important? "Make sure your child drinks plenty of nonirritating fluid." "You can give acetaminophen every 4 to 6 hours for pain." "The lesions should disappear in a few days without scarring." "Hand-foot-mouth disease is associated with a high fever."
Correct response: "Make sure your child drinks plenty of nonirritating fluid." Explanation: Children with hand-foot-mouth disease can experience dehydration related to the high fever, anorexia, and painful mouth lesions. The nurse should educate the family to provide nonirritating fluids to encourage the child to drink to avoid dehydration. Hand-foot-mouth disease is associated with a high fever, and parents can provide acetaminophen. The lesions should disappear in a few days; however, the most important education is aimed at prevention of dehydration.
While assessing a child, the nurse notes a runny nose, temperature 100.4°F (38°C), and a whoop sound when the child coughs. On which diagnosis will the nurse anticipate providing education for this family? influenza pertussis tuberculosis nasopharyngitis
Correct response: pertussis Explanation: Pertussis, also known as whooping cough, begins as an upper respiratory illness and progresses to a persistent cough characterized by a whooping sound. Tuberculosis, influenza, and nasopharyngitis are not characterized by a whooping sound.
When developing the plan of care for a 5-year-old boy with Rocky Mountain spotted fever, the nurse knows the cause of the illness is: the bite of a tick. contact with contaminated sports equipment. infection with group A streptococcus. an animal bite.
Correct response: the bite of a tick. Explanation: Rocky Mountain spotted fever is a tick-borne infection. Rabies is due to the bite of an animal. Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is transmitted through direct person-to-person contact, respiratory droplets, blood, or sharing of personal items and touching surfaces or items contaminated with MRSA. Scarlet fever is an infection resulting from group A streptococcus.
The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which skin condition best describes erythema? redness of the skin produced by congestion of the capillaries small elevation of epidermis filled with a viscous fluid discolored skin spot not elevated at the surface small, circumscribed, solid elevation of the skin
correct response: redness of the skin produced by congestion of the capillaries Explanation: Erythema is redness of the skin produced by congestion of the capillaries.
The nurse is providing teaching to the parents of a child with varicella. Which statement indicates that the parents have understood the instructions? "The lesions should eventually form soft crusts that drain." "We should apply alcohol to the lesions every four hours." "If he has a fever, we can give him some aspirin." "We need to make sure that he washes his hands frequently."
Correct response: "We need to make sure that he washes his hands frequently." Explanation: The child with varicella needs to wash his hands frequently with antibacterial soap to reduce bacterial colonization. A cool bath with soothing colloidal oatmeal may help the skin discomfort. Alcohol would be too drying to the skin. Acetaminophen, not aspirin, should be used to reduce fever. The lesions should eventually crust over. Soft crusts with drainage may suggest an infection.
The nurse is providing teaching to the parents of a child with varicella. Which statement indicates that the parents have understood the instructions? "We need to make sure that he washes his hands frequently." "If he has a fever, we can give him some aspirin." "The lesions should eventually form soft crusts that drain." "We should apply alcohol to the lesions every four hours."
Correct response: "We need to make sure that he washes his hands frequently." Explanation: The child with varicella needs to wash his hands frequently with antibacterial soap to reduce bacterial colonization. A cool bath with soothing colloidal oatmeal may help the skin discomfort. Alcohol would be too drying to the skin. Acetaminophen, not aspirin, should be used to reduce fever. The lesions should eventually crust over. Soft crusts with drainage may suggest an infection.
While assessing a child, the nurse notes a runny nose, temperature 100.4°F (38°C), and a whoop sound when the child coughs. On which diagnosis will the nurse anticipate providing education for this family? tuberculosis influenza pertussis nasopharyngitis
Correct response: pertussis Explanation: Pertussis, also known as whooping cough, begins as an upper respiratory illness and progresses to a persistent cough characterized by a whooping sound. Tuberculosis, influenza, and nasopharyngitis are not characterized by a whooping sound.
A school-aged child is recovering from varicella. The parent calls the school nurse and states, "my child is feeling much better" and asks when the child can return to school. What information does the nurse provide the parent? "Your child may return to school when free of any lesions." "Your child may return to school when all of the lesions have crusted over." "Your child may return to school when a health care provider has given written permission." "Your child may return to school when there has been no fever for 48 hours."
Correct response: "Your child may return to school when all of the lesions have crusted over." Explanation: Varicella is a highly communicable disease. It is spread via airborne transmission or by direct contact with the nasopharyngeal secretions of an infected person. Varicella is communicable from 1 to 2 days before the rash occurs until all the vesicles have crusted over. The nurse would be correct in telling the parent the child cannot return to school, even though the child is feeling better, until all the vesicles have crusted over. The child does not have to be free of lesions. Being free of fever does not make the child less communicable. The child would not need a permission slip from the health care provider unless this is a specific requirement by the child's school district.
A school-aged child is recovering from varicella. The parent calls the school nurse and states, "my child is feeling much better" and asks when the child can return to school. What information does the nurse provide the parent? "Your child may return to school when there has been no fever for 48 hours." "Your child may return to school when all of the lesions have crusted over." "Your child may return to school when free of any lesions." "Your child may return to school when a health care provider has given written permission."
Correct response: "Your child may return to school when all of the lesions have crusted over." Explanation: Varicella is a highly communicable disease. It is spread via airborne transmission or by direct contact with the nasopharyngeal secretions of an infected person. Varicella is communicable from 1 to 2 days before the rash occurs until all the vesicles have crusted over. The nurse would be correct in telling the parent the child cannot return to school, even though the child is feeling better, until all the vesicles have crusted over. The child does not have to be free of lesions. Being free of fever does not make the child less communicable. The child would not need a permission slip from the health care provider unless this is a specific requirement by the child's school district.
After teaching the parents of a child with chickenpox (varicella zoster), the nurse determines that the parents have understood the teaching when they state that their child can return to school at which time? After day 5 of the rash After the lesions have crusted Once the rash appears When the rash is completely healed
Correct response: After the lesions have crusted Explanation: Children with chickenpox (varicella zoster) can return to school once the lesions have crusted.
The nurse is caring for a child whose family recently emigrated from a developing country. While completing the admission history, the parents report all the child's immunizations are up to date. Which nursing action is most appropriate? Document that immunizations are up to date in the chart. Administer varicella and meningococcal vaccines. Request parents follow WHO vaccine recommendations. Ask parents which immunizations have been given.
Correct response: Ask parents which immunizations have been given. Explanation: When caring for a child recently emigrated from a developing country, the nurse should be aware that WHO recommended vaccinations and U.S. recommended vaccinations may be different. The most appropriate action is for the nurse to determine which vaccinations have been given to decide if additional immunizations may be needed.
The nurse is triaging a child diagnosed with poliomyelitis. After ensuring appropriate precautions are in place, what will the nurse do next? Place the child on bed rest. Auscultate the child's lungs. Begin physical therapy. Administer an antipyretic.
Correct response: Auscultate the child's lungs. Explanation: Because poliomyelitis can cause motor paralysis of the respiratory muscles, assessing respiratory status is priority. Once the nurse has ensured respiratory function is intact, the nurse can place the child on bed rest, administer an antipyretic, and begin physical therapy.
The nurse is performing a physical examination for a 7-year-old girl who was bitten by a tick. What would alert the nurse to the possibility of early localized Lyme disease? Recurrent arthritis in the large joints Multiple erythema migrans on the skin Cranial nerve palsies Bull's-eye rash around the bite
Correct response: Bull's-eye rash around the bite Explanation: A bull's-eye rash (ring-like rash) around the bite is typical of early localized Lyme disease. Multiple erythema migrans on the skin occurs during early disseminated disease. Cranial nerve palsies are indicative of early disseminated disease. Recurrent arthritis in the large joints occurs in the late stage of the disease.
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? Standard precautions Airborne precautions Droplet precautions Contact precautions
Correct response: Contact precautions Explanation: Contact precautions means placing the client in an isolation room with limited access, wearing gloves during contact with the client and all body fluids, wearing two layers of protective clothing, limiting movement of the client from the room, and avoiding sharing equipment between clients. Standard precautions are used with every client. They involve good handwashing and the use of gloves for client contact. Airborne precautions are used for diseases where small particles are dispersed in the air. They require that the client be in a negative-pressure room and, in addition to standard personal protective equipment, the mask should be N95 or higher. Varicella would need airborne precautions. Droplet precautions are used for diseases such as pertussis, which produce large droplets. They require standard precautions plus a surgical mask, preferably with a face shield.
It is summertime, and the mother of a 6-year-old boy tells the nurse that the mosquitoes in their neighborhood are terrible this year. She says she has heard of cases of West Nile virus in the area and asks the nurse what she can do to protect her son from it. Which of the following should the nurse recommend to the mother? Have the son dress in light-colored clothing. Instruct the son to stay inside from 11 am to 3 pm. Avoid using mosquito repellants that contain DEET. Drain any standing water in the yard.
Correct response: Drain any standing water in the yard. Explanation: Parents can help prevent the spread of West Nile disease by adhering to the "5D's": Instruct children to stay inside between dusk and dawn (not 11 am to 3 pm) when mosquitoes are most prevalent. Drain standing water so there are few opportunities for mosquitoes to breed. Dress should include long pants and long sleeves when outside (not light-colored clothing). Apply mosquito repellant that contains DEET (use a concentration not over 30% and apply only once a day. Don't place it on children's hands so they don't ingest it or use it with infants under 2 months of age).
Which collaborative intervention will the nurse provide when caring for an infant diagnosed with pertussis? Select all that apply. Have suction available in the room. Utilize droplet and standard precautions. Encourage small, frequent feedings. Administer erythromycin for 10 days. Restrict visitors for 48 hours of hospitalization.
Correct response: Have suction available in the room. Encourage small, frequent feedings. Administer erythromycin for 10 days. Utilize droplet and standard precautions. Explanation: Infants with pertussis are generally admitted to the hospital for at least 48 hours to see how the disease course is progressing. Droplet precautions are used until 5 days after a child starts antibiotic therapy, and visitors may be restricted during this time (5 days). Standard precautions will be used throughout the hospitalization. Frequent small meals are vomited less than larger meals, making it easier for the infant to maintain nutritional status. A full 10-day course of erythromycin or azithromycin may be prescribed because these drugs have the potential to shorten the period of communicability and may shorten the duration of symptoms. Infants with pertussis may need airway suction for thick secretions.
A nurse is instructing the parents of a child who is suspected of having pinworms how to check the child. Which instruction would be most appropriate? Observe the characteristics of the child's stool, which will be watery. Check the washcloth after having the child wipe himself during bathing. Inspect the child's anus with a flashlight 2 to 3 hours after he is asleep. Look on the child's bed linens for evidence of black dots.
Correct response: Inspect the child's anus with a flashlight 2 to 3 hours after he is asleep. Explanation: Diagnosis is confirmed by direct visualization of worms by the parents or by microscopy. Tell parents to view the child's anus with a flashlight 2 to 3 hours after the child is asleep. The worm is white, thin, and about 1/2 inch long, and it moves. Pinworms are not identified as black dots on bed linens. Specimens are best obtained as the child awakens before toileting or bathing. Checking the washcloth would be of no benefit. Pinworms do not change the appearance of the stool.
The nurse is performing a physical examination of an 8-year-old girl who was bitten by her kitten. Which assessment would lead the nurse to suspect cat-scratch disease? Swollen neck Strawberry tongue Infected tonsils Swollen lymph nodes
Correct response: Swollen lymph nodes Explanation: Lymph nodes, especially under the arms, can become painful and swollen due to cat-scratch disease. Strawberry tongue is typical of scarlet fever. Infected tonsils and an edematous neck are symptoms of diphtheria.
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. How would the nurse document these findings? Koplik spots Slapped cheek appearance Lymphadenopathy Nits
Correct response: Koplik spots Explanation: 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.
A nurse is preparing a presentation for parents about common childhood infectious diseases. What conditions would the nurse include as being caused by a tick bite? Select all that apply. Scabies Psittacosis Lyme disease Rocky Mountain spotted fever Ascariasis
Correct response: Lyme disease Rocky Mountain spotted fever Explanation: 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 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 condition? Mumps Herpes zoster Poliomyelitis Infectious mononucleosis
Correct response: Mumps Explanation: 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, he points 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 7-year-old child with an earache comes to the clinic. The child's parent reports that 1 day ago the child had a fever and headache and did not want to play. When the nurse asks where it hurts, the child points to the jawline in front of the earlobe. What does the nurse expect the diagnosis will be for this child? Fifth disease Measles Mononucleosis Mumps
Correct response: Mumps Explanation: Mumps begins 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. Mumps is contagious 1 to 7 days prior to the onset of symptoms and 4 to 9 days after the parotid swelling begins. Fifth disease is also known as the "slapping disease," as the rash on the cheeks look like someone slapped the child's face. Measles does not involve parotid swelling or earaches. Mononucleosis does involve swollen lymph nodes but they are in the neck and the axillary area.
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 infectious disease? Measles Mumps Whooping cough Scabies
Correct response: Mumps Explanation: Mumps is an infectious disease with a primary symptom of a swollen parotid gland. It is a contagious disease spread by droplets. The child is contagious 1 to 7 days prior to the onset of the swelling and 4 to 9 days after the onset of the swelling. Pertussis is a respiratory disorder that causes severe paroxysmal coughing, which produces a whooping sound. Measles is recognized by Koplik spots in the mouth and the classic maculopapular rash that starts on the head and spreads downward. Scabies is a skin condition where lice lay eggs under the skin. The rash is very pruritic and is seen on the hands, feet, and folds of the skin.
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? Arms Legs Neck Stomach
Correct response: Neck Explanation: Tetanus progresses in a descending fashion to other muscle groups, causing spasms of the neck, arms, legs, and stomach.
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? Stomach Arms Neck Legs
Correct response: Neck Explanation: Tetanus progresses in a descending fashion to other muscle groups, causing spasms of the neck, arms, legs, and stomach.
After teaching a class on the role of white blood cells in infection, the instructor determines that the teaching was successful when the class identifies which type of white blood cells as important in combating bacterial infections? Basophils Eosinophils Lymphocytes Neutrophils
Correct response: Neutrophils Explanation: Elevations in certain portions of the white blood cell count reflect different processes occurring in the body. Neutrophils function to combat bacterial infection. Eosinophils function in allergic disorders and parasitic infections. Basophils combat parasitic infections and some allergic disorders. Lymphocytes function in viral infections.
The nurse is assessing a child who presents with a history of fever, malaise, fatigue, and headache. The nurse notes a bulls-eye rash on the child's right leg. Which action will the nurse take? Notify the primary health care provider. Place the child on contact precautions. Obtain an electrocardiography (ECG). Clean the rash with rubbing alcohol.
Correct response: Notify the primary health care provider. Explanation: The nurse would suspect the child has Lyme disease and notify the health care provider for additional testing and potential antibiotic therapy. Precautions are not indicated for clients with Lyme disease. An ECG would only be needed if cardiac symptoms were noted. It is recommended to clean the site of the tick bite with rubbing alcohol when the tick is removed, not at a later time.
A mother brings her 8-year-old son for evaluation because of a rash on his lower leg. Which finding would support the suspicion that the child has Lyme disease? Playing in the woods about a week ago High fever occurring about 4 days before the rash Reports of extreme pruritus with visible nits Rash is papular and vesicular
Correct response: Playing in the woods about a week ago Explanation: Lyme disease is caused by the bite of an infected tick, with a rash appearing 7 to 14 days after the tick bite. Ticks are commonly found in wooded areas. Therefore, reports of the child playing in the woods about 7 days ago would support the diagnosis of Lyme disease. A papular and vesicular rash is commonly associated with varicella (chickenpox). A high fever for 3 to 5 days before a rash suggests roseola. Extreme pruritus with visible nits would suggest pediculosis.
A nursing instructor is teaching students about the chain of infection. What does the instructor tell students is responsible for allowing the pathogen to enter? Means of transmission Portal of entry Reservoir Portal of exit
Correct response: Portal of entry Explanation: The chain of infection is the process by which organisms are spread. An infectious agent is any organism capable of causing an infection. It can be bacteria, viruses, or fungi. The reservoir is the place where these organisms thrive and reproduce. After reproduction, the organism must leave the reservoir. This area is the portal of exit. Pathogens can be transmitted via either direct or indirect methods. Direct method would be close contact with the infected person. Indirect transmission occurs with things like droplets in the air (e.g., sneeze, cough). The portal of entry is the way for a pathogen to enter the body. It can be through inhalation, ingestion, or breaks in the skin. Any person who cannot resist the pathogen is the susceptible host.
A nurse practitioner suspects that a child has scarlet fever based on which assessment finding? Severity of the sore throat Red, strawberry tongue An enanthematous rash White exudate on the tonsils
Correct response: Red, strawberry tongue Explanation: 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.
What information should be included in the teaching plan for a child with varicella? Remind the child not to scratch the lesions. Place the child in a warm bath for skin discomfort. Administer aspirin for fever. Utilize salt solutions to assist in healing oral lesions.
Correct response: Remind the child not to scratch the lesions. Explanation: Varicella lesions appear first on the scalp. They spread to the face, the trunk, and to the extremities. There may be various stages of the lesions present at any one time. The lesions are intensely pruritic. The teaching plan for varicella should include that the child not scratch the lesions. Opening the lesions gives access for secondary infection to occur and causes scarring. Acetaminophen, not aspirin, should be administered for fever due to the link with Reye syndrome. The best treatment for skin discomfort is a cool bath with soothing colloidal oatmeal every 3 to 4 hours for the first few days. Warm baths cause more itching and dry the skin.
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 is over 102°F (38.9°C). He has this rash on his face and chest that looks like sunburn but feels really rough." What would the nurse suspect? Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) Pertussis Scarlet fever Diphtheria
Correct response: Scarlet fever Explanation: Scarlet fever typically is associated with a sore throat, fever greater than 101° F (38.9° C), 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 (38.9°C). Airway obstruction is apparent. Pertussis is characterized by cough and cold symptoms that progress to paroxysmal coughing spells along with copious secretions.
What is a true statement regarding varicella zoster virus infection? It is transmitted by fecal-oral route. It tends to be more severe in children. The incubation period is 7 days. Secondary bacterial infections of the skin can occur.
Correct response: Secondary bacterial infections of the skin can occur. Explanation: Varicella zoster virus infection carries with it the complication of a secondary bacterial infection of the skin. The lesions are intensely pruritic, making the child want to scratch the lesions and opening them to a variety of organisms to invade. The incubation period is 10 to 21 days. It is transmitted by direct contact with the vesicles and by airborne route. It tends to be more severe in adolescents and adults.
A school-aged child with an infectious disease is placed on transmission-based precautions. If the child is not dehydrated or otherwise in distress, which nursing diagnosis would be the priority? Social isolation related to infectivity and inability to go to the playroom Fluid volume deficit related to increased metabolic demands and insensible losses Impaired skin integrity related to trauma secondary to pruritus and scratching Deficient knowledge related to how infection is transmitted
Correct response: Social isolation related to infectivity and inability to go to the playroom Explanation: Children who are placed on transmission-based precautions are not allowed to leave their rooms and are not allowed to go to common areas such as the playroom or schoolroom. Thus, they are at risk for social isolation. Impaired skin integrity, fluid volume deficit, and deficient knowledge may be appropriate but would depend on the infectious disease diagnosed.
A school-aged child with an infectious disease is placed on transmission-based precautions. If the child is not dehydrated or otherwise in distress, which nursing diagnosis would be the priority? Impaired skin integrity related to trauma secondary to pruritus and scratching Social isolation related to infectivity and inability to go to the playroom Fluid volume deficit related to increased metabolic demands and insensible losses Deficient knowledge related to how infection is transmitted
Correct response: Social isolation related to infectivity and inability to go to the playroom Explanation: Children who are placed on transmission-based precautions are not allowed to leave their rooms and are not allowed to go to common areas such as the playroom or schoolroom. Thus, they are at risk for social isolation. Impaired skin integrity, fluid volume deficit, and deficient knowledge may be appropriate but would depend on the infectious disease diagnosed. Reference:
A nurse is promoting vaccine administration. When instructing on the physiological changes, which statement best explains what occurs in the child when vaccines are administered? The child becomes a carrier of the disease. The child develops an active immunity. The child becomes a host for the disease. The child develops a passive immunity.
Correct response: The child develops an active immunity. Explanation: When a vaccine is given, active immunity occurs which then stimulates the development of antibodies to destroy infective agents without causing the disease.
A young girl arrives at the emergency room after being bitten by a neighbor's dog. The mother is concerned her daughter will get rabies. The nurse carefully examines and treats the bite and questions the mother and daughter about the details surrounding the dog biting her. What information would most strongly indicate a risk for rabies infection in this client? There have been no other reported instances in the area The dog was unprovoked when he bit the girl The dog belonged to a neighbor The dog was properly immunized for rabies
Correct response: The dog was unprovoked when he bit the girl Explanation: An unprovoked attack is much more suggestive that the animal is rabid, rather than if the bite happens during a provoked attack. The dog being immunized for rabies and there being no other reported instances of rabies in the area would indicate a lower risk that the dog was rabid. The fact that the dog belonged to a neighbor does not necessarily indicate a lower risk for rabies infection.
The nurse is caring for a child hospitalized with pertussis. Which nursing intervention would be the highest priority for this child? The nurse will encourage bed rest. The nurse will administer oxygen. The nurse will monitor caloric intake. The nurse will administer antibiotics.
Correct response: The nurse will administer oxygen. Explanation: The major complication of pertussis (whooping cough) is pneumonia and respiratory complications. Oxygen, bed rest, and monitoring for airway obstruction are nursing interventions. The highest priority is administering oxygen to maintain adequate oxygenation of cells.
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 client that clearly indicates scarlet fever? There is pain along the jawline just in front of the ear lobe Vesicles that become purulent, ooze, and form honey-colored crusts The tongue has a white or red "strawberry" appearance Fever blisters on the lips
Correct response: The tongue has a white or red "strawberry" appearance Explanation: 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 5-year-old girl catches the flu from a friend at day care after the friend sneezed and wiped mucus on a toy that the girl subsequently played with. In this case, what is the portal of exit in the chain of infection? The 5-year-old girl The friend Upper respiratory excretion Toy
Correct response: Upper respiratory excretion Explanation: The portal of exit is the route by which an organism leaves an infected child's body to be spread to others. An 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.
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 ask for suggestions on what to do to reduce their child's risk. What would be appropriate for the nurse to suggest? Select all that apply. Contacting the health care provider if there is any area of inflammation that might be a bite. Dressing the child in dark clothing when going outdoors. Inspecting the skin closely for ticks after the child plays in wooded areas. Wearing protective clothing when playing in wooded areas. Removing ticks by rubbing them away from the skin with a credit card.
Correct response: 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. Explanation: 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.
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 ask for suggestions on what to do to reduce their child's risk. What would be appropriate for the nurse to suggest? Select all that apply. Removing ticks by rubbing them away from the skin with a credit card. Dressing the child in dark clothing when going outdoors. 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. Wearing protective clothing when playing in wooded areas.
Correct response: 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. Explanation: 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.
The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see first? a child diagnosed with measles experiencing photophobia and coryza a child with erythema infectiosum experiencing fatigue and confusion a child diagnosed with chicken pox reporting nausea and malaise a child with herpes simplex who is reporting mouth pain and pruritis
Correct response: a child with erythema infectiosum experiencing fatigue and confusion Explanation: A child with erythema infectiosum experiencing fatigue and confusion is showing signs of decreased oxygenation, possibly related to aplasia of erythrocytes caused by the virus. A child with signs and symptoms of decreased oxygenation should be seen first. Nausea and malaise are symptoms of chicken pox. A child with herpes simplex will most likely report pain an pruritis. Signs and symptoms of measles include photophobia and coryza.
The nurse is telephone triaging multiple pediatric calls. Which telephone call will the nurse return first? a parent who wants to adopt a cat but is worried because the toddler has cat-scratch disease a parent who is concerned that her adolescent diagnosed with mononucleosis has abdominal pain a parent whose infant was diagnosed with hand-foot-mouth disease and is now lethargic a parent whose child was diagnosed with scarlet fever and now has a strawberry tongue
Correct response: a parent whose infant was diagnosed with hand-foot-mouth disease and is now lethargic Explanation: An infant with hand-foot-mouth disease is at risk for dehydration. Lethargy is not a typical sign/symptom of hand-foot-mouth disease; however, it is a sign of dehydration. A child with scarlet fever would be expected to have a strawberry tongue. A child with current cat-scratch disease is unlikely to contract this again from another cat. Abdominal pain is a common symptom of mononucleosis.
Which child will the nurse identify as being at greatest risk for developing a hospital-acquired infection (HAI)? a 3-year-old child with malnutrition and poor weight gain a 1-year-old receiving oral amoxicillin for otitis media an 18-month-old child receiving chemotherapy over 5 days a 2-year-old child with HIV being discharged later that day
Correct response: an 18-month-old child receiving chemotherapy over 5 days Explanation: The children at highest risk for contracting a hospital-acquired infection include children younger than 2 years of age, children with a nutritional deficit, those who are immunosuppressed, those who have indwelling vascular lines or catheters, are receiving multiple antibiotic therapy, or who remain in the hospital for longer than 72 hours. To determine the child at greatest risk, count risk factors and determine which child has the most risk factors.
A young client arrives at the clinic with a rash on the trunk and flexor surfaces of the extremities. The parent 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 health care provider diagnoses the child with erythema infectiosum. The nurse tells the parent that this is also known as: pityriasis rosea. enterovirus. rosacea. fifth disease.
Correct response: fifth disease. Explanation: 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. Pityriasis rosea is a skin rash that begins with a large spot on the chest, abdomen, or back that is followed by a pattern of small lesions. It is self-limiting and can be treated with steroid creams. Rosacea is a chronic inflammatory skin condition that causes redness to the face. An enterovirus infection can many times cause the same symptoms as the common cold or it can include the respiratory system. It is contagious.
The nurse caring for children with fungal infections most often administers which medication? acetaminophen benadryl prednisone griseofulvin
Correct response: griseofulvin Explanation: Griseofulvin, an oral antifungal, is the medication of choice for fungal infections. In some infections the treatment may be prolonged (3 months or more), and compliance must be reinforced.
A teenage client active on the high school football team comes to the clinic with a cut on his leg that looks infected. The culture report returns information that leads to a diagnosis of methicillin-resistant Staphylococcus aureus (MRSA). What should the nurse use as preventive measures in this case? droplet precautions handwashing contact precautions wearing a mask gloves
Correct response: handwashing contact precautions gloves Explanation: Because MRSA is spread through the skin, contact precautions, gloves, and strict handwashing are recommended to prevent the spread to others.
A nursing student learning about childhood infectious diseases correctly identifies which of the following as the disease related to chickenpox, which tends to occur in older children or young adults? mumps measles smallpox herpes zoster
Correct response: herpes zoster Explanation: Herpes zoster is caused by varicella-zoster virus, the same virus that causes chickenpox. Reference:
The immune system works to destroy pathogens by helping the body get rid of or resist the invasion of foreign materials The blood cells that surround, ingest, and neutralize the pathogens are: lymphocytes. erythrocytes. platelets. macrophages.
Correct response: macrophages. Explanation: When a pathogen enters the body, the immune system works to destroy the pathogen. This occurs when white blood cells known as macrophages surround, ingest, or neutralize the pathogen.
A child is diagnosed with giardiasis. The physician prescribes medication to treat the infection. Which of the following would the nurse anticipate being prescribed? metronidazole clotrimazole mebendazole griseofulvin
Correct response: metronidazole Explanation: Treatment of giardiasis is with metronidazole for 7 days. Griseofulvin is used to treat tinea capitis. Mebendazole is used to treat pinworms. Clotrimazole is used to treat tinea cruris and tinea corporis.
A high school football player comes to the clinic with malaise, fever, headache, and anorexia that have been present for the last few days. Upon physical examination, the nurse notes that the cervical lymph nodes are firm and tender. Tonsils are red and enlarged and appear to have a white covering. What should the nurse suspect the diagnosis to be for this client? rubella mumps fifth disease mononucleosis
Correct response: mononucleosis Explanation: Infectious mononucleosis occurs most commonly in adolescents and young adults. Beginning symptoms include chills, fever, headache, anorexia, and malaise. Children develop enlarged lymph nodes and a severe sore throat. The cervical lymph nodes feel tender and firm. The tonsils feel painful and are enlarged and erythematous. A thick, white membrane may cover the tonsils; often, petechiae appear on the palate. The spleen may enlarge, which places the child at risk for spontaneous rupture.
A 3-year-old girl was in the hospital for a week following open heart surgery. By the end of the week, she had contracted an infection. The nurse recognizes this type of infection as a: viral infection. bacterial infection. nosocomial (health care-associated) infection. fungal infection.
Correct response: nosocomial (health care-associated) infection. Explanation: Nosocomial (health care-associated) infections are contracted while in a hospital or other health care setting. Children younger than 2 years, children with a nutritional deficit, those who are immunosuppressed, those who have indwelling vascular lines or catheters, those who are receiving multiple antibiotic therapy, or those who remain in the hospital for longer than 72 hours are at highest risk for contracting such an infection. The infection could be viral, bacterial, or fungal, but not enough information is provided in the scenario to determine this.
A 3-year-old girl was in the hospital for a week following open heart surgery. By the end of the week, she had contracted an infection. The nurse recognizes this type of infection as a: viral infection. fungal infection. nosocomial (health care-associated) infection. bacterial infection.
Correct response: nosocomial (health care-associated) infection. Explanation: Nosocomial (health care-associated) infections are contracted while in a hospital or other health care setting. Children younger than 2 years, children with a nutritional deficit, those who are immunosuppressed, those who have indwelling vascular lines or catheters, those who are receiving multiple antibiotic therapy, or those who remain in the hospital for longer than 72 hours are at highest risk for contracting such an infection. The infection could be viral, bacterial, or fungal, but not enough information is provided in the scenario to determine this.
The nurse is caring for a newborn who was delivered vaginally. The infant has a white coating in the mouth that looks like milk curds. The nurse suspects that the infant has: tinea capitis caused by Microsporum audouinii. atopic dermatitis. pediculosis. oral candidiasis (thrush) caused by Candida albicans.
Correct response: oral candidiasis (thrush) caused by Candida albicans. Explanation: Newborns can be exposed to a candidiasis vaginal infection in the mother during delivery. Oral candidiasis (thrush) appears in the child's mouth as a white coating that looks like milk curds.
A child diagnosed with AIDS comes to the clinic for routine immunizations. In giving immunizations to the child who has AIDS, the nurse can safely administer the injectable vaccine given for which disease? mumps measles poliomyelitis chickenpox
Correct response: poliomyelitis Explanation: Live vaccines can not be given to the child with AIDS because of the child's compromised immune system. Inactivated oral poliovirus vaccine (IPV) is not a live vaccine and therefore could be given.