EAQ Ch. 6 Childhood Communicable & Infectious Diseases
What is the causative agent for erythema infectiosum (Fifth disease)? 1 Paramyxovirus 2 Human parvovirus B19 3 Human herpesvirus type 6 4 Group A β-hemolytic streptococcus
2 Human parvovirus B19 is the causative agent of Fifth disease. Paramyxovirus causes mumps. Human herpesvirus types 1 and 2 are the major causes of herpetic infections in human beings. Group A β-hemolytic streptococcus is the causative agent for scarlet fever.
What is the chief complaint of patients suffering from rashes? 1 Fever 2 Itching 3 Swelling 4 Drainage
2 Itching is the chief complaint from most people with rashes. Fever, swelling, and draining do not accompany rashes as often as itching does.
The nurse observes that a child has swollen eyelids, inflamed conjunctiva, and purulent drainage. The nurse expects the child to be treated for which condition? 1 Viral conjunctivitis 2 Allergic conjunctivitis 3 Bacterial conjunctivitis 4 Conjunctivitis caused by a foreign body
3 Swollen eyelids, purulent drainage, and inflamed conjunctiva are the clinical manifestations of bacterial conjunctivitis. Serous or watery drainage with swollen eyelids indicate viral conjunctivitis. Itching, watery to thick stringy discharge with swollen eyelids indicate allergic conjunctivitis. Pain with inflamed conjunctiva indicates conjunctivitis caused by a foreign body.
How does the nurse refer to the interval between the early manifestations of the disease and the time when the overt clinical syndrome is evident? 1 Source 2 Causative agent 3 Prodromal stage 4 Constitutional symptoms
3 The prodromal stage is the interval between the early manifestations of the disease and the time when an overt clinical syndrome is evident. The source is the causative agent of the disease. The causative agent is the organism that causes the disease. The constitutional symptoms are the symptoms that occur during the active phase of the disease.
A nurse is educating a patient's parents about the use of medicine in bacterial conjunctivitis. Which statement of the parents indicates the need for further teaching? (p. 171) 1 "We can administer eye drops anytime during the day." 2 "We should apply eye ointment before bedtime." 3 "We should use corticosteroids to treat conjunctivitis." 4 "We can use sodium sulfacetamide to treat conjunctivitis."
3 (I put 1) Inflammation of the conjunctiva due to bacterial infection is called bacterial conjunctivitis. Corticosteroids should be avoided, because they reduce ocular resistance to bacteria and worsen the infection. Eye drops should be used during the day, and an ointment should be used at bedtime, because this allows the ointment preparation remains in the eye for longer duration. Sodium sulfacetamide is a topical antibacterial agent and is used to treat bacterial conjunctivitis.
A toddler has bacterial conjunctivitis. Which medicine does the nurse expect the health care provider to order for the patient? 1 Acyclovir 2 Hydroxyzine 3 Mebendazole 4 Sodium sulfacetamide
4 Bacterial conjunctivitis is inflammation of the conjunctiva due to bacterial infection and is treated with topical antibacterial agents. Sodium sulfacetamide is a topical antibacterial agent. Acyclovir is an antiviral agent that is used to treat varicella infections. Hydroxyzine is an antipruritic medication used to treat severe itching. Mebendazole is used for the treatment of pinworms.
A nurse is caring for a preschooler with stomatitis. What should the nurse apply? (p. 172) 1 Kank-A preparation 2 Orabase preparation 3 Anbesol preparation 4 Diphenhydramine solution
4 Stomatitis is inflammation of the oral mucosa. The patient may be unable to eat due to painful lesions in the mouth. The nurse should apply diphenhydramine and Maalox solution with a cotton-tipped applicator before the patient eats to help minimize pain. This also provides mild analgesia, reduces inflammation, and forms a protective coating on the lesions. Kank-A, Orabase, and Anbesol are also used as topical anesthetics, but they do not reduce inflammation. They do not form a protective coating on the lesions.
A child is allergic to neomycin. Which vaccine does the nurse instruct this child's parent to avoid? 1 Tetanus 2 Pertussis 3 Inactivated polio 4 Measles, mumps, and rubella (MMR)
4 The MMR vaccine contains minute amounts of neomycin; it is therefore contraindicated in patients who are allergic to neomycin. The tetanus vaccine, pertussis vaccine, and inactivated polio vaccine do not contain neomycin. These are safely used in patients who are allergic to neomycin.
A preschooler who has giardiasis is receiving metronidazole for treatment. What should the nurse recognize as a side effect of metronidazole? 1 Constipation 2 Inflammation 3 Urine retention 4 Metallic taste in mouth
4 Metronidazole can leave a metallic taste in the mouth. Inflammation, urine retention, and constipation are side effects of other drugs.
A nurse is caring for a toddler who has severe measles. While checking the history, the nurse finds that the toddler has ophthalmologic evidence of vitamin A deficiency. The nurse is ordered to administer vitamin A supplement to the toddler. How should the nurse plan to administer the supplements in this situation? 1 Administer a higher dose to the patient. 2 Administer a single oral dose of 200,000 IU. 3 Administer a single oral dose of 100,000 IU. 4 Administer a repeat dose the next day and after 4 weeks.
4 (I put 2) Vitamin A supplementation reduces both morbidity and mortality in measles. The patient has ophthalmologic evidence of vitamin A deficiency. Therefore, the dose of vitamin A should be repeated the next day and after 4 weeks. Administration of a higher dose should be avoided, because it may lead to vomiting and headache for a few hours. A single oral dose of 200,000 IU is recommended for children who are at least 1 year old. A single oral dose of 100,000 IU is recommended for children aged between 6 and 12 months.
What is the causative agent of chickenpox? 1 Varicella zoster virus 2 Human parvovirus B19 3 Human herpesvirus type 6 4 Group A ß-hemolytic Streptococcus
1 Varicella zoster virus is the causative agent of chickenpox. Human parvovirus B19 is the causative agent of erythema infectiosum (Fifth disease). Human herpesvirus type 6 is the causative agent of exanthema subitum (roseola). Group A ß-hemolytic Streptococcus is the causative agent of scarlet fever.
Which control measures should the nurse include when teaching parents how to prevent the spread of infection at home? Select all that apply. 1 Handwashing 2 Immunizations 3 Contact precautions 4 Not sharing eating utensils 5 Covering the face when sneezing
1, 4, 5 Infection control measures include handwashing, not sharing eating utensils, and covering the face when sneezing. Immunizations are a primary prevention method not available in the home setting. Contact precautions are an isolation method used in the hospital to help prevent the spread of disease.
While reviewing the diagnostic reports of an older child, the nurse finds the presence of giardia lamblia in the child's stool. What symptom is specific to older children? (p. 174) 1 Diarrhea 2 Vomiting 3 Constipation 4 Intermittent hard stools
3 Giardia lamblia is the causative organism of giardiasis. A clinical manifestations of giardiasis specific to older children is constipation. Diarrhea and vomiting are the clinical manifestations of giardiasis observed in infants and young children. The older child will also experience intermittent loose, not hard, stools.
What is the typical mode of transmission of pertussis (whooping cough)? 1 Fecal 2 Blood 3 Droplet 4 Mucous membranes
3 The typical mode of transmission of pertussis is direct contact or the droplet route. The fecal, blood, and mucous membrane routes are typical modes of transmission of other diseases.
Two parents bring their child in for examination. They state that the child looks pale and hasn't been eating for a while. The parents report that they have just returned from a month's vacation to a tropical country. An examination of the child's stool sample shows hookworms. What precaution for preventing the hookworm infestation does the nurse teach the parents? (p. 173) 1 Washing hands before eating food 2 Not consuming undercooked pork 3 Wearing shoes when playing in soil 4 Covering all food using fly covers
3 (I put 4) Soil contaminated with hookworm eggs can lead to hookworm infestation. The worms can enter the body by penetrating the skin. Therefore, wearing shoes is recommended as a preventive measure. Although washing hands in general is recommended before eating, hookworms are not transmitted through food or by eating undercooked pork or meat. Flies and mosquitoes do not transmit hookworms.
What is an important nursing intervention in the care of a child with bacterial conjunctivitis? 1 Oral antihistamines to minimize itching 2 Continuous cold compresses to relieve discomfort 3 Application of optic corticosteroids to reduce inflammation 4 Intermittent warm, moist compresses to remove crusts on the eye area
4 The eye should be kept clean. Intermittent warm, moist compresses can soften the crusting for easier removal, maintaining the cleanliness of the eye. Antihistamines are not usually necessary for bacterial conjunctivitis. Continuous, occlusive compresses would promote bacterial growth. Antibiotics are the treatment of choice for bacterial infections; optic corticosteroids are not warranted.
There is an outbreak of measles in a rural area. The nurse is organizing an informational presentation about measles vaccinations and vitamin A injections for the community. What information should the nurse include? 1 The minimum age at which the measles vaccine can be administered is 12 months. 2 Vitamin A injections are not useful if given to children already infected with measles. 3 Two vitamin A injections can prevent measles infections in children under 2 years of age. 4 The first dose of measles vaccine will be given at 6 months with a second one after 12 months of age.
4 When there is an outbreak of measles (rubeola), the first dose of measles vaccine can be given any time after 6 months of age, followed by a second inoculation after 12 months. When there is no measles outbreak, the recommended age for vaccination is 12 to 15 months. Vitamin A supplementation can decrease the morbidity and mortality associated with measles, and the injections are effective in children with severe measles. However, vitamin A cannot prevent the spread of infection.
A nurse is assessing a toddler who has enterobiasis. The tape test will be performed to identify the infective agent. What instruction does the nurse give to the parents? (p. 174-5) 1 Wrap the tongue blade in a napkin when bringing it in for examination. 2 Collect the sample before the child goes to bed. 3 Place the sticky side of the tape at the center of a tongue depressor. 4 Collect the sample in the morning when the child awakens.
4 (I put 3) The tape test is used to identify the infective agent. In this test, the sample is collected in the morning as soon as the child awakens, before the child has a bowel movement or bathes. From this sample, it is easy to identify the infective agent. The tongue blade should be placed in a glass jar, rather than a paper napkin, to protect it while it is brought in for microscopic examination. A sample collected before the child goes to bed may not yield adequate test results. The sticky side of the tape is placed around the end of a tongue depressor, not at the center of a tongue depressor.
A child presents to the pediatrician's office with a slight fever, malaise, and a highly pruritic rash that started as papules and has now become vesicles. What disease do these clinical manifestations indicate? 1 Varicella 2 Diphtheria 3 Roseola infantum 4 Erythema infectiosum
1 A slight fever, malaise, and highly pruritic rash starting with papules and progressing to vesicles are highly suggestive of varicella, or chickenpox. Diphtheria manifests in a sore throat, fever, swollen lymph nodes, and weakness. A high, not slight, fever is characteristic of roseola infantium. Erythema infectiosum, or Fifth disease, is characterized by a facial rash, sore throat, slight fever, headache, upset stomach, and fatigue.
What does the nurse recognize as having the greatest impact on the significant decline in incidence of communicable diseases of childhood? 1 Immunizations 2 New medical treatments 3 Proper handwashing skills 4 Secondary prevention measures
1 Immunizations have resulted in a significant decline in the incidence of communicable diseases of childhood. New medical treatments help treat disease but do not reduce the incidence of them. Proper handwashing skills help reduce the spread of infection, but immunizations have the greatest impact in the decline in communicable diseases of childhood. Like handwashing, secondary prevention measures are helpful but have not had the greatest impact in the significant decline in communicable diseases of childhood.
Which medication should the nurse most expect to find in the medication profile for a patient with a diagnosis of diphtheria? 1 Equine antitoxin 2 Acyclovir 3 Acetaminophen 4 Diphenhydramine hydrochloride
1 Symptoms of common cold, anorexia, sore throat, and lymphadenitis indicate that the child may have diphtheria. Equine antitoxin is administered via the intravenous route to treat the child. Acyclovir is an antiviral agent used in the treatment of chickenpox. Acetaminophen is an antipyretic used for reducing fever. Diphenhydramine hydrochloride is used to manage the itching that accompanies chickenpox.
The nurse is assessing a child with herpetic gingivostomatitis. The nurse wears gloves when examining the lesions. Is this nursing action necessary or unnecessary? 1 It is unnecessary, because the virus is not easily spread. 2 It is unnecessary, because the virus is sexually transmitted. 3 It is necessary, because the virus can easily enter breaks in the skin. 4 It is necessary only if the nurse touches his or her own mouth after touching the child's mouth.
1 The action is necessary, because herpes simplex virus (HSV) easily enters breaks in the skin and can cause herpetic whitlow on the fingers. Gloves are always necessary, because the virus is easily spread. Herpetic gingivostomatitis is usually caused by HSV-1. HSV-2 is usually transmitted through sexual activity. The nurse should wear gloves regardless of contact with the child's mouth and the nurse's own mouth.
What term does the nurse use to describe the interval between early manifestations of a disease and the overt clinical syndrome? 1 Prodromal period 2 Incubation period 3 Desquamation period 4 Period of communicability
1 The prodromal period is defined as the symptoms that occur between early manifestations of the disease and overt clinical symptoms. The incubation period is the time from exposure to the appearance of the first symptom. The desquamation period refers to the shedding of skin, when applicable, for a syndrome or disorder. The period of communicability describes the period when the child is infectious.
What is the recommended age for a child to begin primary immunizations? 1 At birth 2 2 months 3 4 months 4 1 year
1 The recommended age for children to begin primary immunizations is from birth to 2 weeks, according to the Committee on Infectious Diseases of the American Academy of Pediatrics and the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). For children who were not immunized at birth, there is a catch-up schedule on the CDC website. The ages 2 months, 4 months, and 1 year are too late and will require catch-up immunizations.
A child tells the nurse about pain in his testes. Before this, the child had symptoms including a fever, headache, and an earache while chewing food. The pain was accompanied by swelling in the neck. The nurse instructs the parents to apply warm compresses and provide testicular support with tight-fitting underpants. What is the most probable cause for these symptoms? 1 Rubella 2 Mumps 3 Rubeola 4 Pertussis
1 The signs and symptoms in this child indicate mumps. Fever, headache, and earache while chewing food are present in the prodromal stage of mumps. The swelling in the neck is caused by parotitis, an inflammation of the parotid salivary gland. Epididymoorchitis, a common complication of mumps in male children, is inflammation of the testes and epididymis. The child needs warm compresses and testicular support to relieve the testicular pain. Rubella, rubeola, and pertussis are not associated with these symptoms or this complication.
What can the nurse do to decrease pain when administering a haemophilus influenza type b (DTaP-Hib) vaccine and a pneumococcal conjugate vaccine (PCV)? (p. 159) 1 Administer the DTaP-Hib vaccine before the PCV. 2 Administer the PCV before the DTaP-Hib vaccine. 3 Administer the PCV but not the DTaP-Hib vaccine. 4 Administer the PCV and DTaP-Hib vaccine simultaneously.
1 (I put 2) Administering the DTaP-Hib vaccine before PCV administration reduces pain caused by the PCV injection. Therefore, the nurse should administer the DTaP-Hib vaccine before the PCV. Administering the PCV before the DTaP-Hib vaccine does not reduce pain in the infant. Avoiding the DTaP-Hib vaccine can increase the risk of haemophilus influenza type b in the infant. Simultaneously administering the PCV and the DTaP-Hib vaccine does not result in pain reduction.
During assessment, the nurse finds that a toddler has an upper respiratory tract infection, serous drainage, inflamed conjunctiva, and swollen eyelids. Which condition does this patient likely have? (p. 171) 1 Viral conjunctivitis 2 Allergic conjunctivitis 3 Bacterial conjunctivitis 4 Conjunctivitis caused by a foreign body
1 (I put 3) Conjunctivitis is inflammation of the conjunctiva. Upper respiratory tract infection, serous drainage, inflamed conjunctiva, and swollen eyelids are symptoms suggestive of viral conjunctivitis. Itching in the eye, stringy discharge, inflamed conjunctiva, and swollen eyelids are symptoms of allergic conjunctivitis. Purulent drainage, crusting of eyelids (especially on awakening), inflamed conjunctiva, and swollen eyelids are symptoms of bacterial conjunctivitis. Tearing, pain, and inflamed conjunctiva are symptoms of conjunctivitis caused by a foreign body. In foreign body conjunctivitis, usually only one eye is affected.
The nurse works in a vaccination clinic. Which patients should receive the measles, mumps, and rubella (MMR) vaccine? Select all that apply. 1 A 12-month-old baby with the flu 2 A 14-month-old baby allergic to eggs 3 A breastfeeding mother 4 A pregnant woman in the first trimester 5 A pregnant woman in the third trimester
1, 2, 3 (I put 1 & 3) A nurse should be aware of some of the common contraindications to all the vaccines. Common cold or flu is not a contraindication to immunization, although severely ill patients should not be given any vaccines. Measles and mumps vaccines, which are grown in chick embryo tissue cultures, do not contain a significant amount of egg cross-reacting proteins. Therefore, egg allergy is not a contraindication to MMR vaccine. Similarly, breastfeeding is not a contraindication to MMR vaccine. However, MMR is a live virus vaccine that should not be given to any pregnant women, irrespective of their gestational age.
When preparing to administer the hepatitis B vaccine to a newborn, which steps should the nurse take? Select all that apply. 1 Start an immunization record. 2 Obtain a syringe with a 25-gauge, ⅝-in needle. 3 Confirm the hepatitis B status of the newborn's mother. 4 Assess the dorsogluteal muscle as the preferred site for injection. 5 Confirm that the newborn's mother has signed the informed consent.
1, 2, 3, 5 It is important for the nurse to initiate an immunization record and give it to the mother so a continuous record of immunizations is maintained. The dose of hepatitis B vaccine is 0.5 ml, to be given intramuscularly in the newborn by way of a 25-gauge, ⅝-in needle. The hepatitis B vaccine is primary prevention for the disease. If the mother is positive for the hepatitis B virus, the newborn will need to receive hepatitis B immunoglobulin (HBIG) in addition to the hepatitis B vaccine. Signed informed consent must be obtained from the mother before administration of the vaccine. The only safe intramuscular injection site for the newborn is the vastus lateralis muscle. The dorsogluteal muscle should be avoided.
A toddler has a skin infection. Which instruction does the nurse give to the parents to reduce the toddler's discomfort? Select all that apply. 1 Use calamine lotion regularly. 2 Use nonirritating clothing. 3 Give hot baths to the patient. 4 Avoid patient exposure to the sun. 5 Avoid administering hydroxyzine.
1, 2, 4 The patient may feel discomfort due to the skin infection and may need special precautions. Calamine lotion can be used to reduce itching. Nonirritating clothing can also help to reduce irritation and itching. Sun exposure should be avoided, because exposure to the sun increases skin irritation and worsens the condition. Hot baths should be avoided, because an increase in temperature increases itching. If the patient has severe itching, hydroxyzine can be administered to reduce it.
A child is admitted to the hospital for whooping cough. The plan of care indicates that the nurse should assess the patient for signs of airway obstruction. For which signs will the nurse assess the child? Select all that apply. 1 Cyanosis 2 Skin pallor 3 Apprehension in the child 4 Increased temperature 5 Increased restlessness
1, 3, 5 (I put 3, 4, 5) Whooping cough is a respiratory infection caused by Bordetella pertussis. Airway obstruction can occur due to the infection. Therefore, nurses are instructed to assess for signs of airway obstruction, including cyanosis, apprehension, and increased restlessness. The nurse should immediately report any of these signs. Pallor is seen in cases of shock, and an increased temperature indicates infection, not airway obstruction.
An infant has a low-grade fever, is sneezing, has tearing eyes, and exhibits a short and rapid cough that occurs mainly at night and is followed by a crowing sound. Which nursing actions are appropriate for this patient? Select all that apply. 1 Provide humidified oxygenation and suction. 2 Place the child on the bed in a supine position. 3 Restrict oral fluids since these can aggravate the cough. 4 Place the patient on droplet precautions. 5 Administer mild sedatives to the child as necessary.
1, 4 The child's symptoms are indicative of pertussis (whooping cough). Therefore, the nurse should provide humidified oxygen to the child and suction him or her as needed. The nurse should also use droplet precautions for the child, because pertussis can be transmitted through droplets. The child is at risk of aspiration during coughing fits. Therefore, the child should be placed on his or her side rather than in the supine position in the bed. The child needs oral fluids for adequate hydration. Mild sedatives are given to children with poliomyelitis, because they help to relieve anxiety and promote rest; they are not used when children have pertussis.
Which vaccines are contraindicated for children who are immunocompromised? Select all that apply. 1 Varicella 2 Tetanus 3 Pertussis 4 Inactivated polio 5 Measles, mumps, and rubella (MMR)
1, 5 Varicella is not recommended for children who are immunocompromised, and neither is the MMR vaccine. The tetanus, pertussis, and inactivated polio vaccines can be safely administered to immunocompromised children.
A 12-year-old child having a check-up at a clinic has not received the hepatitis B (HBV) vaccine. Based on his or her knowledge of vaccines, which does the nurse recognize is the most appropriate recommendation? 1 One dose of HBV vaccine is needed at age 14 years. 2 The three-dose series of HBV vaccine should be started at this time. 3 Only one dose of HBV vaccine will be needed sometime during adolescence. 4 The three-dose series of HBV vaccine should be started at age 16 years or sooner if the adolescent becomes sexually active.
2 Adolescents should be vaccinated against hepatitis B at this age if they have not been vaccinated previously. Three doses of the HBV vaccine are required to achieve immunity. It is recommended that the HBV vaccine series be started at birth. The American Academy of Pediatrics recommends that vaccinations be completed by the age of 13 years.
During the handoff report, the nurse is told that the pediatric patient has the following assessment findings: fever of 100° F, malaise, coryza, a cough, conjunctivitis, and Koplik spots for the past 2 days. The patient is going to be admitted to the pediatric unit. The nurse expects to see orders for isolation precautions in the medical record. Which are appropriate isolation precautions for this illness? 1 Standard precautions 2 Airborne precautions 3 Droplet precautions 4 Contact precautions
2 For patients with a diagnosis of measles (rubeola) during the prodromal (catarrhal) stage, the patient experiences fever and malaise, following in 24 hours by coryza, a cough, conjunctivitis, and Koplik spots. Symptoms gradually increase in severity until the second day after the rash appears. If patients are admitted, airborne precautions need to be maintained until the fifth day after the rash appears. Standard precautions should be used with every patient but will not offer enough protection from transmitting measles to others. Droplet and contact precautions will not help prevent the spread of measles to others.
A nurse is caring for a toddler with sickle cell disease. For which complication is this patient at risk? (p. 170) 1 Stomatitis 2 Aplastic anemia 3 Conjunctivitis 4 Gingivostomatitis
2 Sickle cell disease is a hemolytic disease. The patient who has sickle cell disease is at a higher risk of developing aplastic anemia from erythema infectiosum. Human parvovirus B19 infects and causes lysis of red blood cell (RBC) precursors, which interrupts the production of RBCs. Therefore, the virus precipitates a severe aplastic crisis. The patient may need increased RBC production to maintain normal RBC volumes. Stomatitis, conjunctivitis, and gingivostomatitis are not associated with sickle cell disease. Stomatitis is inflammation of the oral mucosa; it may be caused by local or systemic factors. Conjunctivitis is an inflammation of the conjunctiva and occurs from a variety of causes, which are typically age-related. Gingivostomatitis is the inflammation of the mouth and gums.
A parent asks the nurse why health care providers switched to the use of an inactivated polio vaccine (IPV) from the use of an oral polio vaccine (OPV). Which explanation given by the nurse most appropriately describes the reason for not using an OPV? (p. 154) 1 "It is due to the lesser efficacy of the OPV." 2 "It is due to the reduction of vaccine-associated polio paralysis." 3 "It is due to the lack of immunity with the OPV." 4 "It provides protection equivalent to OPV and only needs one dose."
2 The use of the IPV is not associated with rare vaccine-associated polio paralysis as was seen with the use of the OPV. The efficacy of the OPV is greater compared to inactivated polio vaccine. Both types of the vaccine provide adequate immunity against poliovirus infection. Even an IPV has to be administered in multiple doses.
Strict isolation is required for a child who is hospitalized with which infectious disease? 1 Mumps 2 Chickenpox 3 Exanthema subitum (roseola) 4 Erythema infectiosum (Fifth disease)
2 (I put 1) Chickenpox is communicable through direct contact, droplet spread, and contaminated objects. The child hospitalized for chickenpox should therefore be strictly isolated. Mumps is transmitted by way of direct contact with saliva of an infected person and is most communicable before the onset of swelling. The transmission and cause of exanthema subitum (roseola) are unknown. Erythema infectiosum (Fifth disease) is communicable before the onset of symptoms.
What are the clinical manifestations of scarlet fever in the prodromal stage of the disease? (p. 169) 1 Enlarged tonsils 2 Abrupt high fever 3 Rash over the body 4 Red "strawberry tongue"
2 (I put 3) Abrupt high fever, vomiting, headache, chills, malaise, abdominal pain, and halitosis are clinical manifestations of scarlet fever in its prodromal stage. Enlarged tonsils and red "strawberry tongue" (enanthema) occur during the first one to two days. A body rash (exanthema) appears within 12 hours after the onset of prodromal signs.
A child with human immunodeficiency virus (HIV) infection presents with a painful rash on the abdomen. The nurse learns that the child had chickenpox at a younger age. What is the most likely reason for the child's symptoms? 1 Mumps 2 Shingles 3 Measles 4 Rubella
2 (I put 4) Varicella zoster virus, which causes chickenpox, can remain dormant in the human body for a long time. It can get reactivated in cases of decreased immunity and stress, such as HIV infection, and it causes shingles when it gets reactivated. This appears as a painful rash localized to a single dermatome. Rashes occurring due to mumps, measles, or rubella are not painful and are not localized to a single dermatome.
What characteristics of the rash should the nurse expect to find in a child with roseola infantum? Select all that apply. 1 Itchy 2 Rose-pink in color 3 Appears first on the face 4 Appears first on the trunk 5 Fades when pressure is applied
2, 4, 5 The nurse should be aware of how different exanthematous diseases look. In cases of roseola infantum, the rash appears as discrete rose-pink macules on the trunk first; these later spread to the neck, face, and extremities. The rash also fades when pressure is applied. The rash is usually nonpruritic (does not cause itching). In cases of measles, the rash appears on the face first.
What is the most important practice in reducing the transmission of diseases in the health care setting? 1 Covering one's mouth when coughing 2 Wearing gloves while providing patient care 3 Hand hygiene before and after patient care 4 Disposing needles and syringes properly
3 Hand hygiene is the best way to prevent the transmission of disease. Covering one's mouth when coughing or sneezing will help to prevent droplet transmission, but it is not as efficient as good hand hygiene. Wearing gloves during patient care is essential but does not guarantee complete protection. Disposing needles and syringes in a rigid, puncture-resistant container is essential in helping to prevent needlestick injuries but not other modes of disease transmission
The nurse is educating a parent about rotavirus vaccine. Which statement pertaining to the rotavirus vaccine, RotaTeq, is appropriate? 1 "The dose is 1 ml in each administration." 2 "The vaccine is given through subcutaneously." 3 "The first dose is administered between 6 to 12 weeks of age." 4 "The vaccine should not be given beyond 30 weeks of age."
3 RotaTeq vaccine administration should be initiated between 6 to 12 weeks of age. The vaccine has to be administered in two additional doses at four- to 10-week intervals following the initial dose of the vaccine. The dose of the vaccine is 2 ml, not 1 ml. The vaccine is administered orally. The vaccine should not be administered beyond 32 weeks of age.
A child is brought to the hospital with reddened eyes. The child has purulent discharge from the eyes, crusting, and swollen eyelids. What is the most likely reason for the child's symptoms? 1 Virus 2 Allergy 3 Bacteria 4 Foreign body
3 The signs and symptoms indicate that the child is suffering from bacterial conjunctivitis. This is characterized by reddening of the eyes, purulent discharge, and crusting and swelling of the eyelids. In cases of viral conjunctivitis, a serous discharge is often observed. Allergic conjunctivitis is characterized by a watery to thick, stringy discharge. In cases of conjunctivitis occurring due to a foreign body, the pain would be unbearable, and only one eye would be affected.
The nurse has provided information to the parents of an infant about sites and routes of immunizations that have been administered to the infant. Which additional items need to be documented in the medical record? 1 Time, day, year of administration; lot number of vaccine; name, phone number, and title of the person administering the vaccine 2 Year of administration; manufacturer and lot number of vaccine; name, address, and title of the person administering the vaccine 3 Day, month, year of administration; manufacturer and lot number of vaccine; name, address, and the title of the person administering the vaccine 4 Time, day, month, and year of administration; manufacturer and lot number; name, address, phone number, and title of the ordering physician
3 (I guessed 4)
The physician instructs parents to begin administering pyrvinium pamoate to their child for treatment of enterobiasis. The nurse is educating the parents regarding the administration and side effects of the medication. Which statement about pyrvinium pamoate will the nurse include? 1 The eye ointment may be used at night because it remains in the eye longer and may blur the vision. 2 The medication has a metallic taste and gastrointestinal side effects, including nausea and vomiting. 3 Be aware the medication stains the vomitus, stool, skin, clothing, and anything else it touches bright red. 4 The medication is effective in reducing the number of oral lesions.
3 (I put 1) Pyrvinium pamoate stains the vomitus and stool bright red, as well as clothing or skin that comes in contact with the drug; it is available without prescription. Eye ointment is used in the treatment of conjunctivitis. Metrodianazole and tinidazole have a metallic taste and patients may have gastrointestinal symptoms. Acyclovir is used to reduce the number of oral lesions in the treatment of stomatitis.
A preschooler is admitted to the hospital with an undiagnosed exanthema. What precautions should the nurse take in this situation? 1 Droplet and standard precautions 2 Standard and airborne precautions 3 Airborne and droplet precautions 4 Standard and all transmission-based precautions
4 The nurse should be aware that both standard and transmission-based precautions (contact, airborne, and droplet) must be instituted when an exanthema is undiagnosed. Exanthema can be a symptom of measles, chickenpox, mumps, and scarlet fever, and these conditions may spread if all precautions are not taken. Therefore, only droplet and standard precautions, only standard and airborne precautions, and only airborne and droplet precautions are enough.
With a diagnosis of histoplasmosis, the nurse would expect to find which symptoms during the patient assessment? (p. 181) 1 Headache, dizziness, stiff neck, and signs of increased intracranial pressure 2 Pulmonary symptoms, such as cough, fever, chest pain, weakness, weight loss 3 Cough, fever, malaise, myalgia, headache, chest pain, and hepatosplenomegaly 4 General systemic symptoms such as pallor, diarrhea, vomiting, and irregularly spiking temperature
4 The presenting symptoms of histoplasmosis include general systemic symptoms such as pallor, diarrhea, vomiting, irregularly spiking temperature, hepatosplenomegaly and pulmonary symptoms. Cryptococcosis presents with headache, dizziness, stiff neck, and signs of increased intracranial pressure. North American blastomycosis presents with pulmonary symptoms, such as cough, fever, chest pain, weakness, and weight loss. Coccidioidomycosis presents with a cough, fever, malaise, myalgia, headache, and chest pain.
How should the nurse instruct the parent to care for the eye of a child who has bacterial conjunctivitis? 1 Apply continuous warm compresses to the eye. 2 Apply topical corticosteroids to reduce inflammation. 3 Wipe from the outer canthus toward the opposite eye. 4 Wipe from the inner canthus downward and outward away from the opposite eye.
4 To remove secretions from the eye, the nurse should instruct the parent to wipe from the inner canthus of the eye downward and outward away from the opposite eye. Applying continuous warm compresses on the eye can promote bacterial growth. Topical corticosteroids are avoided because they reduce ocular resistance to bacteria. Wiping from the outer canthus of the eye toward the opposite eye may spread the infection to the other eye.
The community nurse is teaching a pregnant woman about prenatal care. The woman says that her first child was diagnosed with erythema infectiosum. What should the nurse tell the mother? 1 "The child needs two doses of vitamin A injections on consecutive days." 2 "It is a bacterial infection; you and the child should take antibiotics." 3 "It spreads by contaminated water; take good care to drink safe water." 4 "You should undergo fetal ultrasonography for detection of fetal hydrops."
4 (I guessed 2) Pregnant women in contact with erythema infectiosum should be advised to undergo fetal ultrasonography for the detection of fetal hydrops. Hydrops fetalis (fetal hydrops) is a serious fetal condition defined as abnormal accumulation of fluid in two or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin edema.. A child with measles needs vitamin A injections on consecutive days. Administering antibiotics is not required, because erythema infectiosum is a viral infection. It is transmitted by respiratory secretions, blood, and blood products, not by contaminated water.
The nurse is preparing to administer the hepatitis B, diphtheria and tetanus toxoids and acellular pertussis, right ventricle, Haemophilus influenzae, pneumococcal conjugate vaccine, and inactivated polio vaccine immunizations to a 2-month-old infant. The nurse has given the vaccine information sheet to the parents. The parents are concerned about the amount of injections their infant is going to receive. Which nursing statement is the most appropriate response? (p. 159) 1 "The length of the needle is short and will not cause much pain, and I will give them in different locations. That will help to limit the pain as well." 2 "I understand your concern. I was concerned about that as well when my baby had the same immunizations, but to my surprise, she did fine." 3 "This will not take too long to administer the immunizations. Once I have administered the immunizations, you can hold your baby to provide comfort." 4 "I hear you are concerned about the amount of injections your baby is to receive. You can come back on another day, and we can divide the immunizations over two visits."
4 (I put 1) The nurse needs to be flexible and provide parents with options regarding the administration of multiple vaccines, especially in infants, who must receive multiple injections at 2, 4, and 6 months old. It is important to respect the family's concerns and not dismiss them by saying the needles won't cause pain. Discussing the nurse's own child is inappropriate and takes the focus off the patient. Saying that administering the immunizations won't take long ignores the family's concerns.
