Immunizations, Skin, and Communicable Disease

Which parental statement indicates correct understanding for the prevention of sunburn for a toddler-age client? a. "I will use a sunscreen with an SPF of 30 or higher for my child." b. "I will keep my child indoors when the sun is out." c. "I do not have to reapply sunscreen unless they are playing in water." d. "I will make sure my child wears long sleeves and long pants while outside."

a. "I will use a sunscreen with an SPF of 30 or higher for my child."

A 5-year-old-child is undergoing chemotherapy. The mother tells the nurse that the child is not up to date on the required immunizations for school. What is the best response by the nurse? a. "This isn't the best time to finish the immunizations, because your child's immune system is suppressed." b. "Maintaining current immunizations is critical. Make sure the series is completed." c. "By this time your child has developed sufficient antibodies to provide immunity." d. "It's important to complete the immunizations because your child needs to be protected from childhood diseases that could be fatal."

a. "This isn't the best time to finish the immunizations, because your child's immune system is suppressed." Rationale: Chemotherapy compromises the immune system. The vaccines may be administered after the completion of the chemotherapy protocol, once the immune system has returned to its previous state. The child has not developed sufficient antibodies; booster immunizations are needed, but not at this time. Administering immunizations at this time could prove fatal.

To evaluate kidney function, the nurse must accurately measure the hourly urine output of a 1½-year-old toddler weighing 22 lb (11 kg) who has been admitted with extensive burns. What is the minimum safe output per hour for a child this age? a. 10 to 20 mL b. 61 to 80 mL c. 41 to 60 mL d. 21 to 40 mL

a. 10 to 20 mL Rationale: *The minimum safe urine output for a 1½-year-old toddler is 1 mL/kg/hr.* The 18-month-old toddler whose weight is at the 50th percentile weighs approximately 11 kg. This is approximately 11 mL/hr, which is within the minimum safe output of 10 to 20 mL/hr. Sixty-one to 80 mL/hr is more than the minimum output for any age group. Forty-one to 60 mL/hr is more than the minimum output for any age group. Twenty-one to 40 mL/hr is the minimum safe output for children who weigh 21 to 40 kg and are 5 to 11 years old.

A nurse explains to the mother of a 1-year-old with a history of frequent ear infections that the primary cause of otitis media in young children is what? a. An obstructed eustachian tube b. Sinusitis c. Recurrent tonsillitis d. An inflamed mastoid process

a. An obstructed eustachian tube Rationale: A blocked eustachian tube impairs drainage and creates negative pressure; when the tube opens, bacteria are pulled into the middle ear. Sinusitis is not related to otitis media. Recurrent tonsillitis is not the direct cause of otitis media. Mastoiditis is a complication, not a cause, of otitis media.

A parent of a 7-year-old child asks a nurse how to tell the difference between measles (rubeola) and German measles (rubella). What should the nurse tell the parent differentiates rubeola from rubella? a. High fever and Koplik spots b. Rash on the trunk and pruritus c. Nausea, vomiting, and abdominal cramps d. Characteristics of a cold, followed by a rash

a. High fever and Koplik spots Rationale: The signs and symptoms of rubeola (measles) include a high fever, photophobia, Koplik spots (white patches on the mucous membranes of the oral cavity), and a rash. Rubella (German measles) usually does not cause a high fever, runs a 3- to 6-day course, and never causes Koplik spots. The rash of rubeola (measles) spreads over most of the body. Nausea, vomiting, and abdominal cramps are vague clinical findings and occur with many illnesses. Some signs and symptoms may be similar to those of a severe cold, but rubeola is associated with high fever.

A 12-month-old infant has become immunosuppressed during a course of chemotherapy. What information regarding the measles, mumps, and rubella (MMR) vaccine should the nurse, preparing for the infant's discharge, give the parents? a. Infants who are receiving chemotherapy should not be given these vaccines. b. It should not be given until the infant reaches 2 years of age. c. It should be given to protect the infant from contracting any of these diseases. d. The parents should discuss this with their healthcare provider at the next visit

a. Infants who are receiving chemotherapy should not be given these vaccines. Rationale: The MMR vaccine is composed of live attenuated virus, and its administration could be life threatening for an immunosuppressed child. When the infant reaches 12 to 15 months of age and if the blood values have returned to normal, the MMR vaccine should be given. Because the MMR vaccine is composed of live viruses, giving it while the infant is immunosuppressed can be as life threatening as the disease itself. It is the nurse's responsibility to provide this information at the time of discharge.

A 4-year-old child is being transported to a trauma center for treatment of a partial- and full-thickness burn injury that is estimated as covering more than 40% of the body. The nurse anticipates that which treatment will be prescribed initially? a. Insertion of a Foley catheter b. Insertion of a nasogastric tube c. Administration of an anesthetic agent for sedation d. Application of an antimicrobial agent to the burns

a. Insertion of a Foley catheter

A nurse in the pediatric clinic is teaching a mother how to care for her infant who has eczema. What is most important for the nurse to teach the mother? a. Preventing secondary infections b. Ensuring physical growth c. Identifying causative factors d. Providing adequate hydration

a. Preventing secondary infections

A school-aged child is brought to the emergency department with partial- and full-thickness burns of the lower extremities. The practitioner writes multiple prescriptions. What is the nurse's priority intervention? a. Starting an intravenous line with a large-bore catheter b. Administering oxygen c. Inserting a urinary catheter d. Giving prescribed pain medication

a. Starting an intravenous line with a large-bore catheter

The parent of a 10-month-old infant with otitis media tells the nurse in the pediatric clinic that this is the baby's third episode in 3 months. The infant is tugging at the ear but is not acutely ill. What factor should the nurse consider before responding? a. The eustachian tube is short and horizontal. b. Analgesics are contraindicated. c. Oral antibiotics will be prescribed. d. The labyrinth and cochlea are inflamed.

a. The eustachian tube is short and horizontal. Rationale: This anatomical difference in young children permits easier migration of microorganisms from the oral cavity into the middle ear, predisposing them to otitis media. Analgesics such as acetaminophen or ibuprofen are recommended to relieve discomfort. Studies have shown that antibiotics are not effective in children younger than 2 years if the child is not severely ill. Antibiotic therapy is necessary when the infant has a fever or is in severe pain. The labyrinth and cochlea are part of the inner ear and are not affected by otitis media.