PEDS: Chapter 43: Nursing Care of a Family when a Child has an Infectious Disorder Prep-U

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." 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.

When the nurse is instructing on disease transmission, which is noted as the smallest infectious agent known?

Virus Explanation: Viruses are the smallest infectious agents known, so small they cannot be seen through an ordinary microscope.

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." 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.

What is a true statement regarding varicella zoster virus infection?

A complication of this infection includes secondary bacterial infections of the skin. Explanation: Varicella zoster virus infection carries with it the complication of a secondary bacterial infection of the skin. 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 nurse is assessing a child brought to the clinic because of swelling on one side of the face. The nurse assesses the swelling by placing a hand along the child's jaw line. The nurse suspects that the child has parotitis because most of the swelling occurs at which location?

Above the nurse's hand Explanation: When placing the hand at the jawline, most swelling associated with parotitis is above the nurse's hand. If it is below the hand, the condition is most likely submaxillary adenitis.

The nurse is caring for an adolescent diagnosed with genital herpes. The drug of choice for treating genital herpes is:

Acyclovir Explanation: The drug acyclovir is useful in relieving or suppressing the symptoms of genital herpes.

The nurse is caring for a child whose family recently immigrated 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?

Ask parents which immunizations have been given. Explanation: When caring for a child recently immigrated 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 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?

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?

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.

A nurse is teaching a class to new parents on how to prevent the spread of infection in their children. What is the best suggestion the nurse could offer to these parents?

Encourage frequent hand hygiene. Explanation: An important method of preventing infection is to break the chain of infection. Handwashing is the key.

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?

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.

Infectious mononucleosis ("mono") is caused by which of the following?

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.

Tinea cruris (jock itch) is a protozoan infection.

False Explanation: Tinea cruris (jock itch) is a fungal infection that occurs on the inner aspects of the thighs and scrotum.

After teaching nursing students about childhood exanthems, the instructor determines that the teaching was successful when the students identify what as the primary cause?

Viruses Explanation: Most childhood exanthems are caused by viruses.

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?

Herpes zoster Explanation: Herpes zoster is caused by varicella-zoster virus, the same virus that causes chickenpox.

Nursing students are learning about the infectious process. They correctly identify the first stage of an infectious disease to be the:

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

Put the following stages of infectious disease in correct order:

Incubation period Prodromal period Illness Convalescent period Explanation: Infectious diseases follow certain stages during which the communicability (ability to be spread to others) or severity of the illness can be predicted: 1) incubation period, 2) prodromal period, 3) illness, and 4) convalescent period.

A child is newly diagnosed with whooping cough (pertussis). Which nursing interventions are placed in the plan of care? Select all that apply.

Initiate bed rest daily Instruct on eliminating cigarette smoke and dust Finish a 10-day course of erythromycin or azithromycin Explanation: Children with pertussis are maintained on bed rest until the paroxysms of coughing subside. Urge parents to keep them secluded from environmental factors, such as cigarette smoke and dust, and to avoid strenuous activity as these initiate coughing episodes. Nutrition may become a problem if the child is constantly coughing and vomiting. As a rule, frequent small meals are vomited less than larger meals so should be encouraged. A full 10-day course of erythromycin or azithromycin may be prescribed as these drugs have the potential to shorten the period of communicability and may shorten the duration of symptoms. Increased protein intake is not indicated for this condition. Reference:

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 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.

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 child is diagnosed with giardiasis. The physician prescribes medication to treat the infection. Which of the following would the nurse anticipate being prescribed?

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 curis and tinea corporis.

The nurse is evaluating a complete blood count with differential for a pediatric client with a peritonsilar abscess. Which component of white blood cells serves as a backup for neutrophils during this acute infection?

Monocytes Explanation: Monocytes are a type of white blood cell that act as a backup for neutrophils in acute infections.

A 7-year-old with an earache comes to the clinic. The child's mother reports that 1 day ago her 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 to be for this child?

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

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

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?

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 discussing medications to be given to a child who has been diagnosed with candidiasis. Which of the following medications would most likely be prescribed for the child?

Nystatin Explanation: Application of nystatin to the oral lesions every 6 hours is an effective treatment for candidiasis. Treatment for diaper rash caused by candida albicans is the application of nystatin ointment or cream to the affected area.

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 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 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 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 nurse practitioner suspects that a child has scarlet fever based on which assessment finding?

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.

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 Explanation: Erythema is redness of the skin produced by congestion of the capillaries.

What information should be included in the teaching plan for a child with varicella?

Remind the child not to scratch the lesions. Explanation: The teaching plan for varicella should include that the child not scratch the lesions. Acetaminophen should be administered for fever, not aspirin, 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. The child should avoid citrus, spicy, or salty foods.

A school-aged child with an infectious disease is placed on transmission-based precautions. Which nursing diagnosis would be the priority?

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.

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 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.

The nurse is caring for a child hospitalized with pertussis. Which nursing intervention would be the highest priority for this child?

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.

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 played then with. In this case, what is the portal of exit in the chain of infection?

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. 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 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?

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.

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

a child reporting dark brown urine and a fine sandpaper rash Explanation: The child with a fine sandpaper rash and dark brown urine may be experiencing renal complications secondary to scarlet fever (Β-hemolytic streptococci, group A), and will be seen first. Treatment with penicillin or another antibiotic is needed. Pharyngitis is an expected symptom of mononucleosis, and treatment for mono consists of supportive measures. A child with a rash with honey-colored crust most likely has impetigo (a skin infection). Headache, fever, and arthralgia are expected symptoms of Zika virus. Treatment for Zika virus consists of supportive measures

Which child will the nurse identify as at greatest risk for developing a urinary tract infection?

an 8-month-old bottle-fed female with HIV Explanation: Factors that make an individual more prone to a urinary tract infection include young age, female gender, and immunosuppression. Infants who are formula-fed are at greater risk than infants who are breastfed. To determine the child at greatest risk, the nurse should 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 mother informs the nurse that the rash started a day before on the exterior surfaces of the extremities; 2 days before, the child had a really bad rash on the face. The physician diagnoses the child with erythema infectiosum. The nurse tells the mother that this is also known as:

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.

A child is diagnosed with group A streptococcal pharyngitis. The nurse would teach the parents to be alert for signs and symptoms of:

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.

The most common complication of varicella is:

secondary bacterial infections. Explanation: The most common complication of varicella is secondary bacterial infection caused by the child scratching the lesions. Other complications include pneumonia, scarring, and encephalitis.

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 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 as can be manifested by decreased urine output.

Which of the following is the drug of choice for multidrug-resistant strains of infection?

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-sulfoxazole or clindamycin.

The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see first?

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.

An adolescent comes to the clinic reporting a sore throat and chills. The nurse suspects that the adolescent has infectious mononucleosis based on assessment of which? Select all that apply.

Firm, tender cervical lymph nodes Splenomegaly Thick, white tonsillar exudate Petechiae on the palate Explanation: The beginning symptoms of infectious mononucleosis include chills, fever, headache, anorexia, and malaise. Children develop enlarged lymph nodes and a severe sore throat. The fever is generally high (103° F [39.5° C]). The cervical lymph nodes, most markedly affected, feel firm and tender. 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 enlarges, placing the child at risk for spontaneous rupture. Hepatitis, a maculopapular eruption similar to the rash of rubella, pneumonitis, and central nervous system involvement such as encephalitis, meningitis, or polyneuritis may occur.

The nurse is caring for a child diagnosed with Hepatitis B. Which system is most likely to have complications from this diagnosis?

Gastrointestinal Explanation: Complications of Hepatitis B can be fatal; in particular, issues related to the liver and chronic conditions are concerns.

The nurse caring for children with fungal infections most often administers which of the following medications?

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 patient 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 MRSA. What should the nurse use as preventive measures in this case?

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.

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." Explanation: Herpes zoster (shingles) is reactivation of the latent varicella zoster (chicken pox) 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.

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 which of the following?

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 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 patient?

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 nurse is instructing the parents of a child who is suspected of having pinworms how to check the child. Which of the following instructions would be most appropriate?

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.

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?

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

The parents state they are afraid to have their child vaccinated and ask the nurse for more information. Which response by the nurse is most appropriate?

"Vaccinations are very effective at preventing serious disease and infection." Explanation: Nurses should provide education about the effectiveness of vaccines to prevent serious diseases at every visit. Although state-required vaccinations are needed for the child to attend school (some states allow medical, religious, and philosophical exemptions), this statement does not address the parents' concern. The child may not acquire the disease because others are vaccinated, but this statement could give the parents a false sense of security. Although most vaccinations do not have serious side effects, the nurse cannot ensure the child will not have a serious reaction to the vaccine.

When reviewing infectious diseases in the pediatric population, nursing students identify which disease as a common childhood exanthema?

Rubella Explanation: Rubella is a common childhood exanthema. Mumps is a viral infection. Rabies is a zoonotic infection. West Nile virus is a vector-borne disease.

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?

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 . Airway obstruction is apparent. Pertussis is characterized by cough and cold symptoms that progress to paroxysmal coughing spells along with copious secretions.

The nurse is triaging a child diagnosed with poliomyelitis. After ensuring appropriate precautions are in place, what will the nurse do next?

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 bedrest, administer an antipyretic, and begin physical therapy.

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. 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.

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.

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.