The Child with an Infectious Disease

A mother calls the pediatrician's office to find out how to provide comfort for her son who is itching from chickenpox. Information from the nurse is correct if which information is shared with the mother? a. "Encourage frequent warm baths." b. "Give acetaminophen (Tylenol)." c. "Give diphenhydramine (Benadryl)." d. "Apply a thick coat of Caladryl lotion over open lesions."

ANS: Antipruritic medicines such as diphenhydramine (Benadryl) are useful for severe itching, which interferes with sleep and may contribute to secondary infection. Caladryl lotion (contains Benadryl) should be applied sparingly over open lesions to minimize absorption. Cool baths are recommended for relief of itching. Acetaminophen (Tylenol) has no anti-itching effects.

Which statement made by an adolescent girl indicates an understanding about the prevention of sexually transmitted diseases (STDs)? a. "I know the only way to prevent STDs is to not be sexually active." b. "I practice safe sex because I wash myself right after sex." c. "I won't get any kind of STD because I take the pill." d. "I only have sex if my boyfriend wears a condom."

ANS: A Abstinence is the only foolproof way to prevent an STD. STDs are transmitted through body fluids (semen, vaginal fluids, blood). Perineal hygiene will not prevent an STD. Oral contraceptives do not protect women from contracting STDs. A condom can reduce but not eliminate an individual's chance of acquiring an STD. However, the nurse should encourage condom use 100% of the time to decrease the risk.

The mother of a child with sickle cell disease calls the pediatrician's office because she thinks her son may have fifth disease. What information should the nurse give the mother? a. "Keep your child comfortable at home, but if you notice a major change in his activity level or behavior, call us immediately." b. "Use cool baths with oatmeal to decrease itching first thing in the morning and before going to bed at night." c. "Keep your child away from all of the other members of the household for the next three days." d. "Increase your son's intake of protein and fluids to help replace the liquid he is losing through his skin."

ANS: A Because the disease is mild, complications are not usually reported, especially in children. Patients with sickle cell disease or beta-thalassemia are at risk for anemia and aplastic crisis. A change in activity or energy could indicate anemia. Cool baths with oatmeal are not indicated for this illness. The child needs to be kept away from other family members for longer than 3 days. Increasing protein and fluids is not indicated for this child.

A mother calls the pediatrician's office and states that her 4-year-old son looks like "someone slapped his cheeks" and he's running a fever. What would the nurse suspect the child has based on the mother's description? a. Fifth disease b. Rubella c. Scarlet fever d. Roseola infantum

ANS: A Fifth disease is a relatively mild systemic disease. Typically the child may appear well but has an intense, fiery red, edematous rash on the cheeks, which gives a "slapped cheek" appearance or a history of a rash that "comes and goes." Before the appearance of the rash, many children are asymptomatic or have nonspecific symptoms such as headache runny nose, malaise, and mild fever. Rubella often has the following signs and symptoms: Older children may report profuse nasal drainage, diarrhea, malaise, sore throat, headache, low-grade fever, polyarthritis, eye pain, aches, chills, anorexia, and nausea. Scarlet fever is known for the "strawberry tongue" and a fine red papular rash in the axillae, groin, and neck, which feels like sandpaper to the touch. Roseola infantum causes a sudden high fever (103 to 106° F [39.4 to 41.1° C]), malaise, and irritability, a mild cough, runny nose, abdominal pain, headache, vomiting, and diarrhea, and then several days later when the fever subsides a rash appears. The rash consists of rose-pink maculopapules or macules that blanch with pressure.

Parents report their 3-year-old child appears restless at night and frequently scratches her anal area. What action by the nurse is best? a. Educate parents on the cellophane tape test. b. Review hygiene practices with the parents. c. Suggest the child sleep only in pajama tops. d. Ask parents to bring in a stool sample.

ANS: A The cellophane tape test is used to diagnose pinworms. The parents place a strip of cellophane tape on the child's anus at bedtime and brings it to the clinic for microscopic evaluation. There is no need to review hygienic practices, suggest sleeping in a pajama top only, or to bring in a stool sample.

What should the nurse expect to observe in the prodromal phase of rubeola? a. Macular rash on the face b. Koplik spots c. Petechiae on the soft palate d. Crops of vesicles on the trunk

ANS: B Koplik spots appear approximately 2 days before the appearance of a rash. The macular rash with rubeola appears after the prodromal stage. Petechiae on the soft palate occur with rubella. Crops of vesicles on the trunk are characteristic of varicella.

Which intervention is appropriate for a hospitalized child who has crops of lesions on the trunk that appear as a macular rash and vesicles? a. Place the child in strict isolation with airborne and contact precautions. b. Continue to practice Standard Precautions. c. Pregnant women should avoid contact with the child. d. Screen visitors for immunity to measles.

ANS: A The child's skin lesions are characteristic of varicella. Varicella is transmitted through direct contact, droplets, and airborne particles. In the hospital setting, children with varicella should be placed in strict isolation, and on contact and airborne precautions. The purpose is to prevent transmission of microorganisms by inhalation of small-particle droplet nuclei and to protect other patients and health care providers from acquiring this disease. Standard Precautions are not sufficient for this disease. Certain viral illnesses such as rubella and fifth disease are known to affect the fetus if the woman contracts the disease during pregnancy. This child appears to have varicella. Pregnancy is not a contraindication to caring for a child with varicella. However, all health care personnel should be vaccinated or show immunity to varicella. Screening visitors for immunity to measles is irrelevant. It is important to screen visitors for immunity to varicella.

A preschooler is diagnosed with helminths. The child's mother is very upset and wants to know how her child could have contracted this illness. After obtaining a detailed history, the nurse identifies all possible transmission modes. What do they include? (Select all that apply.) a. Playing in the backyard sandbox b. Not washing hands before eating c. Placing hands in the mouth and nail biting d. Skin-to-skin contact with other children e. Scratches from a neighborhood cat

ANS: A, B, C Common helminths include roundworm, pinworm, tapeworm, and hookworm. Children are frequently infected as the result of frequent hand-mouth activity (unwashed hands, nail biting, not washing hands after using the toilet) and the likelihood of fecal contamination from sandboxes (especially if dogs and cats deposit fecal material in them). Other causes include not adequately washing fruits and vegetables before eating them and drinking contaminated water. Skin-to-skin contact with other children and scratches from a cat are not transmission modes for helminths.

A child who has measles and a compromised immune system needs to be watched for secondary infections or complications. Symptoms of which conditions should the nurse teach the parents to report immediately? Select all that apply. a. Bronchopneumonia b. Epiglottitis c. Laryngotracheobronchitis (croup) d. Otitis media e. Rheumatic fever f. Myocarditis

ANS: A, C, D, F Bronchopneumonia, otitis media and laryngotracheobronchitis (croup), and myocarditis can occur as complications of measles. Epiglottitis and rheumatic fever are not from measles.

The nurse should provide which information to parents about preventing parasitic infections? (Select all that apply.) a. Perform good handwashing. b. Diaper a child when swimming. c. Avoid cleaning the bathroom facilities with bleach. d. Shoes should be worn outside. e. Fruits and vegetables should be washed before eating.

ANS: A, D, E Children are more commonly infected with parasites than adults, primarily as a result of frequent hand-to-mouth activity and the likelihood of fecal contamination. Good handwashing can prevent the transmission. Shoes should be worn when outside to prevent transmission, and fruits and vegetables should be washed before eating. The child should not swim in a pool that allows diapered children. The bathroom facilities should be cleaned with bleach to decrease the chance of transmission.

Which STD should the nurse suspect when an adolescent girl comes to the clinic because she has a vaginal discharge that is white with a fishy smell? a. Human papillomavirus b. Bacterial vaginosis c. Trichomonas d. Chlamydia

ANS: B Bacterial vaginosis is characterized by a profuse, white, malodorous (fishy smelling) vaginal discharge that sticks to the vaginal walls. Manifestations of the human papillomavirus are anogenital warts that begin as small papules and grow into clustered lesions. Infections with Trichomonas are frequently asymptomatic. Symptoms in females may include dysuria, vaginal itching, burning, and a frothy, yellowish-green, foul-smelling discharge. Many people with chlamydial infection have few or no symptoms. Urethritis with dysuria, urinary frequency, or mucopurulent discharge may indicate chlamydial infection.

What should be included in health teaching to prevent Lyme disease? a. Complete the immunization series in early infancy. b. Use insect repellant with DEET in heavily wooded areas. c. Give low-dose antibiotics to the child before exposure. d. Restrict activities that might lead to exposure for the child.

ANS: B Insect repellant with DEET can prevent insect bites. Currently there is no vaccine available for Lyme disease. Antibiotics are used to treat, not prevent, Lyme disease. Children should be allowed to maintain normal growth and development with activities such as hiking.

A school-age child is recovering from infectious mononucleosis. What information should the nurse give the mother about activities when he returns to school? a. The child should eat away from the other children in the lunchroom. b. Participation in his physical education class should be limited to non-contact sports. c. Allow the child to rest until he returns to school without worrying about homework. d. He will be able to return to school full-time when he has his medical release.

ANS: B Participation in his physical education class should be limited to non-contact sports and quiet activities to protect the child's enlarged spleen from rupture. Allowing the child to postpone homework until he returns to school could put the child behind and cause additional stress. He might need to return to school part-time when he has his medical release. There is no reason he needs to eat away from the other children in the lunchroom. However, he should not share any of his lunch or anything saliva has touched.

How should the nurse respond to a parent who asks, "How can I protect my baby from whooping cough?" a. "Don't worry; your baby will have maternal immunity to pertussis that will last until approximately 18 months old." b. "Make sure your child gets the pertussis vaccine." c. "See the doctor when the baby gets a respiratory infection." d. "Have your pediatrician prescribe erythromycin."

ANS: B Primary prevention of pertussis can be accomplished through administration of the pertussis vaccine. Infants do not receive maternal immunity to pertussis and are susceptible to pertussis. Pertussis is highly contagious and is associated with a high infant mortality rate. Prompt evaluation by the primary care provider for respiratory illness will not prevent pertussis. Erythromycin is used to treat pertussis. It will not prevent the disease.

The nurse is explaining the time interval between early manifestations of disease and the overt clinical syndrome to a parent calling about her sick child. Which word would the nurse use? a. The incubation period b. The prodromal period c. The desquamation period d. The period of communicability

ANS: B The definition of prodromal period is the interval between early manifestations of the disease and the appearance of overt clinical symptoms. The "desquamation period" refers to the shedding of skin. The period of communicability is the time when the child is infectious. The incubation period is the time from exposure to appearance of first symptom.

A nurse is conducting a health education class for a group of school-age children. Which statement made by the nurse is correct about the body's first line of defense against infection in the innate immune system? a. Nutritional status b. Skin integrity c. Immunization status d. Proper hygiene practices

ANS: B The first lines of defense in the innate immune system are the skin and intact mucous membranes. Nutritional status is an indicator of overall health, but it is not the first line of defense in the innate immune system. Immunizations provide artificial immunity or resistance to harmful diseases. Practicing good hygiene may reduce susceptibility to disease, but it is not a component of the innate immune system.

What is the best response to a parent of a 2-month-old infant who asks when the infant should first receive the measles vaccine? a. "Your baby can get the measles vaccine now." b. "The first dose is given any time after the first birthday." c. "She should be vaccinated between 4 and 6 years of age." d. "This vaccine is administered when the child is 11 years old."

ANS: B The first measles, mumps, rubella (MMR) vaccine is recommended routinely at 1 year of age. The other statements are not correct.

A child with a depressed immune system due to chemotherapy for cancer has been admitted to the pediatric unit because of possible measles. What would the nurse expect to assess if the child is in the prodrome period of the disease? a. Confusion, chorea, and conjunctivitis b. Coryza, cough, and conjunctivitis c. Coordination problems, clubbing, and contractures d. Croup, congestion, and crying

ANS: B Typically, children have a prodrome period with fever that rises gradually and the "three Cs" ([coryza or profuse runny nose], cough, and conjunctivitis) that lasts between 1 and 4 days. There are no coordination problems, clubbing of the digits, or contractures. Croup is a collection of problems and is not seen with measles. Crying is very vague, but there is some congestion. Confusion doesn't occur unless the fever is very high. There are no uncoordinated movements, but conjunctivitis is present.

A hospitalized child has developed a methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse plans which interventions when caring for this child? (Select all that apply.) a. Airborne isolation b. Administration of vancomycin c. Contact isolation d. Administration of mupirocin ointment to the nares if colonized e. Administration of cefotaxime (Cefotetan)

ANS: B, C, D Vancomycin is used to treat MRSA along with mupirocin ointment to the nares. The patient is placed in contact isolation to prevent spread of the infection to other patients. The infection is not transmitted by the airborne route so only contact isolation is required. This infection is resistant to cephalosporins.

The camp nurse is telling a group of campers and their counselors how to avoid insect and tick bites. What information should the nurse include? Select all that apply. a. Dark, long-sleeved shirts should be worn. b. A hat is helpful when in wooded and grassy areas. c. Try to stay on paths rather than walking through dense areas. d. Apply insect repellent lightly on the hands. e. Ticks should be scraped off the skin. f. Shirts should be tucked into the pants.

ANS: B, C, F A hat is very helpful to protect the head from insects getting in the hair when in wooded and grassy areas. Trying to stay on paths rather than walking through dense areas is true. Shirts should be tucked into the pants to prevent insects and ticks getting to the skin. Light, long sleeved shirts should be worn because of being able to see insects and ticks. Insect repellent should not be applied on the hands because the hands often touch the eyes and mouth. Ticks should be removed with tweezers. The tick should be removed as close to the skin as possible using steady upward pressure. Ensure that all mouthparts are removed from the skin.

The nurse is using Standard Precautions while caring for her patients. Nursing care is correct if which procedures are used to promote infection control? a. Gloves are worn any time a patient is touched. b. Needles are capped immediately after use and disposed of in a special container. c. Gloves are worn to change diapers when there are loose or explosive stools. d. Masks are used only when caring for patients with airborne infections.

ANS: C Changing a diaper with loose or explosive stools has the greatest risk for exposure to body substances. Masks are a component of Transmission-Based Precautions and not Standard Precautions. Gloves are not indicated unless there is potential for contact with body substances. Used needles should never be capped. They should be immediately disposed of in a rigid puncture-proof container.

Which statement indicates that a father understands the treatment for his child who has scarlet fever? a. "I can stop the medicine when my child feels better." b. "I will apply antibiotic cream to her rash twice a day." c. "I will give the penicillin for the full 10 days." d. "My child can go back to school after 7 days of antibiotics."

ANS: C It is necessary to give the entire course of antibiotic for 10 to 14 days. Penicillin is the preferred treatment for any streptococcal infection. The bacteria will not be eradicated if a partial course of antibiotics is given. Treatment of scarlet fever does not include topical antibiotic cream. The child is no longer contagious after 24 hours of antibiotic therapy and can return to daycare or school.

The office nurse is taking a history on a child's illness from the parents. The nurse notes that the parents treated their 7-year-old child appropriately for a fever when they report that they provided what care? a. Gave baby aspirin (ASA) b. Bathed the child in cold water c. Gave fluids at frequent intervals d. Gave alternating dosages of acetaminophen (Tylenol) and ibuprofen (Motrin)

ANS: C Providing fluids at frequent intervals helps to meet the body's need for fluids during a febrile illness. Alternating acetaminophen (Tylenol) and ibuprofen (Motrin) might result in an overdose and has no real benefit. Aspirin is associated with Reye's syndrome and should not be given to children with a fever. The cold bath will chill the child and cause shivering, which is a response that will increase the body temperature.

A parent brings a child to the emergency department and reports fever, foul smell coming from the throat, and a gray covering over the tonsils. What action by the nurse takes priority? a. Place the child on a cardiac monitor. b. Attach a pulse oximeter to the child. c. Assess respiratory status immediately. d. Start an IV and draw blood cultures.

ANS: C The manifestations are characteristic of diphtheria, which can cause respiratory compromise and airway obstruction. The nurse first assesses the child's respiratory status. Putting the child on a cardiac monitor and oximeter are important interventions, but first the nurse needs to assess the respiratory system. The child will need an IV, but that can be started after the respiratory assessment.

The mother of an infant with multiple anomalies tells the nurse that she had a viral infection in the beginning of her pregnancy. Which viral infection is associated with fetal anomalies? a. Measles b. Roseola c. Rubella d. Herpes simplex virus (HSV)

ANS: C The rubella virus can cross the placenta and infect the fetus, causing fetal anomalies. Measles is not associated with congenital defects. Most cases of roseola occur in children 6 to 18 months old. HSV can be transmitted to the newborn infant during vaginal delivery, causing multisystem disease. It is not transmitted transplacentally to the fetus during gestation.

The nurse in the pediatric clinic is caring for a child and assesses this skin rash. What action by the nurse is best? a. Inform parents the child will be contagious for one week. b. Arrange for immediate hospitalization and IV antibiotics. c. Instruct parents to offer the child a soft, bland diet. d. Advise parents the child can maintain normal activities.

ANS: C This rash is characteristic of scarlet fever. The parents should provide soft, bland food. The child is not contagious 24 hours after starting antibiotics. There is no indication the child is sick enough to need hospitalization. The parents should encourage rest.

Which statement made by a parent about intervention for a child's fever shows the need for further education? a. "I should keep her covered lightly when she has a fever." b. "I'll give her plenty of liquids to keep her hydrated." c. "I can give her acetaminophen for a fever." d. "I'll look for over-the-counter aspirin or ibuprofen."

ANS: D Aspirin products are avoided because of the possibility of development of Reye's syndrome. The parent should check labels on all over-the-counter products to be sure they do not contain aspirin. Ibuprofen is alright to give children. Dressing the child in light clothing and using lightweight covers will help reduce fever and promote the child's comfort. Adequate hydration will help maintain a normal body temperature. Acetaminophen is also recommended for fever in children.

What should be included in the care for a neonate who was diagnosed with pertussis? a. Monitoring hemoglobin level b. Hearing test before discharge c. Serial platelet counts d. Prophylactic antibiotics for all close contacts

ANS: D Erythromycin, azithromycin, or clarithromycin is given to all close contacts for the child diagnosed with pertussis. Pertussis does not affect the hemoglobin level. A complication of pertussis is not hearing impairment. Pertussis does not affect platelets.

A parent asks the nurse how she will know whether her child has fifth disease. The nurse should advise the parent to be alert for which manifestation? a. Bull's-eye rash at the site of a tick bite b. Lesions in various stages of development on the trunk c. Maculopapular rash on the trunk that lasts for 2 days d. Bright red rash on the cheeks that looks like slapped cheeks

ANS: D Fifth disease manifests with an intense, fiery red, edematous rash on the cheeks, which gives a "slapped cheek" appearance. The bull's-eye rash at the site of a tick bite is a manifestation of Lyme disease. Varicella is manifested as lesions in various stages of development—macule, papule, then vesicle, first appearing on the trunk and scalp. Roseola manifests as a maculopapular rash on the trunk that can last for hours or up to 2 days.

A child taking oral corticosteroids for asthma is exposed to varicella. The child has not had the varicella vaccine and has never had the disease. What intervention should be taken to prevent varicella from developing? a. No intervention is needed unless varicella develops. b. Administer the varicella vaccine as soon as possible. c. The child should begin a course of oral antibiotics. d. The child should be prescribed acyclovir.

ANS: D For children who are immunosuppressed (such as from corticosteroids), acyclovir is the treatment of choice to prevent infection. Action is needed due to the risk of serious complications. The varicella vaccine is a live virus vaccine and is contraindicated for an immunosuppressed child. An antibiotic is not effective in treating varicella zoster, which is a virus.

Which action is initiated when a child has been scratched by a potentially rabid animal? a. No intervention unless the child becomes symptomatic b. Administration of immune globulin around the wound c. Administration of rabies vaccine on days 3, 7, 14, and 28 d. Administration of both immune globulin and vaccine as soon as possible after exposure

ANS: D Human rabies immune globulin and the first dose of the rabies vaccine are given after exposure. Transmission of rabies can occur from bites with contaminated saliva, scratches from the claws of infected animals, airborne transmission in bat-infested caves, or in a laboratory setting. Rabies is fatal if no intervention is taken to prevent the disease. Human rabies immune globulin is infiltrated locally around the wound, and the other half of the dose is given intramuscularly. This is only part of the treatment after rabies exposure. The rabies vaccine is given within 48 hours of exposure and again on days 3, 7, 14, and 28.

An adolescent has been diagnosed with the Epstein-Barr virus. What discharge information should the nurse give to the parents? a. It is important to protect the adolescent's head during physical activities. b. The teen will feel like himself and be back to his usual routines in a week. c. Treatment of the Epstein-Barr virus is several months of prolonged bed rest. d. Fatigue may persist, so increase school activities gradually.

ANS: D The recovery period is often lengthy and fatigue may continue, necessitating a gradual return to school activities. During the acute and recovery phases, activity restrictions, which include no contact sports or roughhousing, are implemented to protect the child's enlarged spleen from rupture. The recovery process from infectious mononucleosis is a slow and gradual one. Prolonged rest (not bedrest) is indicated during the acute stage of the illness only.