Chapter 15: Nursing Care of the Child with an Infectious or Communicable Disorder

The major reservoir for MRSA is which of the following areas? a) Anterior nares b) Trachea c) Lungs d) Larynx

A The major reservoir for MRSA is the lower part of the nose (anterior nares).

A nurse is preparing a presentation for parents about common childhood infectious diseases. Which of the following would the nurse include as being caused by a tick bite? Select all that apply. a) Rocky Mountain Spotted Fever b) Scabies c) Lyme disease d) Psittacosis e) Ascariasis

A C 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.

Question: Put the following stages of infectious disease in correct order: Illness Prodromal period Convalescent period Incubation period

Incubation Prodromal Illness Convalescence 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.

The appearance of which hallmark clinical manifestation occurs in measles? a) Koplik spots b) Conjunctivitis c) Fever d) Cough

A Explanation: The hallmark of measles is the appearance of Koplik spots. Other typical symptoms include fever, conjunctivitis, and a cough.

Which of the following is a true statement regarding measles? a) Peak outbreaks are in the summer. b) The incubation period is 10 to 12 days. c) It is transmitted by the fecal-oral route. d) Rarely is it contagious.

B The typical incubation period is 10 to 12 days. Outbreaks peak in the winter and spring. It is highly contagious and is transmitted by airborne suspended droplets.

The major reservoir for MRSA is which of the following areas? a) Larynx b) Trachea c) Anterior nares d) Lungs

C The major reservoir for MRSA is the lower part of the nose (anterior nares).

A group of camp nurses is discussing various types of tick bites. One of the nurses states that deer ticks are carried by white-footed mice and white-tailed deer, and can carry the organism that causes which of the following diseases? a) Lyme disease b) Acquired immunodeficiency syndrome c) Rheumatic fever d) Gonorrhea

A Deer ticks, carried by white-footed mice and white-tailed deer, can carry the organism that causes lyme disease.

A nursing instructor is teaching students about the chain of infection. Which of the following does the instructor tell students is responsible for allowing the pathogen to enter? a) portal of exit b) means of transmission c) portal of entry d) reservoir

A The portal of entry, or the opening through which a pathogen can enter a child's body, can be inhalation, ingestion, or breaks in the skin.

A 6-year-old child is brought to the clinic by his parents. The parents state, "He had a sore throat for a couple of days and now his temperature has been over 102° F (38.9° C). He has this rash on his face and chest that looks like sunburn but feels really rough." Which of the following would the nurse suspect? a) Scarlet fever b) Diphtheria c) Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) d) Pertussis

A 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.

Which of the following is a symptom of neonatal sepsis? a) Bradycardia b) Hypertension c) Increased urine output d) Hyperglycemia

A Symptoms of neonatal sepsis are bradycardia or tachycardia, hypotension, decreased urine output, and hypoglycemia.

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which of the following best describes pustule? a) Redness of the skin produced by congestion of the capillaries b) Small elevation of epidermis filled with a viscous fluid c) Discolored skin spot not elevated at the surface d) Small, circumscribed, solid elevation of the skin

B A pustule is a small elevation of epidermis filled with pus

A child is diagnosed with group A streptococcal pharyngitis. The nurse would teach the parents to be alert for signs and symptoms of which of the following? a) Osteomyelitis b) Pneumonia c) Impetigo d) Scarlet fever

D Group A streptococcal pharyngitis can progress to scarlet fever with the rash appearing in about 12 hours after the onset of the disease. Group A streptococcal pharyngitis is not associated with pneumonia. Impetigo is a group A strep infection involving the skin. Osteomyelitis can occur with an infection by group B streptococcus.

A 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. The nurse documents this as which of the following? a) Lymphadenopathy b) Koplik spots c) Slapped cheek appearance d) Nits

B 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 assessing a neonate with sepsis. The nurse understands that most commonly the cause involves which of the following? a) Enterovirus b) Bacteria c) Herpes virus d) Protozoa

B Neonatal sepsis can be caused by viruses such as herpes simplex or enteroviruses and by protozoa (e.g., Toxoplasma gondii). However, bacteria are typically the culprits.

The nurse is caring for a 14-year-old girl who fears she might have a sexually transmitted infection (STI). Which of the following would the nurse expect to assess if the adolescent has trichomoniasis? a) Urinary incontinence b) Green vaginal discharge c) Flu-like symptoms d) Lesions on the vulva

B Symptoms of trichomoniasis include a yellow, green, or gray vaginal discharge with a foul odor. Urinary incontinence is not indicative of trichomoniasis, but dysuria is. Syphilis is associated with flu-like symptoms Lesions on the vulva are a sign of venereal warts.

The nurse is administering a chicken pox vaccination to a 12-month-old girl. Which concern is unique to Varicella? a) This disease can reactivate years later and cause shingles. b) Children with this disease need to avoid pregnant women. c) Vitamin A is indicated for children younger than 2 years. d) Dehydration is caused by mouth lesions.

A Varicella zoster results in a life-long latent infection. It can reactivate later in life resulting in shingles. The American Academy of Pediatrics recommends consideration of Vitamin A supplementation in children 6 months to 2 years hospitalized for measles. Dehydration caused by mouth lesions is a concern with foot and mouth disease. Avoiding exposure to pregnant women is a concern with Rubella, Rubeola, and erythema infectiosum

The nurse is reviewing the assessment data from a 4-year-old admitted to the hospital for management of early onset sepsis. Which finding supports the diagnosis? a) The child is irritable b) The child is unhappy about having to stay in bed c) The child's tympanic temperature is 98.8°F (37.11°C) d) The child is hypotensive

A Sepsis may be associated with lethargy, irritability, or changes in level of consciousness. The septic child will likely not be anxious to have a high activity level and would prefer to remain in bed. The temperature elevation of 98.8 °F (37.11°C) is not significant and does not confirm the presence of sepsis.

The parent of a child with mumps calls the clinic to find out how long the child needs to stay home from school. The nurse would instruct the parent to allow the child to return to school at which time? a) Within 3 days of starting antiviral therapy b) After 9 days from the onset of swelling c) In about 5 days, once the lesions crust d) Usually 7 days after the last lesion appears

B In the home, educate the family to keep the child with mumps from attending school or daycare until 9 days after the onset of swelling. Mumps involves swelling of the salivary glands; no lesions are present. Therapy for mumps is primarily supportive; antiviral agents are not used.

A nursing instructor is teaching the students about the standard and transmission-based precautions. What type of precautions requires placing a patient in an isolated room with limited access, wearing gloves during contact with the patient and all body fluids or contaminated items, wearing two layers of protective clothing, and avoiding sharing equipment between patients? a) Standard precautions b) Airborne precautions c) Contact precautions d) Droplet precautions

C Contact precautions means placing the patient in an isolation room with limited access, wearing gloves during contact with the patient and all body fluids, wearing two layers of protective clothing, limiting movement of the patient from the room, and avoiding sharing equipment between patients.

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? a) Stomach b) Arms c) Neck d) Legs

C Tetanus progresses in a descending fashion to other muscle groups, causing spasms of the neck, arms, legs, and stomach.

The rash in roseola is pruritic. Which of the following measures would you teach the father to provide comfort? a) Dress the child warmly to bring out the rash so that it fades quickly. b) Administer infant aspirin every 4 hours as necessary for comfort. c) Apply cool compresses to the skin to stop local itching. d) Discuss with the child the importance of not scratching lesions.

C Cool compresses can minimize pruritus. Aspirin should not be given with increased temperature (flu-like symptoms).

An 11-year-old girl arrives at the doctor's office with fever, a sore throat, chills, and malaise. A throat culture indicates scarlet fever. Which other symptom should the nurse notice in this patient that clearly indicates scarlet fever? a) The tongue has a white or red "strawberry" appearance b) There is pain along the jawline just in front of the ear lobe c) Vesicles that become purulent, ooze, and form honey-colored crusts d) Fever blisters on the lips

A A "strawberry tongue" is a hallmark symptom of scarlet fever and helps to differentiate the disease from other rashes or pharyngeal infections. Pain along the jawline in front of the ear lobe indicates mumps. Vesicles that become purulent, ooze, and form honey-colored crusts are associated with impetigo. Fever blisters on the lips are caused by a herpes simplex infection.

The nurse is performing a physical examination for a 7-year-old girl who was bitten by a tick. Which of the following would alert the nurse to the possibility of early localized Lyme disease? a) Bull's-eye rash around the bite b) Multiple erythema migrans on the skin c) Cranial nerve palsies d) Recurrent arthritis in the large joints

A 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.

An adolescent girl and her caregiver present at the pediatricians office. The adolescent complains of severe abdominal pain. A diagnosis of pelvic inflammatory disease is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. Which of the following actions by the nurse would be most appropriate? a) Take the child to a private room and interview her regarding her sexual history and partners. b) Talk to the child and caregiver together and explain that the condition is often a result of a sexually transmitted infection and discuss the importance of safe sex practices. c) Contact the necessary authorities to report a suspected case of sexual abuse. d) Take the caregiver to a private room and tell her that the child's diagnosis can only come from sexual activity.

A Adolescents must be made aware of the seriousness of PID, a common result of a chlamydial infection. Pelvic inflammatory disease can cause sterility in the female, primarily by causing scarring in the fallopian tubes that prohibits the passage of the fertilized ovum into the uterus. A tubal pregnancy may be the consequence of a chlamydial infection. In the male, sterility may result from epididymitis caused by a chlamydial infection. All sexual partners must be treated.

A nurse is assessing a child with a tick-borne disease. Which of the following would indicate to the nurse that the child has developed ehrlichiosis and not Rocky Mountain Spotted Fever? a) Absence of rash b) Headache c) Fever d) Malaise

A Both Rocky Mountain Spotted Fever and ehrlichiosis are manifested by fever, headache, and malaise. However, there is rarely a rash with ehrlichiosis, which helps to differentiate it from Rocky Mountain Spotted Fever.

Which of the following should be included in the teaching plan for a child with varicella? a) Remind the child not to scratch the lesions. b) Administer aspirin for fever. c) Place the child in a warm bath for skin discomfort. d) Utilize salt solutions to assist in healing oral lesions.

A 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.

The nurse is administering a chicken pox vaccination to a 12-month-old girl. Which concern is unique to Varicella? a) This disease can reactivate years later and cause shingles. b) Dehydration is caused by mouth lesions. c) Children with this disease need to avoid pregnant women. d) Vitamin A is indicated for children younger than 2 years.

A Varicella zoster results in a life-long latent infection. It can reactivate later in life resulting in shingles. The American Academy of Pediatrics recommends consideration of Vitamin A supplementation in children 6 months to 2 years hospitalized for measles. Dehydration caused by mouth lesions is a concern with foot and mouth disease. Avoiding exposure to pregnant women is a concern with Rubella, Rubeola, and erythema infectiosum.

A nurse is assessing a child with a tick-borne disease. Which of the following would indicate to the nurse that the child has developed ehrlichiosis and not Rocky Mountain Spotted Fever? a) Headache b) Absence of rash c) Malaise d) Fever

B Both Rocky Mountain Spotted Fever and ehrlichiosis are manifested by fever, headache, and malaise. However, there is rarely a rash with ehrlichiosis, which helps to differentiate it from Rocky Mountain Spotted Fever.

A 3-year-old girl was in the hospital for a week following open heart surgery. By the end of the week, she had contracted an infection. The nurse recognizes this type of infection as which of the following? a) Bacterial infection b) Health care-associated infections (HAI) c) Fungal infection d) Viral infection

B Health care-associated infections (HAI) or nosocomial infections which are contracted while in a hospital or other health care setting. Children younger than 2 years, children with a nutritional deficit, those who are immunosuppressed, those who have indwelling vascular lines or catheters, are receiving multiple antibiotic therapy, or who remain in the hospital for longer than 72 hours are at highest risk for contracting such an infection. The infection could be viral, bacterial, or fungal, but not enough information is provided in the scenario to determine this.

A group of grade-school children is going camping. As a school nurse, you would offer them which advice to prevent Lyme disease? a) "Don't approach strange animals outside the campsite." b) "Wear jeans tucked inside your socks when in the woods." c) "Don't drink water from mountain streams while hiking." d) "Don't touch any bush without knowing what kind it is."

B Lyme disease is prevented by measures to reduce the possibility of tick bites

The nurse at the pediatrician's office receives a call from the mother of a child who has just been bitten by the neighbor's dog. Which of the following would be the priority? a) Explain how to care for the dog bite. b) Tell the mother to seek medical help immediately. c) Explain how to educate the child about animals. d) Describe methods of managing a fever.

B The mother should seek medical help for her child immediately. Once the child has been seen by a physician, it can be determined whether immunoprophylaxis is necessary. Education about animals is important to prevent any recurrent bites, but this is appropriate only after the child has been seen and a plan has been determined. Flu-like symptoms such as fever occur early in rabies infection. However, the child must be seen first. Explaining how to care for the bite would be done only after the child is seen and an appropriate plan is determined.

A young girl arrives at the emergency room after being bitten by a neighbor's dog. The mother is in a panic because she fears her daughter will get rabies. The nurse carefully examines and treats the bite and questions the mother and daughter about the details surrounding the dog biting her. Which of the following would most strongly indicate a risk for rabies infection in this client? a) The fact that the dog was properly immunized for rabies b) The fact that the dog was unprovoked when he bit the girl c) The fact that the dog belonged to a neighbor d) The fact that there have been no other reported instances in the area

B An unprovoked attack is much more suggestive that the animal is rabid, rather than if the bite happens during a provoked attack. The dog being immunized for rabies and there being no other reported instances of rabies in the area would indicate a lower risk that the dog was rabid. The fact that the dog belonged to a neighbor does not necessarily indicate a lower risk for rabies infection.

A young patient 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 which of the following? a) Pityriasis rosea b) Fifth disease c) Enterovirus d) Rosacea

B 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.

Which of the following is the leading cause of neonatal sepsis and death? a) Cytomegalovirus infection b) Group B streptococcus c) Epstein-Barr virus infection d) Herpes simplex virus infection

B Group B streptococcus is the leading cause of neonatal sepsis and death. Herpes simplex virus, Epstein-Barr virus, and cytomegalovirus are not leading causes of neonatal sepsis and death.

The nurse at the pediatrician's office receives a call from the mother of a child who has just been bitten by the neighbor's dog. Which of the following would be the priority? a) Explain how to educate the child about animals. b) Tell the mother to seek medical help immediately. c) Describe methods of managing a fever. d) Explain how to care for the dog bite.

B The mother should seek medical help for her child immediately. Once the child has been seen by a physician, it can be determined whether immunoprophylaxis is necessary. Education about animals is important to prevent any recurrent bites, but this is appropriate only after the child has been seen and a plan has been determined. Flu-like symptoms such as fever occur early in rabies infection. However, the child must be seen first. Explaining how to care for the bite would be done only after the child is seen and an appropriate plan is determined.

Which child needs to be seen immediately in the physician's office? a) 8-month-old who is restless, irritable, and afebrile b) 10-month-old with a fever and petechiae who is grunting c) 2-month-old with a slight fever and irritability after getting immunizations the previous day d) 4-month-old with a cough, elevated temperature and wetting eight diapers every 24 hours

B The presence of petechiae can indicate serious infection in an infant. Grunting is abnormal, indicating respiratory difficulty. The behavior of the 2-month-old is normal after immunizations. The 4-month-old needs to be watched but is adequately hydrated and the 8-month-old also needs to be watched. What the 8-month-old is experiencing is common in infants who are teething and is not indicative of illness.

Which of the following should be included in the teaching plan for a child with varicella? a) Place the child in a warm bath for skin discomfort. b) Remind the child not to scratch the lesions. c) Utilize salt solutions to assist in healing oral lesions. d) Administer aspirin for fever.

B 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.

Which of the following is a true statement regarding varicella zoster virus infection? a) It is transmitted by fecal-oral route. b) A complication of this infection includes secondary bacterial infections of the skin. c) It tends to be more severe in children. d) The incubation period is 7 days.

B 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 preparing a presentation for a local mothers group about common viral infections associated with a rash during childhood. When describing rubella, which of the following would the nurse include? Select all that apply. a) The disease most often occurs during late summer and early fall. b) Any itching with the rash is usually mild. c) Incubation period usually ranges from 16 to 18 days. d) The infection is communicable for a week before to a week after the rash appears. e) The rash typically begins on the trunk and spreads to the face.

B C D Explanation: Rubella has an incubation period ranging from 12 to 23 days, but usually 14 days. It is communicable for 7 days before the rash to 7 days after the onset of the rash. Itching is usually mild. It occurs most commonly during late winter and early spring and the rash typically begins on the face and spreads down the neck, trunk, and extremities.

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 of the following infectious diseases? a) scabies b) whooping cough c) mumps d) measles

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

An adolescent girl and her caregiver present at the pediatricians office. The adolescent complains of severe abdominal pain. A diagnosis of pelvic inflammatory disease is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. Which of the following actions by the nurse would be most appropriate? a) Take the caregiver to a private room and tell her that the child's diagnosis can only come from sexual activity. b) Contact the necessary authorities to report a suspected case of sexual abuse. c) Take the child to a private room and interview her regarding her sexual history and partners. d) Talk to the child and caregiver together and explain that the condition is often a result of a sexually transmitted infection and discuss the importance of safe sex practices.

C Adolescents must be made aware of the seriousness of PID, a common result of a chlamydial infection. Pelvic inflammatory disease can cause sterility in the female, primarily by causing scarring in the fallopian tubes that prohibits the passage of the fertilized ovum into the uterus. A tubal pregnancy may be the consequence of a chlamydial infection. In the male, sterility may result from epididymitis caused by a chlamydial infection. All sexual partners must be treated.

Parents usually ask when their child can return to school after having chickenpox. The correct answer would be a) 10 days after the initial lesions appear. b) not until all lesions have completely faded. c) as soon as all lesions are crusted. d) as soon as the temperature is normal.

C Chickenpox lesions are infectious until they crust.

The nurse is teaching a group of middle school students about sexually transmitted infections (STIs). Which statement by the students indicates a need for additional teaching about condom use? a) "Latex condoms provide the best protection against STIs." b) "Don't store condoms in your wallet." c) "Put the condom on just before orgasm." d) "Putting the condom on just before insertion defeats the purpose."

C Condoms should be placed on the penis before any genital contact occurs. Latex condoms are best to protect against infection. Condoms should be applied before any genital contact occurs. Applying them at a later time decreases their effectiveness. Condoms should be stored in a cool, dry place that is away from direct sunlight. A wallet is subject to extreme changes in temperature and is an inappropriate place to store a condom.

The pediatric nurse knows that there are a number of anatomic and physiologic differences between children and adults. Which statement about the immune systems of infants and young children is true? a) Cellular immunity is not functional in children. b) Children have an increased inflammatory response. c) Children have an immature immune response. d) Passive immunity overlaps immunizations.

C Infants and young children are more susceptible to infection due to the immature responses of their immune systems. Cellular immunity is generally functional at birth; humoral immunity develops after the child is born. Newborns have a decreased inflammatory response. Young infants lose the passive immunity from their mothers, but disease protection from immunizations is not complete.

It is summer time, and the mother of a 6-year-old boy tells the nurse that the mosquitoes in their neighborhood are terrible this year. She says she has heard of cases of West Nile virus in the area and asks the nurse what she can do to protect her son from it. Which of the following should the nurse recommend to the mother? a) Avoid using mosquito repellants that contain DEET b) Instruct the son to stay inside from 11 am to 3 pm c) Drain any standing water in the yard d) Have the son dress in light-colored clothing

C Parents can help prevent the spread of West Nile disease by adhering to the "5D's": Instruct children to stay inside between Dusk and Dawn (not 11 am to 3 pm) when mosquitoes are most prevalent. Drain standing water so there are few opportunities for mosquitoes to breed. Dress should include long pants and long sleeves when outside (not light-colored clothing). Apply mosquito repellant that contains DEET (use a concentration not over 30% and apply only once a day. Don't place it on children's hands so they don't ingest it or use with infants under 2 months of age).

When developing the plan of care for a 5-year-old boy with Rocky Mountain spotted fever, the nurse integrates knowledge of this infection as being caused by which of the following? a) Animal bite b) Infection with group A streptococcus c) Bite of a tick d) Contact with contaminated sports equipment

C Rocky Mountain spotted fever is a tick-borne infection. Rabies is due to the bite of an animal. Community-acquired methicillin-resistant Staphylococcus aureus is transmitted through direct person-to-person contact, respiratory droplets, blood, or sharing of personal items and touching surfaces or items contaminated with methicillin-resistant S. aureus. Scarlet fever is an infection resulting from group A streptococcus.

A nurse practitioner suspects that a child has scarlet fever based on which of the following assessment findings? a) Severity of the sore throat b) An enanthematous rash c) Red, strawberry tongue d) White exudate on the tonsils

C 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 caring for an adolescent diagnosed with genital herpes. The drug of choice for treating genital herpes is which of the following? a) Rocephin b) Penicillin c) Valcyclovir d) Griseofluvin

C The drug valcyclovir is useful in relieving or suppressing the symptoms of genital herpes.

Which child needs to be seen immediately in the physician's office? a) 2-month-old with a slight fever and irritability after getting immunizations the previous day b) 8-month-old who is restless, irritable, and afebrile c) 10-month-old with a fever and petechiae who is grunting d) 4-month-old with a cough, elevated temperature and wetting eight diapers every 24 hours

C The presence of petechiae can indicate serious infection in an infant. Grunting is abnormal, indicating respiratory difficulty. The behavior of the 2-month-old is normal after immunizations. The 4-month-old needs to be watched but is adequately hydrated and the 8-month-old also needs to be watched. What the 8-month-old is experiencing is common in infants who are teething and is not indicative of illness.

The student nurse is discussing the plan of care for a child admitted to the hospital for treatment of an infection. Which action should be taken first? a) Initiate intravenous therapy b) Obtain urine specimen for analysis c) Initiate antibiotic therapy d) Obtain blood cultures

D When treating a child suspected of having an infection, the blood cultures must be obtained first. The administration of antibiotics may impact the culture's results. A urine specimen may be obtained but is not the priority action. Intravenous fluids will likely be included in the plan of care but are not the priority action.

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which of the following best describes erythema? a) Discolored skin spot not elevated at the surface b) Small, circumscribed, solid elevation of the skin c) Small elevation of epidermis filled with a viscous fluid d) Redness of the skin produced by congestion of the capillaries

D Erythema is redness of the skin produced by congestion of the capillaries.

Nursing students are learning about the infectious process. They correctly identify the first stage of an infectious disease to be which of the following? a) Illness period b) Prodromal period c) Convalescent period d) Incubation period

D 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.

A 10-year-old girl with long hair is brought to the emergency room because she began acting irritable, reported a headache, and was very sleepy. Which question is most appropriate for the nurse to ask the parents? a) "Has she done this before?" b) "What medications is she currently taking?" c) "How long has she been acting like this?" d) "What were you doing prior to her beginning to feel sick?"

D If the family had been camping or in a wooded area, the girl could have been bitten by a tick which would not be easy to discover because of her long hair. Ticks like dark, hair-covered areas and the signs and symptoms presented are neurological, with a rapid onset, which can be characteristic of a tick bite. The other questions are important but are not focusing on the causative agent.

The nurse is preparing to administer acetaminophen to a 4-year-old girl to provide comfort to the child. Which precaution is specific to antipyretics? a) Take entire course of medication b) Check for medicine allergies c) Warn of possible drowsiness d) Ensure proper dose and interval

D It is very important to ensure that the proper dose is given at the proper interval because an overdose can be toxic to the child. Concerns with allergies and taking the entire, prescribed dose are precaution when administering antibiotics and all medications. Drowsiness is not a side effect of antipyretics.

When the physician looks in a child's mouth during a sick-visit exam, the mother exclaims: "Her tongue is bright red! It was not like that yesterday." The physician would most likely order which medication based on the probable diagnosis of scarlet fever? a) Steroids to decrease the inflammation b) Erythromycin to prevent the spread to siblings c) Acetaminophen to decrease the throat pain d) Penicillin to prevent acute glomerulonephritis

D A "strawberry tongue" is a classic sign of scarlet fever. Penicillin is prescribed to prevent the complications of acute glomerulonephritis and rheumatic fever associated with beta-hemolytic group A streptococcal infections.

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which of the following best describes erythema? a) Small, circumscribed, solid elevation of the skin b) Discolored skin spot not elevated at the surface c) Small elevation of epidermis filled with a viscous fluid d) Redness of the skin produced by congestion of the capillaries

D Erythema is redness of the skin produced by congestion of the capillaries

The nurse is caring for an adolescent diagnosed with syphilis. The drug of choice for treating syphilis is which of the following? a) Acyclovir b) Griseofluvin c) Rocephin d) Penicillin

D Syphilis responds to one intramuscular injection of penicillin G benzathine; if the child is sensitive to penicillin, oral doxycycline, tetracycline, or erythromycin can be administered as alternative treatment.

The most common complication of varicella includes which of the following? a) Encephalitis b) Pneumonia c) Scarring d) Secondary bacterial infections

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

When obtaining the history of a child diagnosed with West Nile virus, the nurse would expect to find exposure to which of the following? a) Cat feces b) Poor sanitation c) Deer tick d) Mosquito bite

D West Nile Virus is transmitted to humans primarily through the bite of infected mosquitoes. Deer ticks are associated with the transmission of Lyme disease. Exposure to cat feces can increase the risk for toxoplasmosis. Poor sanitation can lead to several infections such as roundworm infestation.

Question: A nursing instructor is describing the progression of signs and symptoms associated with varicella from earliest to latest. Place the signs and symptoms below in the sequence that the instructor would describe them. Low-grade fever Crusting Vesicle formation Macular rash Papular rash

Low grade fever Macular rash Papular rash Vesicle formation Crusting The disease is marked by a low-grade fever, malaise, and, in 24 hours, the appearance of a rash. The lesion begins as a macula, then progresses rapidly within 6 to 8 hours to a papule, then to a vesicle that first becomes umbilicated and then forms a crust.