CH 15 – Infection

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) Children have an increased inflammatory response.
b) Passive immunity overlaps immunizations.
c) Cellular immunity is not functional in children.
d) Children have an immature immune response.

D

A nurse is assessing a child with a tick-borne disease. What finding would indicate to the nurse that the child has developed ehrlichiosis and not Rocky Mountain spotted fever?

a) Headache
b) Absence of rash
c) Fever
d) Malaise

B

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.

a) Lyme disease
b) Scabies
c) Rocky Mountain spotted fever
d) Psittacosis
e) Ascariasis

A, C

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

a) Rocephin
b) Griseofluvin
c) Penicillin
d) Valcyclovir

D

A mother voices concern to the nurse that her child should not be using alcohol-based hand gels to help prevent the spread of infection. How should the nurse respond?

a) "Hand gels are actually very effective in preventing the spread of infection."
b) "Alcohol-based hand gels are not as effective as washing the hands with water."
c) "At least your child is using some form of hand hygiene."
d) "As long as your child washes his hands with soap and water a couple of times a day along with the hand gel, it is effective."

A

What is the leading cause of neonatal sepsis and death?

a) Cytomegalovirus infection
b) Herpes simplex virus infection
c) Epstein-Barr virus infection
d) Group B streptococcus

D

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

a) An enanthematous rash
b) White exudate on the tonsils
c) Severity of the sore throat
d) Red, strawberry tongue

D

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) Acetaminophen to decrease the throat pain
b) Steroids to decrease the inflammation
c) Penicillin to prevent acute glomerulonephritis
d) Erythromycin to prevent the spread to siblings

C

The nurse is preparing a care plan for a pregnant woman who has venereal warts. The nurse identifies the nursing diagnosis Knowledge deficit regarding vaginal delivery. What should the nurse include as teaching points for this client’s care plan?

a) "The teeth, bones, and brain of your newborn can be affected if you deliver vaginally."
b) "During a vaginal delivery, your newborn may develop warts in the throat."
c) "If delivered vaginally your child is at high risk for developing blindness and sepsis."
d) "Low birth rate is a high risk when delivering vaginally with your condition."

B

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) Check for medicine allergies
b) Take entire course of medication
c) Warn of possible drowsiness
d) Ensure proper dose and interval

D

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?

a) Pertussis
b) Diphtheria
c) Scarlet fever
d) Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA)

C

A young girl arrives at the emergency room after being bitten by a neighbor’s dog. The mother is concerned 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. What information would most strongly indicate a risk for rabies infection in this client?

a) The dog belonged to a neighbor
b) The dog was unprovoked when he bit the girl
c) The dog was properly immunized for rabies
d) There have been no other reported instances in the area

D

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

a) Rocephin
b) Griseofluvin
c) Penicillin
d) Acyclovir

C

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) Obtain blood cultures
b) Initiate antibiotic therapy
c) Obtain urine specimen for analysis
d) Initiate intravenous therapy

A

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?

a) Bull’s-eye rash around the bite
b) Cranial nerve palsies
c) Recurrent arthritis in the large joints
d) Multiple erythema migrans on the skin

A

The physician has ordered ibuprofen 150 mg every 6 hours as needed for a 3-year-old child for a fever greater than 38 Celsius. The label of the ibuprofen bottle reads "ibuprofen oral suspension 100 mg/5 mL." How much ibuprofen liquid will the nurse administer if the child’s temperature goes above 38 C? Record your answer using one decimal place.

7.5 mL

The mother of a child with pediculosis capitis infestation tells the nurse that she does not understand why her child still has the infestation. The mother states, "I used the prescribed treatment just like I was instructed." How should the nurse respond?

a) "Maybe you should use some of the home remedies like petroleum jelly or mayonnaise."
b) "Have you been combing the hair for nits from the hair on a weekly basis?"
c) "After finding the infestation did you wash items that your child’s head came into contact with, like bed linen?"
d) "Do you wash your child’s hair daily? Having clean hair will help get rid of the infestation."

C

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.

a) Wearing protective clothing when playing in wooded areas.
b) Removing ticks by rubbing them away from the skin with a credit card.
c) Dressing the child in dark clothing when going outdoors.
d) Contacting the health care provider if there is any area of inflammation that might be a bite.
e) Inspecting the skin closely for ticks after the child plays in wooded areas.

A, D, E

The nurse is obtaining a throat culture from a child with a fever of unknown origin. Which nursing actions demonstrate knowledge of the appropriate way to collect this specimen?

a) The nurse swabs the pharyngeal and tonsillar area
b) The nurse swabs the tongue prior to swabbing the throat
c) The nurse obtains the specimen before administration of antibiotics
d) The nurse stops obtaining the specimen while swabbing the throat if the child starts coughing or gagging
e) The nurse avoids touching the lips when inserting the culturette

A, C, E

A nurse is assessing a neonate with sepsis. The nurse understands that most commonly the cause involves:

a) Protozoa
b) Enterovirus
c) Bacteria
d) Herpes virus

C

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.
1. Vesicle formation
2. Papular rash
3. Crusting
4. Low-grade fever
5. Macular rash

4, 5, 2, 1, 3

An adolescent girl and her caregiver present at the pediatrician’s office. The adolescent reports 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 action by the nurse would be most appropriate?

a) Contact the necessary authorities to report a suspected case of sexual abuse.
b) Take the child to a private room and interview her regarding her sexual history and partners.
c) Take the caregiver to a private room and tell her that the child’s diagnosis can only come from sexual activity.
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.

B

When developing the plan of care for a 5-year-old boy with Rocky Mountain spotted fever, the nurse knows the cause of the illness is:

a) Contact with contaminated sports equipment
b) Infection with group A streptococcus
c) Animal bite
d) Bite of a tick

D

The father of a child with mononucleosis is concerned with his child’s fever and cough. The father asks when antibiotic therapy will begin. What is the best response by the nurse?

a) "We have to get all of the lab results back before the antibiotic can be started."
b) "Mononucleosis is a viral infection so an antibiotic isn’t used. We address the symptoms with appropriate therapy."
c) "It is common treatment to let the infection run its course and let the immune system take care of it."
d) "There aren’t a lot of antibiotics that work for pertussis. We will just treat your son with medications to treat his fever and cough."

B

A neonate is brought to the emergency department by her mother because she "just doesn’t look right." The neonate is suspected of having sepsis. Which statement by the mother would help to confirm this suspicion?

a) "She seems to be breathing a little fast."
b) "She hasn’t had a fever."
c) "My water broke quite a while before I actually delivered her."
d) "Her cry seems to be pretty strong."

C

The nurse is caring for a 10-year-old child with a skin rash. The nurse should include which intervention to manage the associated pruritis?

a) Apply hot compresses
b) Rub powder on the pruritic area
c) Press the pruritic area
d) Encourage warm baths

C

The nurse is discussing fever with the parents of a child who is in the emergency department with a temperature of 101 degrees Fahrenheit. Which statement by a parent indicates an understanding about fevers and their management in the ill child?

a) "We’ve been giving him a little extra acetaminophen to help bring his fever down."
b) "Fevers can be beneficial because they can slow down the growth of the bacteria or virus that may be causing the infection."
c) "We’ve had to wake him up in the night to give him more medicine to reduce his temperature."
d) "My wife and I have been using cold water and washcloths on him because of the fever."

B

The nurse is caring for a 5-year-old girl with scarlet fever. Which intervention will most likely be part of her care?

a) Teaching proper administration of Penicillin V
b) Palpating for and noting enlarged lymph nodes
c) Exercising both standard and droplet precautions
d) Monitoring for changes in respiratory status

A

A young client in the clinic has a rash, cough, and fever that the mother says spiked on day 5 of the rash. The client also had conjunctivitis. What would the nurse expect the physician to tell the family that the child has?

a) Scarlet fever
b) Rubella
c) Chickenpox
d) Measles

D

The appearance of which hallmark clinical manifestation occurs in measles?

a) Cough
b) Fever
c) Conjunctivitis
d) Koplik spots

D

A nursing instructor has presented a class on the stages of an infectious disease to a group of students and asks the students to place the stages in their proper sequence from beginning to end. Place the stages in their proper sequence.
1. Prodrome
2. Convalescence
3. Incubation
4. Illness

3, 1, 4, 2

A child has been diagnosed with hand, foot and mouth disease. The child’s mother wants to know how long it will take for her child to feel better. What information should be provided to the child’s parent?

a) "Once your child completes the antiviral therapy they will feel better."
b) "It can take about 2 weeks for your child to feel better."
c) "Within 10 days of starting the antibiotic therapy your child will start to feel better."
d) "Your child will likely feel better within a week."

D

A 16-year-old is seen in the emergency department with symptoms including a high fever, chills, headache, nausea and vomiting, and painful joints. During the nursing history the teenager reports recently returning from a trip to a rain forest in South America. What infectious disease does the nurse suspect the client has contracted?

a) West Nile disease
b) Malaria
c) Rabies
d) Anaplasmosis

B

A 15-year-old boy visits his primary care physician’s office with fever, headache, and malaise, along with complaints of pain on chewing and pain in the jawline just in front of the ear lobe. The boy asks his mother to leave the exam room for a minute and then tells the nurse that he is also experiencing testicular pain and swelling. The nurse recognizes that this client most likely has which condition?

a) Poliomyelitis
b) Herpes zoster
c) Infectious mononucleosis
d) Mumps

D

A nursing instructor has performed effective teaching of the functions of white blood cells when a student correctly identifies what as a backup for neutrophils in an acute infection?

a) Neutrophils
b) Monocytes
c) Lymphocytes
d) Eosinophils

B

A child is diagnosed with early disseminated Lyme disease. The nurse informs the parents the child will most likely receive antibiotic therapy for which length of time?

a) 14 to 28 days
b) 10 to 14 days
c) 14 to 18 days
d) 7 to 10 days

A

A 9-month-old child has been admitted to rule out sepsis. Which finding offers the most support to the presence of this disorder?

a) The child cries when his mother is not in sight.
b) The child’s birth history indicates he was born at 42 weeks’ gestation.
c) The child has had 7 wet diapers in the past 24 hours.
d) The child has had 8 ounces of formula in the past 24 hours.

D

The nurse at an outpatient facility is obtaining a blood specimen from a 9-year-old girl. Which technique would most likely be used?

a) Administering sucrose prior to beginning
b) Using an automatic lancet device on the heel
c) Puncturing a vein on the dorsal side of the hand
d) Accessing an indwelling venous access device

C

The nurse is caring for a 7-year-old child in droplet precautions due to the diagnosis of pertussis. While visiting the child, which actions by the parents require the nurse to intervene? Select all that apply.

a) The parents state, "We will be sure to finish any antibiotic if our child is sent home with a prescription."
b) The parents wear a respiratory mask when entering their child’s room.
c) The parents remove their personal protective equipment (PPE) at the door before exiting, then wash their hands.
d) The parents state, "We have been limiting our child’s fluids to help decrease the amount of coughing."
e) The parents state, "We should postpone immunizing our 5-year-old since there has been contact with the infection."

D, E

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

a) The nurse will encourage bed rest.
b) The nurse will monitor caloric intake.
c) The nurse will administer antibiotics.
d) The nurse will administer oxygen.

D

The nurse is providing education to the parents of a 5-year-old with a fever. Which statements indicate the need for further instruction? Select all that apply.

a) "I should use a cooling fan in my child’s room to keep the fever down."
b) "Sponging my child with cold water can be a soothing way to manage the fever."
c) "Ibuprofen has been shown to be more beneficial than acetaminaphen when managing a fever."
d) "Fever has many therapeutic properties."
e) "I can administer two baby aspirin tablets to my child every 4 to 6 hours for the fever."

A, B, E

A chief danger of scarlet fever is that children may develop:

a) acute glomerulonephritis.
b) respiratory obstruction.
c) liver destruction.
d) local areas of skin necrosis.

A

A 6-month-old boy is brought to the doctor’s office with a high fever. The physician diagnoses the child as having a viral infection of some kind and recommends acetaminophen to reduce the fever. After 3 days, the mother returns with the child. The fever is gone, but a rash of discrete, rose-pink macules approximately 2 to 3 mm and flat with the skin surface appears. Which condition should the nurse suspect?

a) Chickenpox (varicella)
b) Rubella (German measles)
c) Roseola
d) Measles (rubeola)

C

The most common complication of varicella is:

a) encephalitis.
b) secondary bacterial infections.
c) pneumonia.
d) scarring.

B

The mother of a 10-year-old child diagnosed with rubella asks what can be done to help her child feel better during her illness. What information can be provided?

a) Encourage rest and relaxation.
b) Antibiotic therapy may be initiated.
c) Range of motion to prevent contractures.
d) Antiviral medications can be prescribed.

A

The nurse is collecting data on an adolescent admitted with a diagnosis of a sexually transmitted infection. The child has a hard, red, painless lesion on his penis. The nurse recognizes the lesion as a chancre, which is a sign of:

a) syphilis.
b) chalmydial infection.
c) gonorrhea.
d) genital herpes.

A

The nurse is caring for a 16-year-old child with a diagnosis of acquired immunodeficiency syndrome (AIDS). What treatment goal has the highest priority for this child?

a) Preventing spread of infection
b) Maintaining skin integrity
c) Improving nutrition
d) Promoting comfort

A

The parents of a 4-month-old diagnosed with sepsis tell the nurse that the physician explained sepsis to them but they don’t really understand it. The parents state, "Could you please explain it to us?" What is the best response by the nurse?

a) "The infection your child has causes the release of toxins into the system, which can lead to impaired function in the lungs, liver, and kidneys."
b) "Sepsis results in systemic inflammatory response syndrome (SIRS) due to infection."
c) "The pathogens cause an overproduction of proinflammatory cytokines. These cytokines are responsible for the clinically observable effects of the sepsis."
d) "The pathophysiology of sepsis is complex."

A

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?

a) The 5-year-old girl
b) Upper respiratory excretion
c) Toy
d) The friend

B

A 3-week-old infant is diagnosed with pertussis. Which antimicrobial agent would the nurse expect the physician to prescribe?

a) Clarithromycin
b) Azithromycin
c) Erythromycin
d) Trimethoprim-sulfamethoxazole

B

The nurse is attempting to control the infectious process while caring for a client. The nurse changes the client’s wound dressing when the dressing becomes soiled. Which link of the chain of infection is the nurse interrupting with this intervention?

a) Reservoir
b) Susceptible host
c) Portal of exit
d) Mode of transmission

A

The nurse is obtaining a health history and assessment for a child being admitted who is suspected of having measles. What signs and symptoms does the nurse expect to find during the assessment? Select all that apply.

a) Fever
b) Upper respiratory infection symptoms
c) Clear, fluid-filled vesicles
d) Erythematous flushing
e) Maculopapular rash that began on the face and has spread to the rest of the body

A, B, E

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?

a) Mumps
b) Fifth disease
c) Mononucleosis
d) Measles

A

A young client in the clinic has a rash, cough, and fever that the mother says spiked on day 5 of the rash. The client also had conjunctivitis. What would the nurse expect the physician to tell the family that the child has?

a) Rubella
b) Chickenpox
c) Scarlet fever
d) Measles

D

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) After 9 days from the onset of swelling
b) Within 3 days of starting antiviral therapy
c) Usually 7 days after the last lesion appears
d) In about 5 days, once the lesions crust

A

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

a) Parasites
b) Bacteria
c) Viruses
d) Fungi

C

A nurse is assessing a child who was recently adopted from a foreign country and has not yet received any immunizations. The child has a high fever, rhinitis, and sore throat. The nurse also notes small, irregular, bright red spots on the buccal membrane. What would the nurse suspect?

a) Rubeola
b) Variola
c) Rubella
d) Varicella

A

A child is diagnosed with an enterovirus infection. Which type of infection control precaution would be most important for the nurse to use?

a) Contact
b) Standard
c) Airborne
d) Droplet

A

The nurse is taking a health history for an 8-year-old boy who is hospitalized. Which is a risk factor for sepsis in a hospitalized child?

a) Use of immunosuppression drugs
b) Lack of juvenile immunizations
c) Maternal infection or fever
d) Resuscitation or invasive procedures

A

A group of grade-school children is going camping. As a school nurse, you would offer them which advice to prevent Lyme disease?

a) "Wear jeans tucked inside your socks when in the woods."
b) "Don’t approach strange animals outside the campsite."
c) "Don’t drink water from mountain streams while hiking."
d) "Don’t touch any bush without knowing what kind it is."

A

A chief danger of scarlet fever is that children may develop:

a) local areas of skin necrosis.
b) acute glomerulonephritis.
c) respiratory obstruction.
d) liver destruction.

B

A young child who has been reporting fatigue and running a low-grade fever for 4 days begins to have pustules over the entire body. The physician diagnoses chickenpox. The period before the pustules developed is referred to as the:
a) prodromal period
b) incubation period
c) convalescent period
d) active infection

A

What condition begins as an upper respiratory illness and progresses to a persistent cough characterized by an inspiratory whoop?

a) Pertussis
b) HIV
c) Sepsis
d) TB

A

A 6-year-old child is being treated for a parasitic infection. When reviewing results from the child’s white blood cell count, which finding would be anticipated?

a) Elevated monocytes
b) Reduced basophil levels
c) Reduced neutrophil levels
d) Increased eosinophils levels

D

A 6-year-old boy is suspected of having late-stage Lyme disease. Which assessment should the nurse use to produce findings supporting this concern?

a) Examining for conjunctivitis
b) Observing for facial palsy
c) Asking the child if his knees hurt
d) Inspecting for erythema migraines

C

What is one of the most commonly reported communicable diseases in the United States?

a) Gonorrhea
b) Syphilis
c) Mononucleosis
d) Measles

A

A child has been brought to the pediatric clinic. The assessment reveals the child has a temperature of 100.9 F (38.3 C), as well as a rash that is pink and has raised areas. When the area is palpated the skin blanches. Which disease is most associated with these findings?

a) Varicella zoster
b) Rubella
c) Rubeola
d) Exanthem subitum

D

The nurse is caring for a 10-year-old boy with diphtheria. What would the nurse institute as a tier 2 precaution?

a) Use of a protective face shield
b) Use of a protective mask
c) Use of a protective gown
d) Negative air pressure ventilation

B

The nurse is caring for a child who has been diagnosed with Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA). The parents of the child question how their child became infected. What information can be included in the information provided by the nurse? Select all that apply.

a) The infection is primarily transmitted by sexual contact.
b) This infection can be caught from contaminated surfaces in the school.
c) Poor hygiene is the primary reason that this infection is passed from person to person.
d) Respiratory spread of the infection is possible.
e) Sharing personal care objects can be a source of contamination.

B, D, E

When obtaining the history of a child diagnosed with West Nile virus, the nurse would expect to find exposure to what cause of this illness?

a) Cat feces
b) Deer tick
c) Poor sanitation
d) Mosquito bite

D

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) "What were you doing prior to her beginning to feel sick?"
b) "What medications is she currently taking?"
c) "How long has she been acting like this?"
d) "Has she done this before?"

A

A child who developed parotid gland swelling on March 5 was diagnosed with mumps. The nurse determines that the child will no longer be contagious at which time?

a) March 19
b) March 12
c) March 8
d) March 14

D

What would you expect to observe about the rash associated with chickenpox (varicella)?

a) Various stages of lesions present at the same time
b) Dark red color (red hen marks)
c) Noticeable crusts but no pruritus
d) Dark red, macular, very pruritic lesions

A

The parents of a 3-year-old child report he was exposed to pertussis 2 days ago. They are concerned and ask the nurse how long it will take until he becomes ill if he indeed contracted the infection. What response by the nurse is indicated?

a) "It normally takes about 3 weeks before symptoms begin."
b) "The signs of disease will be noted in 1 to 3 weeks."
c) "If your child had contracted the disease symptoms would have be noted by this time."
d) "If you child has contracted the illness he will become ill in about 2 weeks."

B

The 6-year-old child has been diagnosed with Lyme disease. She is allergic to penicillin. Which medication will most likely be ordered for this client?

a) Doxycycline
b) Amoxicillin
c) Tetracycline
d) Cefuroxime

D

What would the nurse include in the teaching plan for parents and their child with a pruritic rash? Select all that apply.

a) Making sure the child’s hands are clean
b) Keeping fingernails trimmed short
c) Using warm baths to soothe the skin
d) Encouraging pressure on the skin rather than scratching
e) Using distraction to prevent scratching

A, B, D, E

The nurse is talking to the parents of an 2-month-old infant who has been admitted to the hospital with sepsis. The parents report being confused since their older children also had the flu but they recovered without incident. What information can the nurse provide to the parents?

a) Infants have fewer white blood cells available to fight infection.
b) Infants to not have adequate amounts of immunoglobulin G (IgG)to fight infections.
c) Children this young do not have mature immune systems to fight infection.
d) Passive immunity does not protect the child from infection if the mother has not had the particular infection.

C

The mother of a an 8-year-old boy with mumps tells the nurse that she does not understand how her son could have gotten mumps since he was immunized according to her physician’s recommendations. What is the best response by the nurse?

a) "I am wondering if your physician followed the immunization schedule correctly?"
b) "I am sure it must be frustrating. Where did you have the immunizations performed?"
c) "While immunizations are highly effective they aren’t 100% effective at preventing infectious diseases."
d) "Are you sure your child received an immunization for mumps?"

C

Which child needs to be seen immediately in the physician’s office?

a) 8-month-old who is restless, irritable, and afebrile
b) 2-month-old with a slight fever and irritability after getting immunizations the previous day
c) 4-month-old with a cough, elevated temperature and wetting eight diapers every 24 hours
d) 10-month-old with a fever and petechiae who is grunting

D

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?

a) Whooping cough
b) Measles
c) Scabies
d) Mumps

D

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) Neck
b) Arms
c) Stomach
d) Legs

A

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

a) Remind the child not to scratch the lesions.
b) Utilize salt solutions to assist in healing oral lesions.
c) Place the child in a warm bath for skin discomfort.
d) Administer aspirin for fever.

A

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?

a) Contact precautions
b) Standard precautions
c) Droplet precautions
d) Airborne precautions

A

The nurse is providing teaching to the parents of a child with varicella. Which statement indicates that the parents have understood the instructions?

a) "We need to make sure that he washes his hands frequently."
b) "If he has a fever, we can give him some aspirin."
c) "The lesions should eventually form soft crusts that drain."
d) "We should apply alcohol to the lesions every four hours."

A

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

a) pneumonia.
b) impetigo.
c) osteomyelitis.
d) scarlet fever.

D

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

a) Convalescent period
b) Incubation period
c) Illness period
d) Prodromal period

B

The nurse is administering a chicken pox vaccination to a 12-month-old girl. Which concern is unique to varicella?

a) Children with this disease need to avoid pregnant women.
b) Vitamin A is indicated for children younger than 2 years.
c) This disease can reactivate years later and cause shingles.
d) Dehydration is caused by mouth lesions.

C

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:

a) enterovirus.
b) rosacea.
c) pityriasis rosea.
d) fifth disease.

D

What is a true statement regarding measles?

a) It is not contagious.
b) It is transmitted by the fecal-oral route.
c) The incubation period is 10 to 12 days.
d) Peak outbreaks are in the summer.

C

Parents usually ask when their child can return to school after having chickenpox. The correct answer would be:

a) as soon as all lesions are crusted.
b) as soon as the temperature is normal.
c) not until all lesions have completely faded.
d) 10 days after the initial lesions appear.

A

The rash in roseola is pruritic. Which measure would you teach the father to provide comfort?

a) Apply cool compresses to the skin to stop local itching.
b) Dress the child warmly to bring out the rash so that it fades quickly.
c) Discuss with the child the importance of not scratching lesions.
d) Administer infant aspirin every 4 hours as necessary for comfort.

A

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 disease?

a) Gonorrhea
b) Rheumatic fever
c) Lyme disease
d) Acquired immunodeficiency syndrome

C

What is a true statement regarding varicella zoster virus infection?

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

C

The nurse is discussing infection control with the parents of an immunocompromised child. Which causative factors should be presented as the most effective means to prevent infection?

a) Handwashing
b) Cleaning all equipment between uses
c) Use of hand sanitizer before eating
d) Use of aseptic techniques for procedures performed on the child

A

The parents of a child voice concern to the nurse that they believe their child has Lyme disease but their physician won’t do the proper testing. The nurse reviews the chart to determine if specific testing for the disease has been performed. Which tests is the nurse looking for?

a) Erythrocyte-sedimentation rate (ESR)
b) Western immunoblot
c) Enzyme immunoassay (EIA)
d) Immunofluorescent assay (IFA)
e) C-reactive protein (CRP)

B, C, D

The nurse is concerned that the child is developing septic shock. Which findings are consistent with this condition? Select all that apply.

a) White blood cell count is elevated.
b) The child is pale and lethargic.
c) C-reactive protein is decreased.
d) The child’s blood pressure is reduced.
e) The child’s respiratory rate is elevated.

A, B, D, E

The nurse is caring for a child who is suspected of having an early onset of scarlet fever. Which clinical manifestations support this diagnosis? Select all that apply.

a) Low grade fever.
b) Body aches.
c) Red swollen pharynx.
d) Red red rash on palms of hands and soles of feet.
e) Swollen cervical lymph nodes.

B, C, E

A 10-year-old boy has an unknown infection and will need to provide a urine specimen for culture and sensitivity. To assure that the sensitivity results are accurate, which step is most important?

a) Ensure that the specimen is obtained from proper area
b) Use aseptic technique when getting the specimen
c) Obtain specimen before antibiotics are given
d) Collect three specimens on three different days

C

After teaching a class to a group of nursing students about reporting infectious diseases to the Centers for Disease Control and Prevention, the instructor determines a need for additional discussion when the students identify which infection as being reportable:

a) Gonorrhea
b) Pinworm
c) Pertussis
d) Lyme disease

B

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?

a) Nits
b) Slapped cheek appearance
c) Lymphadenopathy
d) Koplik spots

D

Which diagnostic tool is used to identify children who may have an infection or inflammatory process?

a) Blood culture
b) Erythrocyte sedimentation rate (ESR)
c) Gastric lavage
d) Arterial blood gas analysis

B