Ch.37 Nursing Care of the Child W/ Infectious or Communiable Disorder

The nurse is caring for a child whose family recently emigrated from a developing country. While completing the admission history, the parents report all the child's immunizations are up to date. Which nursing action is most appropriate?

A. Administer varicella and meningococcal vaccines.

B. Request parents follow WHO vaccine recommendations.

C. Document that immunizations are up to date in the chart.

D. Ask parents which immunizations have been given.

D. Ask parents which immunizations have been given.

Rationale: When caring for a child recently emigrated from a developing country, the nurse should be aware that WHO recommended vaccinations and U.S. recommended vaccinations may be different. The most appropriate action is for the nurse to determine which vaccinations have been given to decide if additional immunizations may be needed.

The nurse is reviewing the assessment data from a 4-year-old child admitted to the hospital for management of early onset sepsis. Which finding supports the diagnosis?

A. The child's tympanic temperature is 98.8°F (37.11°C).

B. The child is unhappy about having to stay in bed.

C. The child is hypertensive.

D. The child is irritable.

D. The child is irritable.

Rationale: Sepsis may be associated with lethargy, irritability, or changes in level of consciousness. The septic child will likely not desire 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.

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. fever

B. headache

C. absence of rash

D. malaise

C. absence of rash

Rationale: 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.

The nurse is providing education to the parents of a child diagnosed with pinworms. Which statement will the nurse include in the teaching?

A. "Make sure your child washes their hands before eating."

B. "Seal the child's clothing in a plastic bag for at least 10 days."

C. "After applying this special cream, leave it on for about 8 to 10 hours."

D. "Be sure your child wears shoes at all times."

A. "Make sure your child washes their hands before eating."

Rationale: The most effective measure to prevent pinworms or a recurrence is good hand hygiene, especially after using the bathroom and before eating. Sealing the child's clothing in a plastic bag is appropriate for pediculosis capitis. Having the child wear shoes at all times is helpful in preventing hookworm. Use of a cream that remains on for a specified time is associated with scabies.

A nurse suspects that an adolescent may have community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). What would the nurse expect to assess? Select all that apply.

A. erythematous rash over the trunk and face

B. raised, fluctuant lesions

C. recent cut on the lower leg

D. history of a recent sore throat

E. participation in contact sport

B. raised, fluctuant lesions

C. recent cut on the lower leg

E. participation in contact sport

Rationale: With community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), skin and tissue infections are common, often appearing as a bump or area of skin that is red, swollen, painful, and warm to the touch. There also may be fluctuance and purulent drainage. Participation in contact sports, openings in the skin such as abrasions and cuts, contact with contaminated items and surfaces, poor hygiene, and crowded living conditions are risk factors for CA-MRSA. Recent sore throat and an erythematous rash on the trunk, face, and possibly the extremities are associated with scarlet fever.

The nurse is performing a physical examination on a 9-year-old child who has experienced a tick bite on the lower leg and is suspected of having Lyme disease. Which assessment finding does the nurse expect to find?

A. confusion and anxiety

B. ring-like rash on lower leg

C. hypersalivation

D. swelling in the neck

B. ring-like rash on lower leg

Rationale: A ring-like rash at the site of the tick bite is characteristic for Lyme disease. Swelling in the neck is a symptom of mumps. Confusion, anxiety, and hypersalivation are symptoms of rabies.

The client has a heavily draining wound for which there is an order to change the dressing every 4 hours. The nurse becomes busy and does not change the dressing as ordered. Which link in the chain of infection has the nurse allowed to flourish?

A. susceptible host

B. portal of exit

C. mode of transmission

D. reservoir

D. reservoir

Rationale: The reservoir is the area where a pathogen grows and reproduces. Leaving the dressing unchanged allows for a dark, warm, nutrient-rich, and moist environment where many organisms will thrive. A susceptible host is a person who cannot fight off an infection. The portal of exit is the way a pathogen exits the host. The mode of transmission is the way the pathogen travels.

The nurse is preparing to obtain a blood specimen via capillary heel puncture. Which action will the nurse take?

A. Elevate the extremity used after puncturing it.

B. Wipe away the first drop of blood with dry gauze.

C. Apply a cool compress for several minutes before collection.

D. Squeeze the area to facilitate specimen collection.

B. Wipe away the first drop of blood with dry gauze.

Rationale: When obtaining a blood specimen by capillary puncture, the nurse should wipe away the first drop of blood with a cotton ball or dry gauze pad and then collect the sample without squeezing the foot to prevent possible hemolysis. Prior to the puncture, the nurse can apply a commercial heel warmer or warm compress for several minutes to promote vasodilation. The extremity being used should be placed in the dependent position after puncturing the heel.

A child is brought to the emergency department by their parents. The parents report that the child stepped on a rusty nail about a week and a half ago. The child is reporting cramping in their 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. Legs

C. Stomach

D. Arms

A. Neck

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

The nurse is caring for a school-aged child hospitalized with an infectious disease. The child is placed on transmission-based precautions. What would the nurse include in the plan of care? Select all that apply.

A. Encourage the parents to contact friends and classmates so cards can be sent and displayed.

B. Permit the immediate family to avoid wearing the gown and mask during visits in the room.

C. Plan for extra time to visit the child throughout the shift between assessments and procedures.

D. Allow the child to view the staff's face through the door window before entering the room.

E. Provide the child with age-appropriate games and toys for their room.

F. Monitor the child for changes in mood or level of aggression.

A. Encourage the parents to contact friends and classmates so cards can be sent and displayed.

C. Plan for extra time to visit the child throughout the shift between assessments and procedures.

D. Allow the child to view the staff's face through the door window before entering the room.

E. Provide the child with age-appropriate games and toys for their room.

F. Monitor the child for changes in mood or level of aggression.

Rationale: The child in transmission-based isolation may experience feelings of isolation and sensory deprivation because of restricted visiting and the use of personal protective gear (gown, mask and gloves) by those in the child's hospital room. The use of age appropriate toys and games dedicated to the child's room, extra time spent with the child by staff, the display of cards from friends and classmates, and allowing the child to view staff members' faces from outside the room all promote sensory stimulation and lessen the feeling of isolation. The family would be taught to follow the same precautions as the staff. Sensory overload is not a concern for a child in transmission-based precautions.

The nurse is preparing to administer acetaminophen to a 4-year-old child to provide comfort. Which precaution is specific to antipyretics?

A. Take the entire course of medication.

B. Ensure proper dose and interval.

C. Warn of possible drowsiness.

D. Check for medicine allergies.

B. Ensure proper dose and interval.

Rationale: 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 precautions when administering antibiotics and all medications. Drowsiness is not a side effect of antipyretics.

The health care provider has ordered ibuprofen 150 mg every 6 hours as needed for a 3-year-old child for a fever greater than 38°C (100.4°F). 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 (100.4°F)? Record your answer using one decimal place.

7.5ml

Rationale: The dose ordered (150 mg) is divided by the available dosage (100 mg) then multiplied by 5 mL.

The nurse determines that it is necessary to implement airborne precautions for a child with which infection?

A. scarlet fever

B. measles

C. streptococcus group A

D. rubella

B. measles

Rationale: Airborne precautions are designed to reduce the risk of infectious agents transmitted by airborne droplet nuclei or dust particles such as for a child with measles, varicella, or tuberculosis. Droplet precautions would be used for a child with streptococcal group A infections, rubella, and scarlet fever.

The nurse is caring for a child newly diagnosed with diphtheria. Which nursing interventions would the nurse include in the child's plan of care? Select all that apply.

A. Adhering to droplet precautions

B. Administering antitoxin intravenously

C. Monitoring for airway obstruction

D. Instituting airborne precautions

E. Ensuring complete bed rest

A. Adhering to droplet precautions

B. Administering antitoxin intravenously

C. Monitoring for airway obstruction

E. Ensuring complete bed rest

Rationale: Treatment of diphtheria involves intravenous administration of antitoxin in large doses. In addition, children are given penicillin or erythromycin intravenously. Complete bed rest is crucial during the acute stage of the illness. Droplet precautions must be followed until cultures are negative. Children need careful observation at all times to prevent airway obstruction. If obstruction occurs, endotracheal intubation may be necessary.

The nurse is assessing a child who presents with a history of fever, malaise, fatigue, and headache. The nurse notes a bulls-eye rash on the child's right leg. Which action will the nurse take?

A. Place the child on contact precautions.

B. Clean the rash with rubbing alcohol.

C. Obtain an electrocardiography (ECG).

D. Notify the primary health care provider.

D. Notify the primary health care provider.

Rationale: The nurse would suspect the child has Lyme disease and notify the health care provider for additional testing and potential antibiotic therapy. Precautions are not indicated for clients with Lyme disease. An ECG would only be needed if cardiac symptoms were noted. It is recommended to clean the site of the tick bite with rubbing alcohol when the tick is removed, not at a later time.

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 antibiotic therapy.

B. Obtain blood cultures.

C. Initiate intravenous therapy.

D. Obtain urine specimen for analysis.

B. Obtain blood cultures.

Rationale: 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 concerned that the child is developing septic shock. Which finding(s) are consistent with this condition? Select all that apply.

A. The child is pale and lethargic.

B. The child's respiratory rate is elevated.

C. The child's blood pressure is reduced.

D. C-reactive protein is decreased.

E. White blood cell count is elevated.

A. The child is pale and lethargic.

B. The child's respiratory rate is elevated.

C. The child's blood pressure is reduced.

E. White blood cell count is elevated.

Rationale: Assessment findings consistent with septic shock include elevated white blood cell counts, pallor, lethargy, tachypnea, and hypotension. Often, the C-reactive protein level is elevated, not decreased.

A child is diagnosed with varicella. The parent states the child is "just miserable" and wants to know how best to make the child feel more comfortable. Which instruction(s) would the nurse give this parent? Select all that apply.

A. "Keep your child's fingernails short so scratching will not disturb vesicles."

B. "Administer prescribed topical steroid ointment to reduce inflammation."

C. "Keep only light clothing on your child."

D. "Place the child in a soothing tepid bath."

E. "You can administer acetaminophen to help with fever and pain."

A. "Keep your child's fingernails short so scratching will not disturb vesicles."

C. "Keep only light clothing on your child."

D. "Place the child in a soothing tepid bath."

E. "You can administer acetaminophen to help with fever and pain."

Rationale: Varicella is an extremely contagious disease spread via the airborne route or through direct contact with nasopharyngeal secretions. Initially, the rash is intensely pruritic. It begins as erythematous macules that evolve into papules and then form into fluid-filled vesicles. The child generally has a fever and is very uncomfortable. To help reduce some of the discomfort, the nurse should teach the parent to administer antipyretics and analgesics. Reducing the fever increases the comfort of the child and also decreases the fluid requirements. It is best to keep the child in light, restrictive clothing. Tighter clothing can cause more diaphoresis and more itching. Blankets should be kept off the child to reduce fever and provide comfort. The child's fingernails should be cut short to prevent opening lesions and potentially causing a secondary infection. Socks or mitts can be placed on the hands. Cool compresses or tepid baths can help with comfort by decreasing inflammation. The health care provider may prescribe an anti-itch medication. Steroids, either topical or oral, are not used in the treatment.

The nurse is preparing to provide education on the prevention of infection to parents of children. Which intervention(s) will the nurse include? Select all that apply.

A. judicious antibiotic use

B. proper handwashing

C. limiting exposure to sick persons

D. vaccination administration

E. proper handling and preparation of foods

A. judicious antibiotic use

B. proper handwashing

C. limiting exposure to sick persons

D. vaccination administration

E. proper handling and preparation of foods

Rationale: Interventions to limit the spread of infections and diseases include proper handwashing, appropriate antibiotic use (take prescribed amount), follow the recommended vaccination schedule, limiting exposure to known sick persons, and proper handling and consumption of foods. The nurse would include all choices in the teaching.

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

A. amoxicillin

B. doxycycline

C. cefuroxime

D. tetracycline

C. cefuroxime

Rationale: Lyme disease should be treated with cefuroxime when the child is younger than 8 years old and allergic to penicillin. Doxycycline is the drug of choice for children older than 8 years. Children younger than 8 who take a tetracycline like doxycycline risk permanent teeth discoloration and should be given amoxicillin unless they are allergic to it.

The nurse assesses a child and notes the following: oral temperature 101.1°F (38.3°C), pruritis, and a generalized rash that develops in crops with macules, papules, vesicles, and crusts present. The parent reports the child is immunocompromised. Which health care provider prescription(s) will the nurse request? Select all that apply.

A. complete blood count (CBC)

B. placement in private hospital room

C. diphenhydramine topical cream for itching

D. acyclovir liquid suspension

E. acetylsalicylic acid orally for fever

A. complete blood count (CBC)

B. placement in private hospital room

C. diphenhydramine topical cream for itching

D. acyclovir liquid suspension

Rationale: Fever, itching, and a generalized rash in crops with macules, papules, vesicles, and crusts are signs and symptoms of varicella zoster (chicken pox). Diphenhydramine can be used because varicella zoster is very pruritic (itchy). Placement in a private hospital room is needed because varicella zoster is highly contagious. A complete blood count can be used to check for secondary infections of the lesions. Children with varicella zoster who are also immunocompromised may need acyclovir to reduce the course of infection.

A 10-year-old child 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. Obtain specimen before antibiotics are given.

B. Use aseptic technique when getting the specimen.

C. Collect three specimens on three different days.

D. Ensure that the specimen is obtained from proper area.

A. Obtain specimen before antibiotics are given.

Rationale: Treatment of diphtheria involves intravenous administration of antitoxin in large doses. In addition, children are given penicillin or erythromycin intravenously. Complete bed rest is crucial during the acute stage of the illness. Droplet precautions must be followed until cultures are negative. Children need careful observation at all times to prevent airway obstruction. If obstruction occurs, endotracheal intubation may be necessary.

A parent calls the nurse triage line at the clinic. The parent is concerned and believes the preschool-aged child may have contracted rubeola. Which question(s) should the nurse ask the parent to aid in making this diagnosis? Select all that apply.

A."How long has your child had the cough and runny nose?"

B. "Can you describe what your child's rash looks like?"

C. "Has your child been around any other children with measles?"

D. "When you look in your child's mouth can you see any spots or anything unusual?"

E. "Has your child completed the measles vaccine series?"

A."How long has your child had the cough and runny nose?"

B. "Can you describe what your child's rash looks like?"

C. "Has your child been around any other children with measles?"

D. "When you look in your child's mouth can you see any spots or anything unusual?"

Rationale: Rubeola is caused by the rubeola virus and is spread through droplet transmission. Symptoms generally start with a cough, coryza, conjunctivitis and fever. This stage can last 2 to 4 days. A classic sign is Koplik spots. These are bright red spots with blue-white centers on the buccal mucosa. The rash begins to appear 3 to 4 days after the prodromal symptoms. It is erythematous and maculopapular in nature. The rash starts on the head and expands downward and outward. If the preschool-aged child received a measles vaccine, it should have been administered between 12 to 15 months of age. The second dose would not be due until 4 to 6 years of age, so this preschool-aged child may be too young for the second dose. It would be important to know if the child had been around anyone else with measles. The virus could have been via another child's coughing and sneezing, and the preschool-aged child may not be thoroughly protected with only one dose of the vaccine.

The nurse is assessing a child with a varicella infection. The nurse would be alert for which possible complication(s)? Select all that apply.

A. Encephalitis

B. Scarlet fever

C. Scarring

D. Secondary bacterial infection

E. Pneumonia

A. Encephalitis

C. Scarring

D. Secondary bacterial infection

E. Pneumonia

Rationale: The most common complication of varicella is secondary bacterial infection caused by the child scratching the lesions. Other complications include pneumonia, scarring, and encephalitis. Scarlet fever is a complication associated with group A streptococcal infections.

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. Droplet precautions

B. Standard precautions

C. Airborne precautions

D. Contact precautions

D. Contact precautions

Rationale: Contact precautions means placing the client in an isolation room with limited access, wearing gloves during contact with the client and all body fluids, wearing two layers of protective clothing, limiting movement of the client from the room, and avoiding sharing equipment between clients. Standard precautions are used with every client. They involve good handwashing and the use of gloves for client contact. Airborne precautions are used for diseases where small particles are dispersed in the air. They require that the client be in a negative-pressure room and, in addition to standard personal protective equipment, the mask should be N95 or higher. Varicella would need airborne precautions. Droplet precautions are used for diseases such as pertussis, which produce large droplets. They require standard precautions plus a surgical mask, preferably with a face shield.

A nurse is obtaining a history from the parents of a child diagnosed with an infection. The parents report that the child started running a fever a couple of days ago and that they "just didn't seem like themself." Then this morning, the child started having yellow-green discharge from the nose. The nurse would identify the child has just completed which stage of an infectious disease?

A. illness

B. prodrome

C. incubation

D. convalescence

B. prodrome

Rationale: The child is in the prodrome stage of the infection. Prodrome refers to the time from the onset of nonspecific symptoms—such as fever, malaise, and fatigue—to more specific symptoms. Incubation refers to the time from the entrance of the pathogen into the body to the appearance of the first symptoms. The illness stage is the time during which the child demonstrates signs and symptoms specific to an infection type. Convalescence refers to the time when the acute symptoms of the illness disappear.

The nurse is educating parents of a child admitted to the hospital with rubella (German measles). Which statement by the parents indicates the further education is needed?

A. "Acetaminophen or ibuprofen can be given to help with pain."

B. "Family members should wear a mask when coming to visit us."

C. "Antibiotics are needed to help our child recover from rubella."

D. "Our child is contagious for 1 week after the rash appeared."

Submit Answer

C. "Antibiotics are needed to help our child recover from rubella."

Rationale: Rubella (German measles) is caused by the rubella virus. Children will be contagious for 1 week before to approximately 1 week after the rash appears. Acetaminophen or ibuprofen can be given to help with pain or fever, and the child will be on droplet precautions (mask) while in the hospital.

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 has had 7 wet diapers in the past 24 hours.

B. The child cries when their parent is not in sight.

C. The child has had 8 ounces of formula in the past 24 hours.

D. The child's birth history indicates they are born at 42 weeks' gestation.

C. The child has had 8 ounces of formula in the past 24 hours.

Rationale: Sepsis is a systemic overresponse to infection resulting from bacteria and viruses, which are the most common fungi, viruses, rickettsia, or parasites. It can lead to septic shock, which results in hypotension, low blood flow, and multisystem organ failure. Signs of sepsis include a lack of appetite, lethargy, hypotonia, and temperature elevations.

Assessment of a child reveals black burrows of about 1-inch long between the fingers and toes and in the axilla. A diagnosis of scabies is made. When planning this child's care, the nurse anticipates which medication being prescribed?

A. oral albendazole

B. topical permethrin

C. oral nitazoxanide

D. oral pyrantel pamoate

B. topical permethrin

Rationale: Topical permethrin 5% cream is the drug of choice for treating scabies. The oral medications albendazole, pyrantel pamoate and nitazoxanide are used to treat helminthic (parasitic worm) infections.

Which collaborative interventions will the nurse implement for a child with acute herpetic gingivostomatitis? Select all that apply.

Which collaborative interventions will the nurse implement for a child with acute herpetic gingivostomatitis?

A. Administer acetaminophen.

B. Provide popsicles and ice.

C. Give an oral dose of acyclovir.

D. Initiate contact precautions.

E. Assess intake and output.

A. Administer acetaminophen.

B. Provide popsicles and ice.

C. Give an oral dose of acyclovir.

D. Initiate contact precautions.

E. Assess intake and output.

Rationale:A child with acute herpetic gingivostomatitis will have painful mouth ulcers, drooling, anorexia, and a high fever. The nurse will provide acetaminophen for fever and pain, administer acyclovir to shorten the course of the illness, and offer popsicles and ice to help with mouth pain. Contact precautions will be initiated to prevent spreading the illness to others, and because the child is at risk for dehydration from a high fever and painful mouth, the nurse will assess intake/output.

The nurse is caring for a neonate who is suspected of having sepsis. Which assessment finding is indicative of sepsis?

A. edematous neck

B. rash on face

C. coughing

D. hypothermia

D. hypothermia

Rationale: Hypothermia is a sign of sepsis in neonates. A rash on the face is a symptom of scarlet fever. An edematous neck is a sign of diphtheria. Paroxysmal coughing is a symptom of pertussis.

When the health care provider looks in a child's mouth during a sick-visit examination, the parent exclaims: "The tongue is bright strawberry red! It was not like that yesterday." The health care provider would most likely prescribe which medication based on the probable diagnosis?

A. Penicillin to prevent acute glomerulonephritis

B. Acetaminophen to decrease the throat pain

C. Erythromycin to prevent the spread to siblings

D. Steroids to decrease the inflammation

A. Penicillin to prevent acute glomerulonephritis

Rationale:A "strawberry tongue" is a classic sign of scarlet fever. Penicillin is prescribed to treat the beta-hemolytic group A streptococcal infection and to prevent the complication of developing acute glomerulonephritis and rheumatic fever. Erythromycin can be used to treat the disease if the child is allergic to penicillin. Antibiotics are not given prophylactically to siblings. The disease is spread via droplets, so keeping the siblings away from the infected child and handwashing are the best preventive measures. Acetaminophen can be administered for fever control. It works systemically and has very little, if any, affect locally. Antibiotics are the mainstay of treatment. Steroids are used infrequently.

While assessing a child, the nurse notes a runny nose, temperature 100.4°F (38°C), and a whoop sound when the child coughs. On which diagnosis will the nurse anticipate providing education for this family?

A. tuberculosis

B. influenza

C. pertussis

D. nasopharyngitis

C. pertussis

Rationale:Pertussis, also known as whooping cough, begins as an upper respiratory illness and progresses to a persistent cough characterized by a whooping sound. Tuberculosis, influenza, and nasopharyngitis are not characterized by a whooping sound.

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

A. Accessing an indwelling venous access device.

B. Using an automatic lancet device on the heel.

C. Administering sucrose prior to beginning.

D. Puncturing a vein on the dorsal side of the hand.

D. Puncturing a vein on the dorsal side of the hand.

Rationale: The usual sites for obtaining blood specimens are veins on the dorsal side of the hand or the antecubital fossa. Administration of sucrose prior to beginning helps control pain for young infants. Accessing an indwelling venous access device may be appropriate if the child is in an acute care setting. An automatic lancet device is used for capillary puncture of an infant's heel.

The nurse is caring for a child admitted to the hospital for sepsis. Which assessment finding is the most concerning?

A. oral temperature 102.3°F (39°C)

B. white blood cell count 18,000/mm3

C. apical heart rate 120 beats per minute

D. urine output of 10 ml over 3 hours

D. urine output of 10 ml over 3 hours

Rationale: Children with sepsis will show alteration in temperature, heart rate, respiratory rate, and white blood cell count. Septic shock with organ dysfunction is more serious and can be manifested by decreased urine output.

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

A. a child with herpes simplex who is reporting mouth pain and pruritis

B. a child diagnosed with measles experiencing photophobia and coryza

C. a child with erythema infectiosum experiencing fatigue and confusion

D. a child diagnosed with chicken pox reporting nausea and malaise

C. a child with erythema infectiosum experiencing fatigue and confusion

Rationale: A child with erythema infectiosum experiencing fatigue and confusion is showing signs of decreased oxygenation, possibly related to aplasia of erythrocytes caused by the virus. A child with signs and symptoms of decreased oxygenation should be seen first. Nausea and malaise are symptoms of chicken pox. A child with herpes simplex will most likely report pain an pruritis. Signs and symptoms of measles include photophobia and coryza.

When caring for a child diagnosed with West Nile virus, the nurse will question which prescription from the primary health care provider?

A. Monitor the client's cardiac status.

B. Place client on fall precautions.

C. amoxicillin 40 mg/kg/day orally every 8 hours

D. acetaminophen every 4 to 6 hours PRN fever

C. amoxicillin 40 mg/kg/day orally every 8 hours

Rationale: West Nile virus is transmitted to humans primarily through the bite of infected mosquitoes and manifestations include: fever, weakness, fatigue, balance problems, memory impairment, headache, myocarditis, hepatitis, myositis and orchitis, and rhabdomyolysis. Treatment is symptomatic. Since this is a viral illness, antibiotics would not be given and the nurse would question such prescriptions. It is appropriate to give acetaminophen for the fever or pain; place on fall precautions due to fatigue, balance problems, and weakness; and monitor the cardiac status for the development of myocarditis.

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. Press the pruritic area.

B. Apply hot compresses.

C. Rub powder on the pruritic area.

D. Encourage warm baths.

A. Press the pruritic area.

Rationale: Pruritis may be managed by pressing on the area instead of scratching. Increases in temperature will result in vasodilation and increase the pruritis. Warm baths and hot compresses should be avoided. Rubbing may result in increased itching.

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

A. resuscitation or invasive procedures

B. infection or fever in the birthing parent

C. use of immunosuppression drugs

D. lack of juvenile immunizations

C. use of immunosuppression drugs

Rationale: The use of immunosuppression drugs is a risk factor for the hospitalized child. Infection or fever in the birthing parent and resuscitation or invasive procedures are sepsis risk factors related to pregnancy and labor. Lack of juvenile immunizations is a risk factor affecting the overall health of the child but does not impact the chance of sepsis.

The parents of a child voice concern to the nurse that they believe their child has Lyme disease but their health care provider 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. Western immunoblot

B. immunofluorescent assay (IFA)

C. enzyme immunoassay (EIA)

D. C-reactive protein (CRP)

E. erythrocyte-sedimentation rate (ESR)

A. Western immunoblot

B. immunofluorescent assay (IFA)

C. enzyme immunoassay (EIA)

Rationale: When testing for Lyme disease, the CDC recommends a two-step test—a sensitive enzyme immunoassay (EIA) or immunofluorescent assay (IFA), if positive, followed by a Western immunoblot test. CRP and ESR may be tested as an indication of inflammation in the body, but they aren't specific to Lyme disease.

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

A. Measles

B. Fifth disease

C. Mononucleosis

D. Mumps

D. Mumps

Rationale: Mumps begins with a fever, headache, anorexia, and malaise. Within 24 hours an earache occurs. When pointing to the site of pain, however, the child points to the jawline just in front of the earlobe. Mumps is contagious 1 to 7 days prior to the onset of symptoms and 4 to 9 days after the parotid swelling begins. Fifth disease is also known as the "slapping disease," as the rash on the cheeks look like someone slapped the child's face. Measles does not involve parotid swelling or earaches. Mononucleosis does involve swollen lymph nodes but they are in the neck and the axillary area.

The nurse is caring for a child brought to the emergency department after an animal bite. Which action will the nurse perform first?

A. Ask if the animal was provoked prior to the bite.

B. Administer rabies vaccine and rabies immune globulin.

C. Assess the child's height, weight, and temperature.

D. Question the child about malaise, pain, and hydrophobia.

A. Ask if the animal was provoked prior to the bite.

Rationale: When a child presents with an animal bite, the nurse will ask the child if the animal was provoked prior to the bite. Animals with rabies will bite unprovoked. If the child states the animal bit without being provoked, and the animal is at risk for rabies, the nurse will administer the rabies vaccine and rabies immune globulin as prescribed by the health care provider and recommended by the local health department. Signs and symptoms of rabies, including fever, malaise, anorexia, pain, and hydrophobia, will occur on average 1 to 3 months after the bite. The nurse's priority is to gather history to help determine if the child needs treatment for rabies to avoid progression to the disease, which is almost always fatal.

The nursing is caring for a hospitalized child diagnosed with varicella-zoster virus. The child's parents ask how to prevent the child's siblings from contracting the virus. Which response by the nurse is best?

A. "Since this is a virus, there is nothing you can do to prevent your other children from getting it."

B. "As long as your other children wash their hands, they should not contract the virus."

C. "We will place your child on contact and airborne precautions. It is best for the other children not to visit."

D. "Vaccinating your other children is the only way to prevent them from contracting the virus."

C. "We will place your child on contact and airborne precautions. It is best for the other children not to visit."

Rationale: The causative agent for chickenpox is the varicella-zoster virus, which is spread through contact and airborne methods. The client should be placed on precautions and limit visitors who are at risk. Vaccinating is the best way to prevent the spread of varicella; however, it is not the only way. Preventing exposure will work as well. Stating there is nothing that can be done is incorrect. Handwashing is not effective against varicella.

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

A. "It normally takes about 3 weeks before symptoms begin."

B. "If you child has contracted the illness they will become ill in about 2 weeks."

C. "If your child had contracted the disease symptoms would have be noted by this time."

D. "The signs of disease will be noted in 1 to 3 weeks."

D. "The signs of disease will be noted in 1 to 3 weeks."

Rationale: Pertussis is an acute respiratory disorder characterized by paroxysmal cough (whooping cough) and copious secretions. The disease is caused by Bordetella pertussis. The incubation period is 6 to 21 days, usually 7 to 10 days.

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. clear, fluid-filled vesicles

C. erythematous flushing

D. maculopapular rash that began on the face and has spread to the rest of the body

E. upper respiratory infection symptoms

A. fever

D. maculopapular rash that began on the face and has spread to the rest of the body

E. upper respiratory infection symptoms

Rationale: Maculopapular rash that began on the face and has spread to the rest of the body, fever, and upper respiratory infection symptoms are characteristic of both rubella (German measles) and rubeola (measles). Clear, fluid-filled vesicles are characteristic of chickenpox (varicella zoster). Erythematous flushing is common with erythema infectiosum (fifth disease).

The nurse at the pediatrician's office receives a call from the parent of a child who has just been bitten by the neighbor's dog. What action would be the priority?

A. Explain how to care for the dog bite.

B. Tell the parent to seek medical help immediately.

C. Describe methods of managing a fever.

D. Explain how to educate the child about animals.

B. Tell the parent to seek medical help immediately.

Rationale: The parent should seek medical help for their child immediately. Once the child has been seen by a health care provider, 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 child hospitalized for surgery develops varicella. The health care provider prescribes isolation for the child. Which type of precautions will the nurse implement to provide care for this child? Select all that apply.

A. protective isolation

B. airborne precautions

C. droplet precautions

D. contact precautions

E. standard precautions

B. airborne precautions

D. contact precautions

E. standard precautions

Rationale: During hospitalization due to a complication of varicella infection, standard infection precautions along with airborne and contact precautions are adhered to until all lesions are crusted. Protective isolation would be used for a child who is immunocompromised and at high risk for infection. Droplet precautions reduce the risk of pathogens being spread through large-particle droplet contact by acts such as coughing, sneezing, and talking—or through procedures such as suctioning or bronchoscopy.

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

A. Begin physical therapy.

B. Place the child on bed rest.

C. Auscultate the child's lungs.

D. Administer an antipyretic.

C. Auscultate the child's lungs.

Rationale: Because poliomyelitis can cause motor paralysis of the respiratory muscles, assessing respiratory status is priority. Once the nurse has ensured respiratory function is intact, the nurse can place the child on bed rest, administer an antipyretic, and begin physical therapy.

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

A. trimethoprim-sulfamethoxazole

B. erythromycin

C. azithromycin

D. clarithromycin

C. azithromycin

Rationale: The macrolides (erythromycin, azithromycin, and clarithromycin) are the drugs of choice for pertussis in children older than 6 months of age. Azithromycin and clarithromycin are not FDA approved for use in infants younger than 6 months; however, infants younger than 1 month old should be treated with azithromycin because erythromycin is associated with increased risk of infantile hypertrophic pyloric stenosis. Trimethoprim-sulfamethoxazole is an alternative antibiotic for children who cannot tolerate erythromycin.

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. "Has she done this before?"

C. "How long has she been acting like this?"

D. "What medications is she currently taking?"

A. "What were you doing prior to her beginning to feel sick?"

Rationale: 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 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 can administer two baby aspirin tablets to my child every 4 to 6 hours for the fever."

B. "I should use a cooling fan in my child's room to keep the fever down."

C. "Fever has many therapeutic properties."

D. "Ibuprofen has been shown to be more beneficial than acetaminophen when managing a fever."

E. "Sponging my child with cold water can be a soothing way to manage the fever."

A. "I can administer two baby aspirin tablets to my child every 4 to 6 hours for the fever."

B. "I should use a cooling fan in my child's room to keep the fever down."

E. "Sponging my child with cold water can be a soothing way to manage the fever."

Rationale: Aspirin should be avoided in children with fever. It may be associated with Reye syndrome. Activities that result in over-cooling or chilling such as using fans and cold baths should be avoided.

The public health nurse is discussing immunizations with a group of parents of infants. One of the parents asks the nurse why the child will need immunizations. Which statement would be the most appropriate for the nurse to make to this parent?

A. "The infant is born with immunity to some diseases, but those immunities decrease over the first year of life."

B. "The immunities that the infant is born with are not for the same diseases they will be immunized against."

C. "Infants are unable to develop antibodies to protect them from diseases so they must be immunized."

D. "The antibodies the fetus gets from the birthing parent are in the placenta, so after birth they are no longer available to the infant."

A. "The infant is born with immunity to some diseases, but those immunities decrease over the first year of life."

Rationale: During fetal life, the birthing parent's antibodies cross the placenta, giving the fetus a temporary immunity against certain diseases. This immunity is present at birth and decreases during the first year of life. In the meantime, the infant begins developing antibodies to fight against pathogens and disease. In addition, during the first year of life immunizations are started to help the infant develop protection against certain diseases.

The school football team has developed an outbreak of community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA). The school nurse is talking with the team to discuss how to stop the spread among the team members. Which fact(s) should the nurse teach these athletes? Select all that apply.

A. "Keep from touching surfaces in the locker room as much as possible."

B. "Cover your mouth when coughing."

C. "Do not borrow deodorant or a hairbrush from each other."

D. "Wash your sports clothes in hot water."

E. "Clean any cut or abrasion and cover with a dry bandage."

A. "Keep from touching surfaces in the locker room as much as possible."

B. "Cover your mouth when coughing."

C. "Do not borrow deodorant or a hairbrush from each other."

E. "Clean any cut or abrasion and cover with a dry bandage."

Rationale: Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) is a staphylococcal infection that is resistant to certain antibiotics. The nurse should teach the athletes that transmission occurs through direct person-to-person contact; respiratory droplets; blood; or sharing personal items, such as hairbrushes, towels, and sports equipment; and touching surfaces or items contaminated with MRSA. The barriers to preventing CAMRSA are intact skin and hand hygiene. Students should clean and cover any open cut or abrasion, cover their mouths while coughing, and not share personal items. They should avoid touching surfaces that could be contaminated. It is not necessary to wash the clothes in hot water.