The Child with an Infectious Disease

MULTIPLE CHOICE

1. Which statement made by an adolescent girl indicates an understanding about the prevention of sexually transmitted diseases (STDs)?

a.
“I know the only way to prevent STDs is not to be sexually active.”
b.
“I practice safe sex because I wash myself right after sex.”
c.
“I won’t get any kind of STD because I take the pill.”
d.
“I have sex only if my boyfriend wears a condom.”

ANS: A

Abstinence is the only foolproof way to prevent an STD. STDs are transmitted through body fluids (semen, vaginal fluids, blood). Perineal hygiene will not prevent an STD. Oral contraceptives do not protect women from contracting STDs. A condom can reduce but not eliminate an individual’s chance of acquiring an STD.

DIF: Cognitive Level: Comprehension REF: p. 354|p. 378

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

2. Which sexually transmitted disease would the nurse suspect when an adolescent girl comes to the clinic because she has a vaginal discharge that is white with a fishy smell?

a.
Human papillomavirus
b.
Bacterial vaginosis
c.
Trichomonas
d.
Chlamydia

ANS: B

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

DIF: Cognitive Level: Analysis REF: p. 380

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

3. An immunosuppressed child is admitted to the hospital with varicella (chickenpox). The nurse should be prepared to administer which prescribed medication?

a.
Erythromycin (Pediazole)
b.
Varicella vaccine
c.
Acetylsalicylic acid (Aspirin)
d.
Acyclovir (Zovirax)

ANS: D

Acyclovir is the antiviral medication that would be used in this case. Response to antiviral drugs is good provided that treatment is started early in the illness. Erythromycin is an antibiotic that is prescribed for bacterial infections. The varicella vaccine is a live virus and would be contraindicated for an immunosuppressed child. Aspirin is not given to children with viral illnesses because of the risk of the child developing Reyes disease.

DIF: Cognitive Level: Application REF: p. 366

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

4. A nurse is conducting a health education class for a group of school-age children. Which statement, made by the nurse, is correct about the body’s first line of defense against infection in the innate immune system?

a.
Nutritional status
b.
Skin integrity
c.
Immunization status
d.
Proper hygiene practices

ANS: B

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

DIF: Cognitive Level: Application REF: p. 354

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

5. The mother of an infant with multiple anomalies tells the nurse that she had a viral infection in the beginning of her pregnancy. Which viral infection is associated with fetal anomalies?

a.
Measles
b.
Roseola
c.
Rubella
d.
Herpes simplex virus (HSV)

ANS: C

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

DIF: Cognitive Level: Comprehension REF: p. 361

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

6. What is the best response to a parent of a 2-month-old infant who asks when the infant should receive the measles vaccine?

a.
“Your baby can get the measles vaccine now.”
b.
“The first dose is given any time after the first birthday.”
c.
“She should be vaccinated between 4 and 6 years of age.”
d.
“This vaccine is administered when the child is 11 years old.”

ANS: B

The first measles, mumps, rubella (MMR) vaccine is recommended routinely at 1 year of age. Some immunizations are initiated at 2 months of age, but not the measles vaccine. The second dose of MMR is recommended at 4 to 6 years of age. Children should receive their second MMR dose no later than 11 to 12 years of age.

DIF: Cognitive Level: Application REF: p. 360

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

7. Which statement made by a parent indicates incorrect information about an intervention for a child’s fever?

a.
“I should keep her covered lightly when she has a fever.”
b.
“I’ll give her plenty of liquids to keep her hydrated.”
c.
“I can give her acetaminophen (Tylenol) for a temperature higher than 101° F.”
d.
“I’ll look for over-the-counter preparations that contain salicylates (Aspirin).”

ANS: D

Aspirin products are avoided because of the possibility of developing Reye’s syndrome. The parent should check labels on all over-the-counter products to be sure they do not contain aspirin. Dressing the child in light clothing and using lightweight covers will help reduce fever and promote the child’s comfort. Adequate hydration will help maintain a normal body temperature. Acetaminophen or ibuprofen should be used as directed for fever control.

DIF: Cognitive Level: Application REF: p. 363

OBJ: Nursing Process Step: Evaluation MSC: Physiological Integrity

8. A 6-month-old infant is due for routine immunizations. The parent reports the infant was exposed to pertussis 2 days ago. The nurse should:

a.
give the 6 month immunizations as scheduled.
b.
hold the 6 month immunizations until the next visit.
c.
hold the 6 month immunizations for 3 weeks.
d.
notify the physician.

ANS: A

An infant exposed to pertussis should receive routine immunizations as scheduled. The nurse would not hold scheduled immunizations or notify the physician for an infant who was only exposed to pertussis.

DIF: Cognitive Level: Application REF: p. 369

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

9. Which symptom should be reported to the primary care provider if it occurs when a child with an infectious disease is febrile?

a.
Anorexia
b.
Fatigue
c.
Itching
d.
Headache

ANS: D

Parents should be told that headache is a symptom that should be reported promptly to the child’s primary care provider when a child has an elevated temperature. It would not be abnormal for a child who is febrile to have a loss of appetite. Fatigue is an expected response when a child is febrile during the course of an infectious disease. Rash and skin lesions occur with many viral illnesses. It would not be unusual for the child to complain of itchiness. The primary care provider may be contacted for interventions to relieve itching.

DIF: Cognitive Level: Analysis REF: p. 358

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

10. A parent asks the nurse how she would know whether her child has fifth disease. The nurse would advise the parent to be alert for which manifestation?

a.
Bull’s-eye rash at the site of a tick bite
b.
Lesions in various stages of development on the trunk
c.
Maculopapular rash on the trunk that lasts for 2 days
d.
Bright red rash on the cheeks that looks like slapped cheeks

ANS: D

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

DIF: Cognitive Level: Application REF: p. 362

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

11. Which intervention is appropriate for a hospitalized child who has crops of lesions on the trunk that appear as a macular rash and vesicles?

a.
Place the child in strict isolation and on airborne precautions.
b.
Continue to practice standard precautions.
c.
Pregnant women should avoid contact with the child.
d.
Screen visitors for immunity to measles.

ANS: A

The child’s skin lesions are characteristic of varicella. In the hospital setting, children with varicella should be placed in strict isolation and on airborne precautions. The purpose is to prevent transmission of microorganisms by inhalation of small-particle droplet nuclei and to protect other patients and healthcare providers from acquiring this disease. Screening visitors for immunity to measles is irrelevant. It would be important to screen visitors for immunity to varicella. Certain viral illnesses such as rubella and fifth disease are known to affect the fetus if the woman contracts the disease during pregnancy. This child appears to have varicella. Pregnancy is not a contraindication to caring for a child with varicella.

DIF: Cognitive Level: Application REF: p. 364|p. 366

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

12. How should the nurse respond to a parent who asks, “How can I protect my baby from whooping cough?”

a.
“Don’t worry; your baby will have maternal immunity to pertussis that will last until your baby is approximately 18 months old.”
b.
“Make sure your child gets the pertussis vaccine.”
c.
“See the doctor when the baby gets a respiratory infection.”
d.
“Have your pediatrician prescribe erythromycin.”

ANS: B

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

DIF: Cognitive Level: Application REF: p. 369

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

13. Which statement indicates that a parent understands the treatment for a child who has scarlet fever?

a.
“I can stop the medicine when my daughter feels better.”
b.
“I will apply antibiotic cream to her rash twice a day.”
c.
“I will give the penicillin for the full 10 days.”
d.
“My daughter can go back to school when she has been on the antibiotic for a week.”

ANS: C

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

DIF: Cognitive Level: Comprehension REF: p. 370

OBJ: Nursing Process Step: Evaluation MSC: Physiological Integrity

14. Which should be included in the follow-up care for a neonate who received aminoglycoside therapy for sepsis?

a.
Hemoglobin level monitoring
b.
Hearing test
c.
Serial platelet counts
d.
Glucose testing

ANS: B

A long-term side effect of aminoglycoside therapy is hearing impairment. Aminoglycosides do not affect the hemoglobin level, glucose control, or directly affect platelets.

DIF: Cognitive Level: Comprehension REF: p. 373

OBJ: Nursing Process Step: Evaluation MSC: Physiological Integrity

15. What discharge information should the nurse give to the parents of an adolescent who has been diagnosed with the Epstein-Barr virus?

a.
It is particularly important to protect the adolescent’s head during physical activities.
b.
The teen will feel like himself and be back to his usual routines in a week.
c.
The treatment of the Epstein-Barr virus is prolonged bed rest, usually lasting several months.
d.
Fatigue may persist, and the adolescent may need to increase school activities gradually.

ANS: D

The recovery period is often lengthy and fatigue may continue, necessitating a gradual return to school activities. During the acute and recovery phases, activity restrictions, which include no contact sports or roughhousing, are implemented to protect the child’s enlarged spleen from rupture. The recovery process is a slow and gradual one and bed rest is indicated during the acute stage of the illness, usually lasting 2 to 4 weeks.

DIF: Cognitive Level: Application REF: p. 368

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

16. Which should the nurse teach parents to expect to observe in the prodromal phase of rubeola?

a.
Macular rash on the face
b.
Koplik’s spots
c.
Petechiae on the soft palate
d.
Crops of vesicles on the trunk

ANS: B

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

DIF: Cognitive Level: Application REF: p. 355

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

17. Health teaching to prevent Lyme disease would include which action?

a.
Complete the immunization series in early infancy.
b.
Wear long sleeves and pants tucked into socks while in wooded areas.
c.
Give low-dose antibiotics to the child before exposure.
d.
Restrict activities that might lead to exposure for the child.

ANS: B

Wearing long sleeves and pants and tucking the pants into socks keeps ticks on the clothing and prevents them from hiding on the body. Currently there is no vaccine available for Lyme disease. The Lyme disease vaccine had been approved for persons aged 15 to 70 years but was withdrawn from the market in 1992. Antibiotics are used to treat, not prevent, Lyme disease. Children should be allowed to maintain normal growth and development with activities such as hiking.

DIF: Cognitive Level: Application REF: p. 375

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

18. Which action is initiated when a child is scratched by a rabid animal?

a.
No intervention unless the child becomes symptomatic
b.
Administration of immune globulin around the wound
c.
Administration of rabies vaccine on days 3, 7, 14, and 28
d.
Administration of both immune globulin and vaccine as soon as possible after exposure

ANS: D

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

DIF: Cognitive Level: Application REF: p. 368

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

MULTIPLE RESPONSE

1. A hospitalized child has developed a methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse plans which interventions when caring for this child? Select all that apply.

a.
Airborne isolation
b.
Administration of vancomycin (Vancocin)
c.
Contact isolation
d.
Administration of mupirocin (Bactroban) ointment to the nares
e.
Administration of cefotaxime (Cefotetan)

ANS: B, C, D

Vancomycin is used to treat MRSA along with mupirocin ointment to the nares. The client is placed in contact isolation to prevent spread of the infection to other clients. The infection is not transmitted by the airborne route so only contact isolation is required. The infection is resistant to cephalosporins.

DIF: Cognitive Level: Application REF: p. 372

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

2. The nurse should provide which information to parents about the prevention of parasitic infections? Select all that apply.

a.
Perform good handwashing.
b.
Diaper a child when swimming.
c.
Avoid cleaning the bathroom facilities with bleach.
d.
Shoes should be worn outside.
e.
Fruits and vegetables should be washed before eating.

ANS: A, D, E

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

DIF: Cognitive Level: Application REF: p. 377

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance