Pediatric Communicable Diseases Exam | Answered with Rationales

Pediatric Communicable Diseases Exam | Answered with Rationales A parent brings a 2-month-old baby in for a routine wellness examination. Which vaccination should the nurse prepare to administer to this patient? 1. He ...

Pediatric Communicable Diseases Exam | Answered with Rationales A parent brings a 2-month-old baby in for a routine wellness examination. Which vaccination should the nurse prepare to administer to this patient? 1. Hepatitis A 2. Hepatitis B 3. Inactivated poliovirus 4. Measles, mumps, rubella 1 This is incorrect. The hepatitis A vaccine is given to all children 12 months and older. 2 This is correct. The hepatitis B vaccine is provided to all newborns. Three doses of hepatitis B are given before age 2 years: at birth, at 1 to 2 months of age, and at 9 to 12 months of age. 3 This is incorrect. The inactivated poliovirus IPV is given in a series of four doses: at 2, 4, and 6 to 18 months as well as 4 to 6 years. 4 This is incorrect. The minimum age for receiving the measles, mumps, and rubella immunization is 12 months. The nurse learns that a 16-year-old patient has not received the human papilloma virus vaccine (HPV-Gardasil). Which should the nurse explain to the patient at this time about the vaccination? 1. "The complete vaccine can be given today." 2. "You can wait a few years before needing the vaccination." 3. "A dose can be given today with the final dose in 6 months." 4. "A dose should be given today with follow-up doses in 1 to 2 months, and the last in 6 months." 1 This is incorrect. The vaccination for HPV is given as either two doses or three doses, depending on the patient's age. 2 This is incorrect. The HPV vaccination is recommended to be given at 11 to 12 years of age (minimum age is 9 years old) in a two-dose series with a minimum of 6 months between dosing. 3 This is incorrect. If vaccination is not begun by age 15, the patient requires a three-dose series: first injection, second injection in 1 or 2 months, and the third injection 6 months after the first. 4 This is correct. Because the patient is over age 15, a first dose should be given now, with follow-up doses in 1 to 2 months, and the final dose in 6 months. 0:00 A new mother contacts the health-care provider's office to ask for guidance regarding a change in the infant's health. For which reason should the nurse direct the mother to seek immediate medical attention? 1. Difficult to arouse 2. Wetting six diapers a day 3. Breastfeeding every 3 hours 4. Sleeping for several hours in the afternoon 1 This is correct. A change in responsiveness or being difficult to arouse could indicate a change in oxygenation or perfusion. The infant should be seen immediately for medical attention. 2 This is incorrect. Wetting six diapers a day is an expected behavior for an infant. 3 This is incorrect. An infant feeding every 3 hours is expected behavior. 4 This is incorrect. Infants have a great need for sleep. Sleeping for several hours in the afternoon is expected behavior. A parent brings his school-age child to the clinic for a rash that developed over the face, trunk, and extremities. Which question should the nurse ask the parent when assessing the patient? 1. "Has the child been nauseated or has the child vomited?" 2. "How often is the child given acetaminophen, or Tylenol?" 3. "Has the child eaten any food that was not properly cooked?" 4. "Was the child exposed to anyone with a respiratory infection?" 1 This is incorrect. This patient's symptoms suggest fifth disease, which is not associated with nausea and vomiting. 2 This is incorrect. Acetaminophen use would not result in these symptoms. 3 This is incorrect. Eating improperly prepared food would not cause these symptoms. 4 This is correct. These symptoms are indicative of fifth disease, which is transmitted through respiratory secretions. Assessing whether the patient was exposed to anyone with a respiratory infection would be appropriate. A school-age patient with rubella is placed in droplet precautions. Which action should the nurse take when implementing these precautions? 1. Use a mask with a HEPA filter. 2. Instruct to cough into the hands. 3. Wear a mask when providing care. 4. Assign to a negative air pressure room. 1 This is incorrect. A mask with a HEPA filter is needed when caring for a patient with tuberculosis. 2 This is incorrect. The patient should be instructed to cover the mouth with a tissue when coughing, properly dispose of the used tissue, and wash the hands. 3 This is correct. For droplet precautions, health-care providers should wear a mask. 4 This is incorrect. A negative air pressure room is needed for the patient with tuberculosis. A parent arrives at the family clinic seeking medical attention for his 14-year-old child. The child has a fever, malaise, nausea, and abdominal pain. Which finding should indicate to the nurse that the patient is experiencing hepatitis A? 1. Elevated serum bilirubin 2. Greater than 10% atypical lymphocytes 3. Presence of the virus in nasal secretions 4. Positive Paul-Bunnell heterophile antibody test 1 This is correct. Abnormal laboratory values that indicate the presence of hepatitis A include an elevated serum bilirubin level. 2 This is incorrect. The presence of greater than 10% of atypical lymphocytes is a finding associated with mononucleosis, not hepatitis A. 3 This is correct. The presence of the virus in nasal secretions is associated with influenza, not hepatitis A. 4 This is incorrect. A positive Paul-Bunnell heterophile antibody test is a finding associated with mononucleosis, not hepatitis A. The nurse is caring for a school-age patient diagnosed with hepatitis A. For which reason should the nurse begin implementing contact precautions for this patient? 1. Incontinent of feces 2. Evidence of dehydration 3. Development of dark urine 4. Severe nausea and vomiting 1 This is correct. A patient with hepatitis A should be placed in contact precautions in the event of fecal incontinence. 2 This is incorrect. Dehydration is not a reason to place the patient in contact precautions. 3 This is incorrect. Development of dark urine is not a reason to place the patient in contact precautions. 4 This is incorrect. Severe nausea and vomiting is not a reason to place the patient in contact precautions. The nurse is caring for a 15-year-old patient who has been diagnosed with mononucleosis. The patient asks how the infection was obtained. Which information should the nurse include when responding to the patient? 1. Drinking from the cup of a person with the infection 2. Eating contaminated food 3. Eating meat that is undercooked 4. Inhaling airborne germs, such as after someone coughs 1 This is correct. The virus that causes mononucleosis is transmitted through person-to-person contact, sharing personal objects such as cups or toothbrushes, and through saliva. 2 This is incorrect. Contaminated food does not cause mononucleosis. 3 This is incorrect. Mononucleosis is not transmitted through undercooked meat. 4 This is incorrect. Mononucleosis is not airborne; that is, it is not transmitted through respiratory droplets or respiratory secretions. An adolescent develops a fever, cough, and a maculopapular rash. Which question should the nurse ask when completing the health history with this patient? 1. "Did you receive any vaccinations recently?" 2. "Do you usually eat cold pizza left on the counter overnight?" 3. "Do you forget to wash your hands after using the bathroom?" 4. "Have you been around anyone with a cold over the last 3 weeks?" 1 This is incorrect. Receiving a vaccination does not cause the symptoms of a fever, cough, and maculopapular rash. 2 This is incorrect. Foodborne viruses do not cause a cough, fever, or maculopapular rash. 3 This is incorrect. Infections transmitted through the fecal-oral route do not cause a fever, cough, and maculopapular rash. 4 This is correct. Foodborne viruses manifest with gastrointestinal distress. Chickenpox is a respiratory-borne viral disease with an incubation period of about 21 days. An older patient with weeping lesions caused by herpes zoster asks if a trip to visit small grandchildren can still occur this upcoming weekend. Which should the nurse say to the patient in response? 1. "There is no reason for you to cancel your trip." 2. "You should not travel until all of the lesions are healed." 3. "Be sure to keep the lesions covered until they crust over." 4. "As long as the lesions are kept uncovered, you can travel without any issues." 1 This is incorrect. Shingles lesions must be covered to prevent spread. It is contagious until all lesions are crusted over. 2 This is incorrect. The patient can travel as long as the lesions are covered until they crust over. 3 This is correct. The lesions of shingles must be covered until they crust over to prevent the transmission of chickenpox to the grandchildren. 4 This is incorrect. Weeping lesions caused by herpes zoster must be covered to prevent transmission of chickenpox to others. A nurse is caring for a school-age child who has inflammation of the right eye. Which finding, if present, would indicate to the nurse that the child has bacterial conjunctivitis rather than viral conjunctivitis? 1. Eye swelling 2. Red conjunctiva 3. Watery discharge 4. Purulent drainage 1 This is incorrect. Eye swelling or edema occurs with both bacterial and viral conjunctivitis. 2 This is incorrect. Pink or red conjunctiva occurs in both bacterial and viral conjunctivitis. 3 This is incorrect. Viral conjunctivitis causes a watery discharge from the effected eye. 4 This is correct. Purulent drainage is a symptom of bacterial conjunctivitis. The nurse is providing care to an 8-week-old infant who has symptoms of an upper respiratory infection. Which assessment finding should indicate to the nurse that the patient is experiencing pertussis? 1. An expiratory wheeze 2. A "whoop" sound after coughing 3. Three wet diapers each day 4. Bulging fontanelles 1 This is incorrect. Expiratory wheezing is a symptom of asthma. 2 This is correct. The characteristic "whoop" that occurs in pertussis occurs after coughing. 3 This is incorrect. For young infants, fewer than five or six wet diapers in 24 hours indicates dehydration. 4 This is incorrect. Bulging fontanelles indicates overhydration, which is unrelated to pertussis. A parent brings her school-age child to the physician's office for evaluation of a sore throat, fever, headache, and fine red rough rash over both arms and abdomen. For which health problem should the nurse plan care for this patient? 1. Croup 2. Tonsillitis 3. Epiglottitis 4. Scarlet fever with strep throat 1 This is incorrect. Croup causes a harsh "barky" cough and does not cause a rash. 2 This is incorrect. Tonsillitis does not cause a fine red rough rash. 3 This is incorrect. Epiglottitis does not cause a fine red rough rash. 4 This is correct. Strep throat and a fine red rough rash are main symptoms of scarlet fever. A school-age child is brought to the clinic to be evaluated for a headache and stomachache. For which reason should the nurse prepare the patient to have a rapid strep test? 1. Runny nose 2. Productive cough 3. Strawberry tongue 4. Jaundiced conjunctiva 1 This is incorrect. A rapid strep test would not be used to assess for a runny nose. 2 This is incorrect. A rapid strep test is not done because of a productive cough. 3 This is correct. A rapid strep test would be done if a strawberry tongue is assessed, an indication of strep throat or scarlet fever. 4 This is incorrect. A rapid strep test would not be done for jaundiced conjunctiva. A school-age child is diagnosed with hand, foot, and mouth disease. Which should the nurse instruct the parent to do when caring for the patient at home? Select all that apply. 1. Provide bland foods and fluids. 2. Offer generous amounts of oral fluids. 3. Wash clothes with hot soapy water and bleach. 4. Use acetaminophen or ibuprofen for pain control. 5. Instruct to flush the mouth with an alcohol-based mouthwash. 1. This is correct. The patient with hand, foot, and mouth disease has oral lesions. The patient should consume bland foods and fluids to reduce pain when eating and drinking. 2. This is correct. The patient with hand, foot, and mouth disease should have ample fluids to ensure adequate hydration. 3. This is incorrect. Clothes do not need to be washed with hot soapy water and bleach for hand, foot, and mouth disease. 4. This is correct. The patient with hand, foot, and mouth disease should be provided with mild over-the-counter analgesics such as acetaminophen or ibuprofen. 5. This is incorrect. An alcohol-based mouthwash is irritating to oral tissues and should not be used. The nurse is visiting the home of a patient with hepatitis B who is 1 week postpartum. Which information should the nurse include when teaching this patient? Select all that apply. 1. "Hepatitis B is only transmitted through sexual contact." 2. "The baby may have contracted hepatitis B through the pregnancy." 3. "There are no medications appropriate for children with hepatitis B." 4. "After the baby has received treatment, there is no need for follow-up." 5. "The baby should have received the hepatitis B immunization and hepatitis B immune globulin." 1. This is incorrect. Hepatitis B virus (HBV) is commonly transmitted through blood or body fluids. 2. This is correct. Newborns may acquire HBV prenatally. Postexposure prophylaxis is needed to prevent the development of chronic hepatitis B. 3. This is incorrect. The newborn receives the hepatitis B vaccination and if the mother is positive for the infection, the newborn should also receive hepatitis B immune globulin. 4. This is incorrect. The newborn should receive adequate care and follow-up. 5. This is correct. The hepatitis B vaccine is administered to all newborns. If the mother is positive for hepatitis B surface antigen (HBsAg), 0.5 mL of hepatitis B immune globulin (HBIG) is also given. An adolescent is diagnosed with mononucleosis. Which teaching should the nurse provide to the parents when providing care at home? Select all that apply. 1. Encourage ample fluids. 2. Avoid all contact sports for 6 to 8 weeks. 3. Encourage rest with quiet activities and play. 4. Limit the amount of caloric intake until recovered. 5. Provide ibuprofen or acetaminophen for elevated temperature. 1. This is correct. The patient with mononucleosis needs to ingest ample fluids to prevent the development of dehydration. 2. This is correct. To prevent injury to the spleen, contact sports are not permitted for 6 to 8 weeks if the spleen is enlarged. Even though the patient's status of the spleen is not identified, the patient should avoid these types of sports until approved by the health-care provider. Examples of contact sports include basketball, football, soccer, rugby, baseball, boxing, ice hockey, rodeo, wrestling, martial arts, lacrosse, and water polo. 3. This is correct. The patient with mononucleosis is easily fatigued and should engage in quiet activities and play. 4. This is incorrect. There is no reason to limit the patient's caloric intake. Adequate calories should be provided to ensure for the patient's nutritional status. 5. This is correct. The patient should be provided with acetaminophen or ibuprofen for fever control. A 17-year-old patient with influenza tells the nurse, "I can't believe I got sick. I've been taking vitamin C, vitamin D, echinacea, and some other herbal remedies to boost my immune system." Which should the nurse say in response to this patient? Select all that apply. 1. "You probably weren't taking enough of the supplements." 2. "Those supplements help with focus and attention, not disease prevention." 3. "The safe use of supplements and herbs has not been determined." 4. "The vitamins you were taking may have reduced the effectiveness of the herbs." 5. "The effectiveness of supplements and herbs against influenza has not been determined." 1. This is incorrect. Additional research is needed regarding alternative supplements to identify safety and efficacy of these therapies. 2. This is incorrect. The vitamins and supplements listed are ones that people commonly take for disease prevention. However, that does not mean they have been proved effective or safe. 3. This is correct. The safety of supplements and herbs have not been determined and need additional study. 4. This is incorrect. There is no evidence that taking vitamins and herbs concurrently reduces the effectiveness of herbs. 5. This is correct. The effectiveness of supplements and herbs for a specific health problem has not been determined and needs additional study. The nurse is writing teaching material about caring for a child with influenza. Which information should the nurse include? Select all that apply. 1. Zanamivir is only prescribed for children over 13 years old. 2. Only one antiviral has been approved by the FDA as of 2017. 3. Tamiflu can be given to children older than one on weight-based dosing. 4. Manifestations of the flu include fever, chills, headache, and myalgia (aching). 5. Medications for influenza must be given within 48 hours of the onset of symptoms. 1. This is incorrect. Zanamivir is recommended for children older than 7 years of age. 2. This is incorrect. Antiviral medications for influenza approved by the Food and Drug Administration (FDA) include oseltamivir (Tamiflu) and zanamivir (Relenza). 3. This is correct. Oseltamivir (Tamiflu) may be given to children older than 1 year and should be given on weight-based dosing. 4. This is correct. Symptoms of influenza include fever, chills, headache, sneezing, cough, malaise, conjunctivitis, and myalgia (aching). 5. This is correct. Medications for influenza must be given within 48 hours of the onset of symptoms. A parent with a school-age child with mumps asks for information about the illness and treatment. Which information should the nurse provide? Select all that apply. 1. "There is no need to isolate the child." 2. "There are no laboratory tests to detect the mumps virus." 3. "Sometimes the complications of mumps involve the testicles." 4. "Mumps are seen by observation of swelling around the ears and jaw." 5. "Provide food and drink that is nonirritating to the mouth and surrounding glands." 1. This is incorrect. Droplet isolation is required to prevent the spread of the infection. 2. This is incorrect. IgM enzyme immunoassay is used to detect the mumps virus. 3. This is correct. Boys may have painful swelling of the testicles (orchitis) from the mumps virus. 4. This is correct. Mumps is manifested by swelling of parotid salivary glands in front of the ear, below the ear, and/or under the jaw. 5. This is correct. The patient with mumps should be provided with bland, soft foods and bland liquids. Citrus juices should be avoided. The patient should be kept well-hydrated. Which of the following is a consideration in the administration of immunizations? 1. Immunizations can only be administered if a child is free from any illnesses. 2. Caregivers should administer aspirin prior to the injection to prevent any side effects. 3. Children should be isolated from other children for 24 hours after receiving immunizations. 4. Caregivers should be advised that immunizations may cause a mild fever or soreness and redness at the injection site. Feedback 1. Children with mild signs and symptoms of a cold may receive immunizations. However, if they are febrile, it is better to hold off on the immunization until later. 2. Acetaminophen or ibuprofen are recommended to relieve any pain or fever following immunizations. 3. Generally, children do not need to be isolated from others after immunizations. 4. Some immunizations may cause a mild fever, or soreness and redness at the injection site. Caregivers may give acetaminophen or ibuprofen to relieve any pain or fever. Warm compresses may also be applied to the injection site. A vaccine that contains fragments of cells that stimulate an immune response, but does not contain the whole cell is known as a: 1. Toxoid. 2. Subunit. 3. Acellular. 4. Attenuated. Feedback 1. A toxoid vaccine is made from toxins produced by bacteria that are inactivated so that they cannot cause harm, but can still stimulate an immune response. 2. A subunit is produced from small fragments of viral protein. 3. An acellular vaccine contains fragments of cells that stimulate an immune response, but do not contain the whole cell. 4. An attenuated vaccine is one produced from the weakened virus. Which of the following is true about immunizations containing thimersal and autism? 1. Thimersal has been removed from all vaccines. 2. Only the MMR vaccine is associated with autism. 3. Thimersal has been linked to learning disabilities, but not autism. 4. Researchers have found no evidence that thimersal is linked to autism Feedback 1. Even though researchers have found no evidence that thimersal is linked to autism, the Advisory Committee on Immunization Practices has recommended that thimersal be removed from all vaccines. 2. Currently, this preservative is only found in very small amounts in some flu vaccines. Also, no evidence has been found that the MMR vaccine is associated with autism. 3. Even though researchers have found no evidence that thimersal is linked to autism, the Advisory Committee on Immunization Practices has recommended that thimersal be removed from all vaccines. 4. Even though researchers have found no evidence that thimersal is linked to autism, the Advisory Committee on Immunization Practices has recommended that thimersal be removed from all vaccines. A 27-year-old mother has just delivered a healthy 7 lb. 3 oz. baby boy. Which of the following is true regarding the babys immunization schedule for Hepatitis B? 1. The infant will need two doses administered at least 6 months apart. 2. The infant should not receive the vaccine until at least 12 months of age. 3. The infant will not need any vaccines at this time because of passive immunity from the mother. 4. If the mother is Hepatitis B surface antigen positive, the baby will need 0.5ml of Hepatitis B Immune Globulin. Feedback 1. Three doses of Hepatitis B are given before age 2: at birth, at 1 to 2 months of age, and after 24 weeks of age. 2. Three doses of hepatitis B are given before age 2: at birth, at 1 to 2 months of age, and after 24 weeks of age. 3. Immunity will not occur passively. 4. If the mother is Hepatitis B surface antigen (HbsAg) positive, 0.5 ml of Hepatitis B Immune Globulin (HBIG) is also given. A mother is bringing her 2-month-old son in for his well-child visit. He is due to receive his Diphtheria, Tetanus, and Pertussis vaccine. The nurse is educating the mother on the possible side effects of the vaccine, which include: 1. Pain and swelling in the joints. 2. Irritability, loss of appetite, and seizures. 3. Nausea, vomiting, and abdominal pain. 4. Fever and decreased white blood cell count. Feedback 1. Swelling occurs at the site, not the joints. 2. Side effects of the DTaP vaccine are irritability, loss of appetite, localized swelling, and seizures, which are rare. 3. Nausea and vomiting are rare. 4. Fever and a decreased white blood cell count are rare.