Deck 24: Infectious Diseases and Immunizations

Question 1

The primary care pediatric nurse practitioner reviews the immunization records of
an 18­month­old child and notes that the child received an MMR immunization 2 days prior to the first birthday. What will the nurse practitioner do?
A. Administer a reduced dose of MMR to ensure adequate immunity.
B. Obtain mumps, measles, and rubella titers to determine immunity.
C. Recommend the next dose of MMR vaccine at 4 to 5 years of age.
D. Repeat the MMR vaccine since the first dose was given too soon

Answer 1

Recommend the next dose of MMR vaccine at 4 to 5 years of age.

Question 2

A 2­month­old infant has a staccato cough and fever. Which aspect of the history is most important in determining the diagnosis?
A. Day care attendance
B. Immunization history
C. Medication history
D. Past medical history

Answer 2

Immunization history

Question 3

The parent of a 2­month­old infant is reluctant to have the baby vaccinated. What is an initial step in responding to these concerns?
A. Inform the parent that all vaccines may be given without thimerosol.
B. Providing Vaccine Information Statements for the parent to review.
C. Question the parent's reasons for concern about immunizations.
D. Remind the parent that the infant is exposed to thousands of germs each day.

Answer 3

Question the parent's reasons for concern about immunizations.

Question 4

A 5­year­old child who has a history of pertussis infection as an infant is in the clinic for immunizations prior to kindergarten. Which vaccine will be given?
A. DTaP
B. DTP
C. Td
D. Tdap

Question 5

When reviewing a white blood cell (WBC) count, the primary care pediatric nurse practitioner suspects a viral infection when which WBC element is elevated?
A. Bands
B. Leukocytes
C. Lymphocytes
D. Neutrophils

Question 6

A toddler is receiving long­term antibiotics to treat osteomyelitis. Which laboratory
test will the primary care pediatric nurse practitioner order to monitor response to therapy in this child?
A. Blood cultures
B. Erythrocyte sedimentation rate (ESR)
C. Serum procalcitonin (Pro­CT)
D. White blood count (WBC)

Question 7

Which lab value is most concerning in an infant with fever and a suspected bacterial infection?
A. C­reactive protein of 11.5 mg/L
B. Lymphocyte count of 8.7
C. Platelet count of 475
D. White blood cell count of 14

Question 8

A 3­year­old child who attends day care has had a fever, nausea, and vomiting
several weeks prior and now has darkened urine and constipation along with hepatomegaly and right upper quadrant tenderness. What treatment is warranted for this child?
A. HAV vaccine
B. Immunoglobulin G
C. Interferon­alfa
D. Supportive care

Question 9

A 5­year­old child who received VariZIG after exposure to varicella while
immunocompromised during chemotherapy is in the clinic 5 months after stopping chemotherapy for kindergarten vaccines. What will the primary care pediatric nurse practitioner order for this child?
A. MMR and Tdap
B. MMR, Varivax, Tdap
C. Tdap only
D. Varivax and Tdap

Question 10

A parent is concerned about vaccine adverse reactions. Based on an Institute of
Medicine report, what will the primary care pediatric nurse practitioner tell the parent?
A. Administering multiple vaccines may trigger the development of type 1 diabetes.
B. The MMR may be linked to febrile seizures in immunocompromised children.
C. There is some risk of CNS disorders associated with the hepatitis B vaccine.
D. Vaccines containing thimerosol are linked to pervasive developmental disorders.

Question 11

According to recent research, which populations may have higher rates of under­ immunization than others?
A. Those with higher rates of Asians
B. Those with higher rates of graduate degrees
C. Those with lower rates of poverty
D. Those with lower rates of primary providers

Question 12

A 2­month­old infant will receive initial immunizations, and the parent asks about
giving medications to increase the infant's comfort and minimize fever. What will the primary care pediatric nurse practitioner recommend?
A. Administering ibuprofen or acetaminophen as needed
B. Avoiding antipyretics if possible to attain better immunity
C. Giving ibuprofen and acetaminophen only after the vaccines
D. Pre­treating the infant with both ibuprofen and acetaminophen

Question 13

A child who is immunocompromised has a fever and a rash consisting of macules, papules, and pustules. What will the primary care pediatric nurse practitioner do?
A. Administer varicella immune globulin (VariZIG).
B. Hospitalize the child for intravenous acyclovir.
C. Order intravenous immunoglobulin as an outpatient.
D. Prescribe oral acyclovir for the duration of the illness.

Question 14

The parent of an infant asks why some vaccines, such as MMR, are not given
along with the other series of immunizations at 2, 4, and 6 months of age. What will the primary care pediatric nurse practitioner tell this parent?
A. Febrile seizures are more likely in younger infants with some vaccines.
B. Maternal antibodies neutralize some vaccines and are delayed until 12 months.
C. The risk of adverse effects is lower for some vaccines after the first year.
D. Too many vaccines at once can overwhelm the infant's immune system.

Question 15

An adolescent female who is sexually active and who has not had the HPV
vaccine asks if she may have it. What will the primary care pediatric nurse practitioner tell her?
A. Getting the vaccine now will still protect her from HPV oncogenic types even if already exposed
B. Receiving the HPV vaccine series will replace the need for regular cervical cancer screening
C. She will need to have Papanicolaou and pregnancy screening prior to receiving the vaccine
D. The vaccine will not protect her from any HPV oncogenic types acquired previously

Question 16

A 9­month­old infant has had a fever of 103°F for 2 days and now has a diffuse,
maculopapular rash that blanches on pressure. The infant's immunizations are up­to­date. What will the primary care pediatric nurse practitioner do?
A. Administer immunoglobulin G to prevent fulminant illness.
B. Perform serologic testing for human herpes virus ­6 and human herpes virus ­7.
C. Reassure the parent that this is a mild, self­limiting disease.
D. Recommend avoiding contact with pregnant women.

Question 17

A 10­month­old infant who is new to the clinic has chronic hepatitis B infection.
What will the primary care pediatric nurse practitioner do to manage this infant's disease?
A. Consult a pediatric infectious disease specialist.
B. Prescribe interferon­alfa.
C. Provide supportive care.
D. Consider use of lamivudine.

Question 18

The primary care pediatric nurse practitioner performs a well child examination on
a 1­month­old. The infant was recently discharged from the neonatal intensive care unit after treatment with parenteral acyclovir for a neonatal herpetic infection and is currently taking oral acyclovir. What will the nurse practitioner do to manage this infant's care?
A. Obtain regular absolute neutrophil counts.
B. Perform routine skin cultures for herpes simplex virus.
C. Reinforce the need to give acyclovir indefinitely.
D. Stop the oral acyclovir at 2 months of age.

Question 19

The primary care pediatric nurse practitioner is performing an initial well child
exam on a 3­year­old child recently adopted from Africa. The adoptive parent has a record of immunizations indicating that the child is fully vaccinated. What will the nurse practitioner do?
A. Administer a booster dose of each vaccine to ensure immunity.
B. Find out whether the vaccines were provided by reliable suppliers.
C. Perform antibody titers and reimmunize the child
D. Record the vaccines in the child's electronic medical record.

Question 20

An 18­month­old child has bronchopulmonary dysplasia. To help prevent pneumococcal disease, which vaccine will be ordered?
A. PCV7
B. PCV13
C. PCV23
D. PCV33

Question 21

A child is brought to the clinic with a fever, headache, malaise, and a red, annular
macule surrounded by an area of clearing and a larger, erythematous annular ring. The child complains of itching at the site. What will the primary care pediatric nurse practitioner do to determine the diagnosis?
A. Ask about recent tick bites
B. Obtain a skin culture
C. Order blood cultures
D. Perform serologic testing

Question 22

A school­age child has fever of 104°F, sore throat, vomiting and malaise. The
primary care pediatric nurse practitioner observes that the tonsils, oropharynx, and palate are
erythematous and covered with exudate; the tongue is coated and red; and there is a red, sandpaper­like rash on the child's neck, trunk, and extremities. A rapid strep test is positive. What will the nurse practitioner do to manage this child's illness?
A. Administer intramuscular ceftriaxone.
B. Hospitalize for further diagnostic tests.
C. Prescribe oral amoxicillin.
D. Refer to a pediatric infectious disease specialist.

Question 23

An adolescent has a TB skin test prior to working as a volunteer in a hospital. The
adolescent is healthy and has not travelled to or from a TB­endemic area or had close contact with anyone who has TB. The Mantoux skin test shows 10 mm of induration after 48 hours. What will the primary care pediatric nurse practitioner do?
A. Ask the adolescent about exposure to homeless persons.
B. Order a chest radiograph to rule out active TB.
C. Reassure the adolescent that this is a negative screen.
D. Refer the adolescent to an infectious disease specialist.

Question 24

A 10­month­old infant has an erythematous, fluctuant, non­draining abscess on
the right buttock after 10 days of treatment with amoxicillin for impetigo. What is the next step in managing this infant's care?
A. Consultation with a pediatric infectious disease specialist
B. Culture of any superficial open surface wounds
C. Empiric treatment with clindamycin
D. Incision and drainage of the abscess with culture

Question 25

An 18­month­old child who developed upper respiratory symptoms 1 day prior is
brought to the clinic with a high fever, chills, muscle pains, and a dry, hacking cough. A rapid influenza test is negative and a viral culture is pending. What will the primary care pediatric nurse practitioner do?
A. Consider therapy with rimantadine.
B. Hospitalize for supportive treatment.
C. Prescribe oseltamivir and follow closely
D. Wait for cultures to determine treatment.

Question 26

An unimmunized school­age child whose mother is in her first trimester of
pregnancy is diagnosed with rubella after a local outbreak. What will the primary care pediatric nurse practitioner recommend?
A. Assessment of maternal rubella titers
B. Intravenous immunoglobulin for the child
C. MMR vaccine for the mother and child
D. Possible termination of the pregnancy

Question 27

The primary care pediatric nurse practitioner is examining a 2­month­old infant
with fever and cough. A WBC is 14,000/mm3 and a chest radiograph is normal. The infant is nursing well and having normal stools. What would be an appropriate next step?
A. Admitting the infant to the hospital for LP and IV antibiotics
B. Obtaining a blood culture, erythrocyte sedimentation rate, and C­reactive protein
C. Performing a catheterized urinalysis to screen for leukocytes and nitrites
D. Prescribing empiric, broad­spectrum antibiotics with close follow­up

Question 28

A child with a history of a pustular rash at the site of a cat scratch on one arm now
has warm, tender, swollen axillary lymph nodes on the affected side. The primary care pediatric nurse practitioner notes induration and erythema of these nodes. What will the nurse practitioner do?
A. Obtain a complete blood count and C­reactive protein.
B. Order an immunofluorescent assay (IFA) for serum antibodies.
C. Perform a needle aspiration of the affected lymph nodes.
D. Prescribe a 5­day course of azithromycin.

Question 29

A child whose parents have refused vaccines has been exposed to chickenpox,
and the parents ask whether the child may attend day care. What will the primary care pediatric nurse practitioner tell them?
A. The child may attend day care as long as no rash is present even with mild fever or other symptoms.
B. The child should remain home and receive oral acyclovir for 5 days to prevent onset of symptoms.
C. The child should stay home until the 21­day incubation period has passed even if symptom free.
D. The child should stay home if any symptoms occur and may return in 1 week if no rash develops.

Question 30

The primary care pediatric nurse practitioner is reviewing medical records for a
newborn that is new to the clinic. The toddler's mother was found to be HIV positive during her pregnancy with this child and received antiretroviral therapy during pregnancy. The child was born by cesarean section, begun on anti­retroviral prophylaxis, and did not breastfeed. What is the correct management for this child?
A. Consult with a pediatric HIV specialist.
B. Discontinue cART after 4 weeks of age.
C. Obtain a CD4+ cell count and HIV RNA levels.
D. Reinforce the need to give cART for life.

Question 31

A 3­year­old child whose immunizations are up­to­date has been exposed to
measles because of a localized outbreak among unvaccinated children. The parent reports that contact with infected children occurred within the last 2 days at a birthday party. What is the best course of action?
A. Administer the MMR vaccine to help prevent disease.
B. Give antiviral medications at the first sign of symptoms.
C. Give the child a dose of immune globulin to mitigate the response.
D. Reassure the parent that most exposed children will not get measles.

Question 32

A 7­year­old child whose immunizations are up­to­date has a fever, headache, stiff neck, and photophobia. What course of treatment is indicated?
A. Empiric treatment with oral antibiotics or intramuscular ceftriaxone
B. Hospitalization for diagnosis and treatment with antibiotics
C. Immediate vaccination with meningococcal vaccine
D. Outpatient lab work, including a CBC and blood and CSF cultures

Question 33

A preschool­age child is brought to clinic for evaluation of a rash. The primary
care pediatric nurse practitioner notes an intense red eruption on the child's cheeks and circumoral pallor. What will the nurse practitioner tell the parents about this rash?
A. This rash may be a prodromal sign of rubella or roseola.
B. The child will need immunization boosters to prevent serious disease.
C. This is a benign rash with no known serious complications.
D. Expect a lacy, maculopapular rash to develop on the trunk and extremities.

Question 34

A child whose family has been camping in a region with endemic Lyme disease
suffered several tick bites. The parents report removing the ticks but are not able to verify the type or the length of time the ticks were attached. The child is asymptomatic. What is the best course of action?
A. Administer a prophylactic single dose of doxycycline.
B. Perform serologic testing for IgG or IgM antibodies.
C. Prescribe amoxicillin three times daily for 14 to 21 days.
D. Teach the parents which signs and symptoms to report.