Deck 31: Infectious Diseases

Question 1

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 anti-retroviral 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.

Answer 1

A

Question 2

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

Answer 2

C

Question 3

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.

Answer 3

D

Question 4

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 5

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 C-reactive protein.
B) Order an immunofluorescent assay (IFA) for serum antibodies.
C) Perform a needle aspiration of the affected lymph nodes.
D) Prescribe a 5-day course of azithromycin.

Question 6

A preschool-age 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 7

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 TB-endemic 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 8

Which lab value is most concerning in an infant with fever and a suspected bacterial infection?

A) C-reactive 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 9

A 9-month-old 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 up-to-date. 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, self-limiting disease.
D) Recommend avoiding contact with pregnant women.

Question 10

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 11

An unimmunized school-age 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 12

A school-age 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, sandpaper-like 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 13

A 3-year-old 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) Interferon-alfa
D) Supportive care

Question 14

A 10-month-old 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 interferon-alfa.
C) Provide supportive care.
D) Consider use of lamivudine.