Question 1

The nurse has provided instructions about home care management for the parents of a child diagnosed with rotavirus infection. Which statements by the parents indicate that teaching has been effective? Select all that apply.

Accepted Answer

Rotavirus is a contagious virus and the leading cause of diarrhea in children less than 5 years old; it is also the cause of many nosocomial infections each year. Rotavirus is spread via the fecal-oral route. Because the virus lives easily outside a human host, transmission can occur through contact with food, toys, diapers, and hands. Meticulous handwashing and proper diaper disposal prevent the spread of the virus (Options A and E). Symptoms include foul-smelling, watery diarrhea that lasts 5-7 days and is often accompanied by fever and vomiting. Vaccination is available and must be given before the child is 8 months old. However, vaccinated children can still acquire Rotavirus as many strains are not covered by the vaccine. Antibiotics are not effective against this viral agent. Because the virus can easily lead to dehydration, parents should be taught the symptoms (eg, lack of tears when crying, extremely fussy or sleepy, decreased urination, dry mucous membranes). Oral rehydration solutions should be used to combat dehydration (Option B). (Option C) Breastfeeding and normal diet should be maintained. There is no evidence that these are harmful. (Option D) Parents should change the child's diapers more frequently and wash the perianal area with mild soap and water. Commercial baby wipes containing alcohol should not be used as they are irritating. Protective zinc oxide can be applied instead. Educational objective: Rotavirus is a contagious infection that is easily spread via the fecal-oral route by touching contaminated objects, food, and hands. It is not treated with antibiotics as it is a viral infection. Vaccination is available for children less than 8 months old. Children with rotavirus are at risk for dehydration.

Question 2

A nurse is caring for a 6-year-old client with tonsillitis. Which further assessment finding requires immediate intervention?

Accepted Answer

11ecbb05_cadc_c86b_b433_1356de762f89_MD0009_00 Trismus (inability to open the mouth due to a tonic contraction of the muscles used for chewing) may indicate a more serious complication of tonsillitis, a peritonsillar or retropharyngeal abscess (collection of pus). Other features include a "hot potato" or muffled voice, pooling of saliva, and deviation of the uvula to one side. This abscess can occlude the airway, making it a medical emergency. Surgical intervention (tonsillectomy or incision and drainage) is often required. In the meantime, maintaining an adequate airway is essential. (Option A) Dry mucous membranes indicate dehydration. This is to be expected in a child with tonsillitis due to the refusal to swallow. Hydration with IV fluids may be indicated in severe cases. Dehydration requires intervention but is not the priority. (Option C) Pulling at the ears is a common symptom in children with otitis media. An ear infection frequently accompanies tonsillitis in children and is easily treated with antibiotics. This is not a serious finding. (Option D) The most common bacterial cause of tonsillitis is group A streptococcal infection. The same organism can also result in scarlet fever, which manifests as fine sandpaper-like skin rash and fever. Antibiotics will effectively treat this condition, and it is not life-threatening. Educational objective: Peritonsillar or retropharyngeal abscess is a serious complication that can result from tonsillitis or pharyngitis. A "hot potato" or muffled voice, trismus (inability to open the mouth), pooling of saliva, and deviation of the uvula to one side are the presenting features. Maintaining an adequate airway is essential.

Question 3

The nurse is reviewing discharge teaching with the parent of a child with acute myelogenous leukemia who was admitted with varicella-zoster virus. The client has multiple lesions that have not crusted. Which of the following instructions should the nurse include? Select all that apply.

Accepted Answer

11ecbb05_cadf_396f_b433_d98df0490644_MD0009_00 Varicella-zoster virus (VZV) infection (chickenpox) is characterized by lesions that begin as a maculopapular rash, progress to weeping vesicular lesions, and typically crust over within approximately 1 week. The lesions are often pruritic and/or painful, and clients frequently have an accompanying fever. In most cases, treatment is supportive in nature and includes: Cool oatmeal baths and topical antihistamines (eg, diphenhydramine) applied to lesions for itching (Option A) Acetaminophen as needed for fever or pain (Option C) Immunocompromised clients (eg, clients with acute myelogenous leukemia [AML]) are at risk for severe varicella (eg, disseminated, pneumonia) and require aggressive therapy, including an antiviral agent (eg, acyclovir). Antiviral therapy should be continued until all the lesions have crusted over (Option B). VZV is spread via airborne and contact transmission. Clients are most infectious in the days leading up to the rash and continue to be infectious until the entire rash reaches the crusting stage (Option E). (Option D) Immunocompromised clients should not receive live attenuated vaccines (eg, varicella virus vaccine). In addition, the vaccine is not indicated for a client who has already developed immunity after recovering from VZV infection. Educational objective: Treatment for clients with varicella-zoster virus infection (chickenpox) is supportive and includes acetaminophen for fever or pain, cool oatmeal baths, and topical antihistamines for itching. Immunocompromised clients are at risk for complications (eg, severe disseminated varicella) and should receive antiviral therapy. Clients are infectious until all lesions crust over.

Question 4

A nurse is teaching the parent of a 6-year-old with a urinary tract infection (UTI) how to avoid repeat infections. Which statements by the parent indicate that the teaching has been effective? Select all that apply.

Accepted Answer

UTIs are one of the most common conditions in children, with a higher occurrence in girls (due to the short urethra and its close proximity to the vagina and anus). Girls should be taught to wipe from front to back; this will help minimize the chances of bacteria entering the urethra from the perianal area (Option D). Urinary stasis (incomplete emptying of the bladder) is the most common contributing factor to UTIs; sedentary urine provides an ideal environment for bacterial growth. Constipation and straining increase the pressure on the bladder neck and may prevent the bladder from emptying completely. The child should be encouraged to drink plenty of fluids and use the restroom as soon as the urge to go is felt, which will decrease the risk of constipation and promote frequent urination. Avoiding "holding in" urine and voiding regularly help to prevent urinary retention and flush bacteria out of the urinary tract (Option B). bladder neck Scented soaps or commercially prepared bubble bath products should be avoided as they cause irritation to the urethra. Antibacterial soap should not be used for bathing a child as it may reduce the presence of normal flora. The bathtub should be filled with water only, and the hair should be washed last (Options C and E). (Option A) Tight clothing and synthetic fabrics (eg, nylon, spandex, Lycra) should be avoided as they seal in moisture and promote bacterial growth. Cotton underwear is recommended as it absorbs moisture. Educational objective: Urinary stasis, constipation, and infrequent voiding are contributing factors to UTIs. The child should be encouraged to drink fluids and avoid holding in urine. Tight clothing and synthetic fabrics (eg, spandex, nylon, Lycra) should be avoided; cotton underwear is recommended. Scented soaps, bubble baths, and antibacterial soaps should not be used for bathing a child (the tub should be filled with water only), and the hair should be washed last.

Question 5

The emergency nurse is triaging four clients. Which client should the nurse assess first?

Accepted Answer

11ecbb05_cadb_41c9_b433_c971417fbbe2_MD0009_00 Infant botulism is food poisoning that occurs after consuming Clostridium botulinum, a bacteria found in soil and animal products (eg, raw honey, milk). In infants, the bacteria often colonize the gastrointestinal tract and release an exotoxin that causes rapid, life-threatening paralysis. In addition to young age, absence of competitive bowel flora predisposes infants (age <1 year) to this infection. Therefore, infants should not be fed honey. Early clinical manifestations of infant botulism often include constipation, difficulty feeding, decreased head control, and diminished deep-tendon reflexes (Option A). It is essential to recognize symptoms early, because botulism progresses rapidly to respiratory failure and arrest. Management of infant botulism often includes administering intravenous botulism immune globulin (BIG-IV), which reduces severity and duration of symptoms by improving immune response. In addition, close monitoring and supportive care (eg, mechanical ventilation, enteral tube feedings) are provided. (Option B) Pain, swelling, and deformity of the elbow after falling may indicate a fracture. However, a fracture should not delay care of clients at risk for imminent respiratory failure. (Option C) Right-sided abdominal pain, fever, and inability to tolerate food may indicate acute appendicitis, which requires prompt care. However, clients with suspected botulism remain the priority. (Option D) Painful urination, back pain, and lethargy are clinical manifestations of urinary tract infection. Laboratory analysis and antibiotics may be required but should not delay care of suspected botulism. Educational objective: Infant botulism is food poisoning causing life-threatening paralysis, which occurs after consuming Clostridium botulinum. Infants (age <1 year) with signs of botulism (eg, constipation, difficulty feeding, decreased head control, diminished deep-tendon reflexes) require prompt intervention because respiratory failure may develop rapidly.

Question 6

What is the priority when caring for a 6-month-old diagnosed with atopic dermatitis?

Accepted Answer

Atopic dermatitis, also known as eczema, is a chronic skin disorder characterized by pruritus, erythema, and dry skin. In infants, red, crusted, scaly lesions may also be present. It is commonly first diagnosed before age 1 year. The exact cause is unknown, although it is associated with an impaired skin barrier that allows penetration of allergens, leading to an immune response. The primary goals of management are to alleviate pruritus and keep the skin hydrated to prevent scratching. Scratching leads to the formation of new lesions and predisposes to secondary infections. Important measures to prevent scratching include cutting and filing nails short, placing gloves or cotton stockings over the hands, not wearing rough fabrics or woolen clothing, and applying moisturizer. These measures would have an immediate effect in preventing scratching. (Option A) A room humidifier may improve skin hydration and comfort in clients with excessively dry skin. However, comfort measures are not as crucial as immediate prevention of scratching (eg, gloves or cotton stockings placed over the hands). (Option B) Having an infant with severe atopic dermatitis may be a source of anxiety or stress for parents. Although it may be beneficial to explore the psychosocial effects on the family, prevention of scratching is a higher priority as it can lead to secondary infection. (Option C) Many clients with atopic dermatitis are also diagnosed with food sensitivities that aggravate the condition and require a hypoallergenic diet. However, nutritional education is a lower priority than infection prevention. Educational objective: Atopic dermatitis (eczema) is a chronic skin disorder manifested in infants by pruritus, dry skin, and red, crusted, scaly lesions. The priority management is to prevent scratching as this would promote formation of new lesions and predispose to secondary infections.

Question 7

The most recent laboratory results for a 12-month-old who is HIV-positive show a CD4 lymphocyte count of 500/mm³ and a CD4 lymphocyte percentage of 10%. The nurse anticipates administering which immunizations? Select all that apply.

Accepted Answer

Routine immunization is particularly beneficial to children who are HIV-positive as they are more susceptible to preventable diseases due to a compromised immune system. The standard vaccine schedule for a 12-month-old includes Hib, PCV (PVC13), MMR, varicella, and Hep A. HIV-positive children who are asymptomatic and not extremely immunocompromised can receive the appropriate age-specific immunizations as recommended. standard vaccine However, live vaccine preparations (eg, MMR, varicella) are contraindicated in the presence of marked immunosuppression, as determined by CD4 lymphocyte percentages and/or counts (Options C and E). An individual with a CD4 lymphocyte percentage <15% is considered to be severely immunocompromised. Low CD4 lymphocyte counts vary slightly by age due to the normal occurrence of elevated CD4 counts during infancy and early childhood. Low CD4 counts are defined as <750/mm³ for infants 12 months or younger, <500/mm³ for children between age 1-5 years, and <200/mm³ for children age >5 years and adults. Educational objective: Children who are HIV-positive and not severely immunocompromised can receive routine childhood immunizations. Children with severe immunosuppression as indicated by CD4 lymphocyte counts and/or percentages should not receive any live vaccines, including MMR and varicella.

Question 8

A 15-month-old begins to seize during assessment for a high-grade fever. What is the most appropriate nursing action?

Accepted Answer

This client likely has febrile seizures. It is important to never leave seizing clients alone as the goal is to prevent them from causing self-injury. The nurse should call out for help if needed. The main objective is to ensure that seizing clients maintain their airway; therefore, it is important to monitor their oxygen saturation levels. If these levels begin to drop or cyanosis occurs, prompt intervention is needed, which may be as simple as a head tilt or jaw thrust. (Option A) Aspirin should not be used in children to treat fever, except in a setting such as Kawasaki disease; this is because aspirin use is associated with Reye syndrome (swelling of the liver and brain). Fever in children is treated with ibuprofen or acetaminophen. (Option B) Most clients experiencing a febrile seizure do not require anti-seizure medications to stop convulsions. Once seizing has stopped, the fever needs to be treated. If seizing is continuous, medication administration may be necessary. (Option D) Many clients experiencing a febrile seizure are able to maintain their own airway with no intervention needed. It would not be necessary to bag mask this client if there are no signs of hypoxia or distress. Educational objective: Most clients experiencing a febrile seizure remain stable but still need continuous monitoring for hypoxia. They usually do not require anti-seizure medication. Ensuring client safety is important; therefore, the nurse should never leave a seizing client alone and stay to monitor oxygen saturation levels.

Question 9

The nurse plans care for a 3-year-old who was admitted with suspected pertussis infection. Which instructions will the nurse include in the plan of care? Select all that apply.

Accepted Answer

Pertussis (whooping cough) is a very contagious communicable disease caused by the Bordetella pertussis bacteria. These organisms attach to the small hairs in the airway and release a toxin that causes swelling and irritation. Pertussis is spread from person to person by coughing, sneezing, and close contact. As a result, an affected client should be placed in standard (universal) and droplet isolation precautions when hospitalized. At first, symptoms similar to the common cold and a mild fever occur, but eventually these clients develop a characteristic violent, spasmodic cough. Coughing is so severe that the person is forced to inhale afterward, resulting in a distinctive, high-pitched "whooping" sound. Coughing episodes may continue until a thick mucus plug is expectorated and are sometimes followed by vomiting (posttussive emesis). Treatment consists of antibiotics and supportive measures. Humidified oxygen and adequate fluids will help loosen the thick mucus. Suction as needed is important in infants. Respiratory status should be monitored for obstruction. The client should be positioned on the left side to prevent aspiration if vomiting occurs. Vaccination against whooping cough is available, but some individuals will still develop the disease, although in a milder form. (Option D) An airborne precaution such as placing the client in a negative pressure isolation room is needed for individuals with measles, tuberculosis, and varicella zoster (chicken pox) infections (airing MTV). (Option E) Cough suppressants are not used as they are not very effective for pertussis. In addition, the child needs to cough up any mucus plugs that might develop to keep the airway clear. Educational objective: Pertussis can occur despite vaccination. Characteristic features include a cough lasting ≥2 weeks with ≥1 of the following: paroxysms of cough, inspiratory whooping sound, and posttussive vomiting. Clients need oral antibiotics, droplet precautions, and supportive measures (humidified oxygen and oral fluids).

Question 10

The clinic nurse cares for a 4-year-old who has been diagnosed with a pinworm infection.  Which client symptom supports this diagnosis?

Accepted Answer

11ecbb05_cade_00ed_b433_013bfa623c5a_MD0009_00 The most common worm infection in the United States is pinworm, which is easily spread by inhaling or swallowing microscopic pinworm eggs, which can be found on contaminated food, drink, toys, and linens. Once eggs are ingested, they hatch in the intestines. During the night, the female pinworm lays thousands of microscopic eggs in the skinfolds around the anus, resulting in anal itching and troubled sleep. When the infected person scratches, eggs are transferred from the fingers and fingernails to other surfaces. Pinworm infection is treated with anti-parasitic medications. (Option B) Hookworms (eg, Ancylostoma) are parasitic bloodsucking roundworms that are contracted from larvae in contaminated soil. They can infect the intestines, causing intestinal bleeding and anemia. (Option C) Poor appetite, inadequate absorption of nutrients from food, and weight loss are symptoms associated with tapeworm infection (eg, Taenia solium). Tapeworm larvae are ingested when a person eats food that is contaminated with feces or undercooked meat from an infected animal. (Option D) Ringworm is a skin infection caused by a fungus. It leads to red, scaly, blistered rings on the skin or scalp that grow outward as infection spreads. The fungus is easily spread by sharing hair care instruments and hats or via towels, linens, clothing, and sports equipment. Educational objective: The most common worm infection is pinworm, which is spread by inhaling or swallowing microscopic pinworm eggs, which travel to and hatch in the intestines. During the night, the female pinworm lays eggs in the skinfolds around the anus, resulting in anal itching and disturbed sleep.

Question 11

A nurse is giving instructions related to antibiotic eye drops to the parent of a 5-year-old with bacterial conjunctivitis. Which instruction is most important?

Accepted Answer

Bacterial conjunctivitis (pink eye) is highly contagious. The hands must be washed properly before and after instilling eye drops and after cleaning away eye drainage or crusting; this is the single best method to prevent the spread of infection to the other eye, the parents, other family members, or anyone else. Therefore, parents should ensure that affected children wash their hands frequently and discourage them from rubbing their eyes. Tissues used to clean the eye should be discarded. The child's washcloths and towels should be kept separate. Many schools and day care centers require that children be kept at home during the time when they are most contagious. (Option A) These tissues should be thrown away immediately, but this step is not as critical as frequent and appropriate hand washing. Gentle wiping should be done from the inner canthus downward and outward, away from the other eye. (Option B) Eye drops are easiest instilled in the eye when the child is lying down or sitting with the head tilted back. (Option C) Warm, moist compresses help remove the crusting present on the eyelid and in the lashes. However, the compress should not be left for long periods as it may promote bacterial growth. Educational objective: Frequent and proper hand washing is necessary to prevent the spread of bacterial conjunctivitis to the other eye or to other individuals. Tissues used to wipe eye medication should be discarded, towels and washcloths should be kept separate, and the child should be discouraged from rubbing the affected eye.

Question 12

The clinic nurse assesses an 8-year-old client who reports a sore throat and has a bright red, pruritic rash on the chest that feels like fine bumps and looks like a sunburn.  Which diagnostic tool does the nurse anticipate the health care provider will prescribe?

Accepted Answer

11ecbb05_cade_c43e_b433_75ee3c50667b_MD0009_00 Scarlet fever (ie, scarlatina), a complication of group A streptococcal infection (eg, streptococcal pharyngitis), is common in early childhood and is characterized by a distinctive red rash. The rash begins on the neck and chest and spreads to the extremities, resembles a bad sunburn, blanches with pressure, and has fine bumps like sandpaper. Additional manifestations of streptococcal pharyngitis (eg, exudative pharyngitis, fever, swollen anterior cervical lymph nodes) are typically present. Because the clinical presentation (ie, rash plus sore throat) is characteristic, but not diagnostic, of scarlet fever, the health care provider will prescribe a rapid streptococcal antigen test to confirm symptom etiology (Option C). Swabbing the posterior pharynx and tonsils provides test results within minutes. Throat culture may be necessary to verify results. (Option A) Dermatologic manifestations of an allergic reaction (eg, contact dermatitis) may necessitate allergy testing (eg, scratch or patch testing). However, the client's symptoms are characteristic of scarlet fever, not an allergic reaction. (Option B) A complete blood count may reveal elevated WBCs in the presence of any infection, but this is not diagnostic for streptococcal pharyngitis. (Option D) A skin biopsy involves removing skin and examining it under a microscope to detect certain dermatologic conditions (eg, infection, lupus) but is not anticipated because the client's symptoms are characteristic of scarlet fever. Educational objective: Scarlet fever (ie, scarlatina), a complication of group A streptococcal infection (eg, streptococcal pharyngitis), is characterized by a distinctive red rash. Diagnosis is based on clinical presentation, rapid streptococcal antigen testing, and possible throat culture.

Question 13

The nurse is reinforcing teaching to the parent of a child diagnosed with ringworm. Which statement by the parent indicates a need for further teaching?

Accepted Answer

Ringworm, or tinea corporis, is a fungal infection on the superficial keratin layers of the skin, hair, and/or nails. Ringworm is a misleading name as the condition is not caused by a worm infestation. However, it is highly contagious and spreads via contact. Management includes teaching appropriate hygiene (eg, washing hands after touching infected areas), limited contact with personal items (eg, hair brush), and treatment with the prescribed shampoos as well as topical and/or oral medications (eg, terbinafine [Lamisil], miconazole). (Option A) Antifungal cream (terbinafine [Lamisil]) is the preferred treatment and is applied to infected areas twice a day. It may take 1-4 weeks to complete treatment depending on infection severity. (Option B) Ringworm is spread via contact with shared surfaces (eg, bathroom floors, gymnasium mats, car seats), personal items, or pets. Important preventive measures include cleaning surfaces frequently, not sharing personal items, and practicing hand hygiene. (Option D) This is not a dangerous condition; however, the client will be uncomfortable due to itching. Efforts should be made to discourage scratching as this facilitates spread of infection. Educational objective: Ringworm is a fungal infection that spreads via contact with infected skin, shared surfaces, and personal items (eg, hair brushes). It is treated with antifungal shampoos, creams, and oral medications. Infection spread can be limited by practicing frequent hand hygiene, cleaning shared surfaces, and refraining from sharing personal items.

Question 14

An adolescent client with a sore throat is diagnosed with infectious mononucleosis. Which comment by the caregiver would alert the nurse that additional instruction is necessary?

Accepted Answer

11ecbb05_cad6_86d7_b433_195fe06f15c9_MD0009_00 Mononucleosis is caused by the Epstein-Barr virus. It is typically seen in adolescence from the sharing of drinks, kissing, or other direct exposure to saliva. Symptoms may include fatigue, fever, sore throat, splenomegaly, hepatomegaly, and swollen lymph nodes. Antibiotic treatment is inappropriate for a viral infection. Inadvertent intake of antibiotics (amoxicillin) can cause a rash. Treatment for mononucleosis is management of symptoms and includes hydration, rest, control of pain, and reducing fever as necessary. Sore throat is treated with saline gargles or anesthetic troches. Complications include airway obstruction (eg, stridor, difficult breathing) from swollen lymph nodes around the neck and severe abdominal pain (splenic rupture). These should be reported to the health care provider (HCP) immediately. (Option B) Ibuprofen or acetaminophen is appropriate treatment to control pain and manage fever in the child with mononucleosis. Aspirin should be avoided in children due to the risk of Reye syndrome. (Option C) Fatigue is a symptom of mononucleosis. Rest is very important in the care of a client with mononucleosis. (Option D) Mononucleosis may cause splenomegaly or hepatomegaly. Contact sports such as soccer should be avoided to prevent injury to the spleen or liver. Educational objective: Treatment for mononucleosis is largely symptomatic. It includes rest, hydration, pain control for sore throat, and fever reduction. Clients should avoid contact sports such as soccer to prevent injury to the spleen or liver. Breathing difficulty or abdominal pain should be reported to the HCP.

Question 15

The clinic nurse provides teaching for the parent of a child diagnosed with scabies. Which instructions should the nurse include in the teaching plan? Select all that apply.

Accepted Answer

11ecbb05_cad9_1ee8_b433_656f26e93cc0_MD0009_00 Scabies is a highly contagious skin infestation of the Sarcoptes scabiei mite. Scabies spreads easily via direct person-to-person contact (eg, skilled nursing facility, day care, prison). The pregnant female mite burrows into the outer skin layer to lay eggs and feces, leaving a superficial burrow track. Intense itching, especially at night, occurs due to the body's inflammatory response to the mite's eggs and feces. Treatment for scabies typically involves 1 or 2 applications of a scabicide cream (eg, 5% permethrin). For infants and children, permethrin should be massaged into all skin surfaces from the head to the feet, avoiding contact with the eyes (Option B). Even after effective treatment, itching often continues for several weeks. All persons in close contact with the client during the lengthy 30- to 60-day incubation period (time from infestation to symptom onset) should also seek treatment (Option A). To prevent reinfection, clothing and linens should be washed and dried on the hottest settings (Option E). (Options C and D) Discarding stuffed animals is not required. Nonwashable belongings can be sealed in plastic bags for ≥3 days because scabies mites can survive away from skin for only 2-3 days. Fumigation of living areas is not necessary. Educational objective: Scabies spreads easily through skin-to-skin contact. Clients with scabies and all persons in close contact should receive treatment with a scabicide cream applied to all skin surfaces. Potentially infested belongings should be washed and dried on the hottest settings or sealed in plastic bags for ≥3 days.

Question 16

The parent of an 11-month-old child calls the pediatric outpatient clinic and tells the nurse that the child was exposed to measles 2 days ago during a family trip to a theme park. What is the best response by the nurse?

Accepted Answer

The Centers for Disease Control and Prevention (CDC) recommends that the first dose of MMR vaccine be given to children between age 12-15 months to ensure optimal vaccine response. However, the vaccine is safe for children age <12 months; it could provide some protection or modify the clinical course of the disease if administered within 72 hours of the child's initial measles exposure. Immunoglobulin, if administered within 6 days of exposure, is also utilized as post-exposure prophylaxis. A child who receives the MMR vaccine prior to the first birthday will need to be revaccinated at age 12-15 months and again between age 4-6 years. (Option B) Because a fever is one of the first emerging signs of a measles infection, it would be appropriate to advise the parent to check the child's temperature. However, this is not the most important action. (Option C) This is not the most important instruction to give to the parent. After receiving the MMR vaccine, the child can be around other children. If the child does not receive the MMR vaccine, exposure to other children would not be advised. (Option D) Although fever and rash are 2 of the clinical signs of measles, the measles incubation period is 7-21 days. The clinical indicators of measles would not be seen only 2 days after exposure. Educational objective: As advised by the CDC, a child age <12 months can and should receive the MMR vaccine when there is an outbreak of measles and the child risks contracting the illness due to an exposure. The child will need to be revaccinated between age 12-15 months and between age 4-6 years.

Question 17

Which discharge teaching instructions should the nurse provide to the parents of a 2-year-old with group A streptococcal pharyngitis? Select all that apply.

Accepted Answer

Pharyngitis caused by group A β-hemolytic Streptococcus is a contagious bacterial throat infection that can lead to renal (glomerulonephritis) or cardiac complications (rheumatic fever) if not treated. Children may refuse to eat due to pain. A soft diet and cool liquids (ice chips) should be offered rather than solid foods (Option B). It is important to complete the full course of antibiotics to prevent reinfection and complications (Option A). Toothbrushes should be replaced 24 hours after starting antibiotics; the bristles can harbor the bacteria and reinfection may occur (Option D). Young children may have minor cold symptoms and still be infected. The health care provider should test siblings age <3. (Option C) Children with streptococcal pharyngitis may return to school or daycare after they have completed 24 hours of antibiotics and are afebrile. (Option E) Throat lozenges can be given to older children but are a choking hazard in younger children. Acetaminophen or ibuprofen (liquid preparations) should be given for pain. Educational objective: Pharyngitis caused by group A β-hemolytic Streptococcus is a bacterial throat infection that can cause renal or cardiac complications if not treated. It is important to discard the child's toothbrush 24 hours after starting antibiotics, test siblings age <3 years, and complete the full course of prescribed antibiotics.

Question 18

The parent of a 15-month-old calls the nurse and says that the child developed a rash and mild fever after receiving a routine measles, mumps, rubella, and varicella (MMRV) vaccine in the pediatric clinic 5 days ago. What is the best response by the nurse?

Accepted Answer

Some children have a mild reaction to the MMRV vaccine within 5-12 days after the first dose. Problems include low-grade fever, mild rash, swelling and erythema at the injection site, irritability, and restlessness. Although rare, fever after MMRV vaccination can lead to febrile seizures. Therefore, it is important for the nurse to determine the child's temperature to evaluate the risk for a febrile convulsion. It would also be important for the nurse to instruct the parent to monitor the child's temperature and administer acetaminophen for a fever above 102 F (38.9 C). Children with a history of seizures should be vaccinated with separate MMR and varicella vaccines instead of the combination MMRV vaccine. (Option A) This is not an appropriate intervention. The rash should disappear in 2-3 days. (Option B) The child seems to be experiencing a normal reaction to the vaccine; a clinic visit is not necessary. (Option C) Although this is an appropriate response, it is most important for the nurse to first determine the child's temperature and the extent of the fever. Educational objective: The normal MMRV vaccine reactions that occur within 5-12 days after vaccination include mild fever and rash, irritability and restlessness, and swelling and erythema at the injection site. Febrile seizure is a rare but more serious reaction to the vaccine.

Question 19

The nurse plans care for a child admitted with measles. Which of the following interventions will the nurse include in the plan of care? Select all that apply.

Accepted Answer

11ecbb05_cadb_de0a_b433_7709faf64727_MD0009_00 Measles (ie, rubeola) is a highly contagious viral illness that affects people of all ages. Measles spreads when infected individuals cough or sneeze, sending the virus through the air, where it remains suspended for up to 2 hours. Widespread vaccination with the measles, mumps, and rubella (MMR) vaccine, such as in the United States, has reduced measles incidence by 99%. However, an increase in international travel and unvaccinated children have caused a resurgence of the disease. For hospitalized clients with measles, the plan of care should include the following: Recommendation of postexposure prophylaxis (ie, MMR vaccine) for eligible, susceptible (eg, unvaccinated) family members within 72 hours of exposure to decrease the severity and duration of symptoms in case they contract the disease (Option A) Implementation of airborne precautions, including a negative-pressure isolation room and use of an N95 respirator mask, during contact with the client by health care staff (Options D and E) Administration of vitamin A supplements to prevent severe, measles-induced vitamin A deficiency, which can cause blindness, particularly in clients in low-resource areas (Option B) An erythematous, maculopapular, morbilliform rash is characteristic of measles, but it is not typically pruritic. Calamine lotion is effective for soothing pruritic rashes (eg, varicella [chickenpox]). (Option C) A tracheostomy tray is not required for this client with measles because respiratory paralysis or emergency intubation is not expected. Educational objective: Clients with measles are highly contagious and require airborne precautions (eg, negative-pressure isolation room, N95 respirator). Susceptible family members should receive postexposure prophylaxis (eg, measles, mumps, and rubella vaccine).

Question 20

The nurse is providing teaching for parents of a child diagnosed with fifth disease. Which statement by a parent indicates a need for further teaching?

Accepted Answer

11ecbb05_cadd_3d9c_b433_953926e481f1_MD0009_00 Fifth disease ("slapped face," or erythema infectiosum) is a viral illness caused by the human parvovirus and affects mainly school-age children. The virus spreads via respiratory secretions, and the period of communicability occurs before onset of symptoms. The child will have a distinctive red rash on the cheeks that gives the appearance of having been slapped. The rash spreads to the extremities and a maculopapular rash develops, which then progresses from the proximal to distal surfaces. The child may have general malaise and joint pain that are typically well controlled with nonsteroidal anti-inflammatory drugs such as ibuprofen. Affected children typically recover quickly, within 7-10 days. Once these children develop symptoms (eg, rash, joint pains), they are no longer infectious. Isolation is not usually required unless the child is hospitalized with aplastic crisis or immunocompromising condition. (Options A, C, and D) These statements indicate that parent teaching regarding fifth disease was effective. Educational objective: Children with fifth disease are communicable only prior to onset of symptoms (eg, rash, joint pains). The causative agent, human parvovirus, spreads via respiratory secretions. Fifth disease is self-limiting and short-lived; treatment is given to alleviate symptoms. Isolation is not usually required for a non-hospitalized child.

Exam 2: Child Health

The nurse has provided instructions about home care management for the parents of a child diagnosed with rotavirus infection. Which statements by the parents indicate that teaching has been effective? Select all that apply.

A nurse is caring for a 6-year-old client with tonsillitis. Which further assessment finding requires immediate intervention?

The nurse is reviewing discharge teaching with the parent of a child with acute myelogenous leukemia who was admitted with varicella-zoster virus. The client has multiple lesions that have not crusted. Which of the following instructions should the nurse include? Select all that apply.

A nurse is teaching the parent of a 6-year-old with a urinary tract infection (UTI) how to avoid repeat infections. Which statements by the parent indicate that the teaching has been effective? Select all that apply.

The emergency nurse is triaging four clients. Which client should the nurse assess first?

What is the priority when caring for a 6-month-old diagnosed with atopic dermatitis?

The most recent laboratory results for a 12-month-old who is HIV-positive show a CD4 lymphocyte count of 500/mm³ and a CD4 lymphocyte percentage of 10%. The nurse anticipates administering which immunizations? Select all that apply.

A 15-month-old begins to seize during assessment for a high-grade fever. What is the most appropriate nursing action?

The nurse plans care for a 3-year-old who was admitted with suspected pertussis infection. Which instructions will the nurse include in the plan of care? Select all that apply.

The clinic nurse cares for a 4-year-old who has been diagnosed with a pinworm infection. Which client symptom supports this diagnosis?

A nurse is giving instructions related to antibiotic eye drops to the parent of a 5-year-old with bacterial conjunctivitis. Which instruction is most important?

The clinic nurse assesses an 8-year-old client who reports a sore throat and has a bright red, pruritic rash on the chest that feels like fine bumps and looks like a sunburn. Which diagnostic tool does the nurse anticipate the health care provider will prescribe?

The nurse is reinforcing teaching to the parent of a child diagnosed with ringworm. Which statement by the parent indicates a need for further teaching?

An adolescent client with a sore throat is diagnosed with infectious mononucleosis. Which comment by the caregiver would alert the nurse that additional instruction is necessary?

The clinic nurse provides teaching for the parent of a child diagnosed with scabies. Which instructions should the nurse include in the teaching plan? Select all that apply.

The parent of an 11-month-old child calls the pediatric outpatient clinic and tells the nurse that the child was exposed to measles 2 days ago during a family trip to a theme park. What is the best response by the nurse?

Which discharge teaching instructions should the nurse provide to the parents of a 2-year-old with group A streptococcal pharyngitis? Select all that apply.

The parent of a 15-month-old calls the nurse and says that the child developed a rash and mild fever after receiving a routine measles, mumps, rubella, and varicella (MMRV) vaccine in the pediatric clinic 5 days ago. What is the best response by the nurse?

The nurse plans care for a child admitted with measles. Which of the following interventions will the nurse include in the plan of care? Select all that apply.

The nurse is providing teaching for parents of a child diagnosed with fifth disease. Which statement by a parent indicates a need for further teaching?