Chapter 41: The Child with an Infectious Disease My Nursing Test Banks

Chapter 41: The Child with an Infectious Disease

Test Bank

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 to not be sexually active.

b.

I practice safe sex because I wash myself right after sex.

c.

I wont get any kind of STD because I take the pill.

d.

I only have sex if my boyfriend wears a condom.

ANS: A

Feedback

A

Abstinence is the only foolproof way to prevent an STD.

B

STDs are transmitted through body fluids (semen, vaginal fluids, blood). Perineal hygiene will not prevent an STD.

C

Oral contraceptives do not protect women from contracting STDs.

D

A condom can reduce but not eliminate an individuals chance of acquiring an STD.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1033

OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

2. Which STD should 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

Feedback

A

Manifestations of the human papillomavirus are anogenital warts that begin as small papules and grow into clustered lesions.

B

Bacterial vaginosis is characterized by a profuse, white, malodorous (fishy smelling) vaginal discharge that sticks to the vaginal walls.

C

Infections with Trichomonas are frequently asymptomatic. Symptoms in females may include dysuria, vaginal itching, burning, and a frothy, yellowish-green, foul-smelling discharge.

D

Many people with chlamydial infection have few or no symptoms. Urethritis with dysuria, urinary frequency, or mucopurulent discharge may indicate chlamydial infection.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1035

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

3. A child taking oral corticosteroids for asthma is exposed to varicella. The child has not had the varicella vaccine and has never had the disease. What intervention should be taken to prevent varicella from developing?

a.

No intervention is needed unless varicella develops.

b.

Administer the varicella vaccine as soon as possible.

c.

The child should begin a course of oral antibiotics.

d.

The child should be prescribed acyclovir.

ANS: D

Feedback

A

Children taking oral corticosteroids are immunosuppressed and are at high risk for serious complications. Intervention must be taken to prevent the disease when exposure occurs.

B

The varicella vaccine is a live virus vaccine and is contraindicated for an immunosuppressed child.

C

An antibiotic is not effective in treating varicella zoster, which is a virus.

D

For children receiving short-term corticosteroid treatment, acyclovir is often used in the treatment plan.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1020

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic 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 bodys 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

Feedback

A

Nutritional status is an indicator of overall health, but it is not the first line of defense in the innate immune system.

B

The first lines of defense in the innate immune system are the skin and intact mucous membranes.

C

Immunizations provide artificial immunity or resistance to harmful diseases.

D

Practicing good hygiene may reduce susceptibility to disease, but it is not a component of the innate immune system.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1008

OBJ: Nursing Process: Implementation MSC: Client Needs: 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

Feedback

A

Measles is not associated with congenital defects.

B

Most cases of roseola occur in children 6 to 18 months old.

C

The rubella virus can cross the placenta and infect the fetus, causing fetal anomalies.

D

HSV can be transmitted to the newborn infant during vaginal delivery, causing multisystem disease. It is not transmitted transplacentally to the fetus during gestation.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1015

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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

Feedback

A

Some immunizations are initiated at 2 months of age, but not the measles vaccine.

B

The first measles, mumps, rubella (MMR) vaccine is recommended routinely at 1 year of age.

C

The second dose of MMR is recommended at 4 to 6 years of age.

D

Children should receive their second MMR dose no later than 11 to 12 years of age.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1015

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

7. Which statement made by a parent indicates incorrect information about intervention for a childs fever?

a.

I should keep her covered lightly when she has a fever.

b.

Ill give her plenty of liquids to keep her hydrated.

c.

I can give her acetaminophen for a fever.

d.

Ill look for over-the-counter preparations that contain aspirin.

ANS: D

Feedback

A

Dressing the child in light clothing and using lightweight covers will help reduce fever and promote the childs comfort.

B

Adequate hydration will help maintain a normal body temperature.

C

Acetaminophen or ibuprofen should be used as directed for fever control.

D

Aspirin products are avoided because of the possibility of development of Reyes syndrome. The parent should check labels on all over-the-counter products to be sure they do not contain aspirin.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1017

OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

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

a.

Bulls-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

Feedback

A

The bulls-eye rash at the site of a tick bite is a manifestation of Lyme disease.

B

Varicella is manifested as lesions in various stages of developmentmacule, papule, then vesicle, first appearing on the trunk and scalp.

C

Roseola manifests as a maculopapular rash on the trunk that can last for hours or up to 2 days.

D

Fifth disease manifests with an intense, fiery red, edematous rash on the cheeks, which gives a slapped cheek appearance.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1016

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

9. 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; airborne and contact 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

Feedback

A

The childs skin lesions are characteristic of varicella. Varicella is transmitted through direct contact, droplets, and airborne particles. In the hospital setting, children with varicella should be placed in strict isolation, and on Contact and Airborne Precautions. The purpose is to prevent transmission of microorganisms by inhalation of small-particle droplet nuclei and to protect other patients and health care providers from acquiring this disease.

B

The childs skin lesions are characteristic of varicella. Additional measures must be instituted to protect other patients and staff who may be susceptible to the disease.

C

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.

D

The child appears to have varicella. Screening visitors for immunity to measles is irrelevant. It is important to screen visitors for immunity to varicella.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1020

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

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

a.

Dont worry; your baby will have maternal immunity to pertussis that will last until they are 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

Feedback

A

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.

B

Primary prevention of pertussis can be accomplished through administration of the pertussis vaccine.

C

Prompt evaluation by the primary care provider for respiratory illness will not prevent pertussis.

D

Erythromycin is used to treat pertussis. It will not prevent the disease.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1024

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

11. Which statement indicates that a father understands the treatment for his child who has scarlet fever?

a.

I can stop the medicine when my child 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 child can go back to school when she has been on the antibiotic for a week.

ANS: C

Feedback

A

The bacteria will not be eradicated if a partial course of antibiotics is given.

B

Treatment of scarlet fever does not include topical antibiotic cream.

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.

D

The child is no longer contagious after 24 hours of antibiotic therapy and can return to daycare or school.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1026

OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

12. What should be included in the care for a neonate who was diagnosed with pertussis?

a.

Monitoring hemoglobin level

b.

Hearing test before discharge

c.

Serial platelet counts

d.

Treatment of all close contacts with a prophylactic antibiotic

ANS: D

Feedback

A

Pertussis does not affect the hemoglobin level.

B

A complication of pertussis is not hearing impairment.

C

Pertussis does not affect platelets.

D

Erythromycin, azithromycin, or clarithromycin is given to all close contacts for the child diagnosed with pertussis.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1024

OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

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

a.

It is particularly important to protect the adolescents 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

Feedback

A

During the acute and recovery phases, activity restrictions, which include no contact sports or roughhousing, are implemented to protect the childs enlarged spleen from rupture.

B

The recovery process from infectious mononucleosis is a slow and gradual one.

C

Bed rest is indicated during the acute stage of the illness, usually lasting 2 to 4 weeks.

D

The recovery period is often lengthy and fatigue may continue, necessitating a gradual return to school activities.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1023

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

14. What should the nurse expect to observe in the prodromal phase of rubeola?

a.

Macular rash on the face

b.

Koplik spots

c.

Petechiae on the soft palate

d.

Crops of vesicles on the trunk

ANS: B

Feedback

A

The macular rash with rubeola appears after the prodromal stage.

B

Koplik spots appear approximately 2 days before the appearance of a rash.

C

Petechiae on the soft palate occur with rubella.

D

Crops of vesicles on the trunk are characteristic of varicella.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1009

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

15. What should be included in health teaching to prevent Lyme disease?

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

Feedback

A

Currently there is no vaccine available for Lyme disease. The Lyme disease vaccine had been approved for persons ages 15 to 70 years; however, was withdrawn from the market in 1992.

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.

C

Antibiotics are used to treat, not prevent, Lyme disease.

D

Children should be allowed to maintain normal growth and development with activities such as hiking.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1030 | Box 41-2

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

16. Which action is initiated when a child has been 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

Feedback

A

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.

B

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.

C

The rabies vaccine is given within 48 hours of exposure and again on days 3, 7, 14, and 28.

D

Human rabies immune globulin and the first dose of the rabies vaccine are given after exposure.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1023

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

MULTIPLE RESPONSE

1. A preschooler is diagnosed with helminthes. The childs mother is very upset and wants to know how her child could have contracted this illness. After obtaining a detailed history, the nurse identifies all possible transmission modes. Select all modes that apply.

a.

Playing in the backyard sandbox

b.

Not washing hands before eating

c.

Placing hands in the mouth and nail biting

d.

Skin-to-skin contact with other children

e.

Scratches from a neighborhood cat

ANS: A, B, C

Feedback

Correct

Common helminthes include roundworm, pinworm, tapeworm, and hookworm. Children are frequently infected as the result of frequent hand-mouth activity (unwashed hands, nail biting, not washing hands after using the toilet) and the likelihood of fecal contamination from sandboxes (especially if dogs and cats deposit fecal material in them). Other causes include not adequately washing fruits and vegetables before eating them and drinking contaminated water.

Incorrect

Skin-to-skin contact with other children and scratches from a cat are not transmission modes for helminthes.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1032 | Table 41-2

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

2. 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

Feedback

Correct

Vancomycin is used to treat MRSA along with mupirocin ointment to the nares. The patient is placed in contact isolation to prevent spread of the infection to other patients.

Incorrect

The infection is not transmitted by the airborne route so only contact isolation is required. This infection is resistant to cephalosporins.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1027

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

3. 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

Feedback

Correct

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.

Incorrect

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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1032

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

COMPLETION

1. It is late winter when a 7-year-old child reports to the school nurse with fever, headache, myalgia, and glandular swelling. After assessment the nurses preliminary diagnosis includes the viral infection most commonly known as ________.

ANS:

mumps

The classic indication of mumps is parotid glandular swelling, although a number of children will have no such swelling. This is often accompanied by fever. The parents should be notified and provided with educational information regarding care of the child with the mumps.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1021

OBJ: Nursing Process: Diagnosis MSC: Client Needs: Health Promotion and Maintenance

TRUE/FALSE

1. Human cytomegalovirus (CMV) infection is a common cause of congenital infection and is the leading cause of hearing loss and intellectual disability in the United States. The neonate may be infected during the prenatal, perinatal, or postnatal period. Only infections acquired in utero cause permanent infection. Is this statement true or false?

ANS: T

Approximately one third of women with primary CMV infection transmit the virus to the fetus. The prevalence is one in 150 live births. Only 10% of infected newborns go on to manifest symptoms. These include jaundice, lethargy, seizures, petechiae, respiratory distress, enlarged liver, and microcephaly.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1021

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

2. Clostridium difficile (C-difficile) is a gram-positive anaerobic bacteria known to cause diarrhea, abdominal cramps, and fever. The CDC has reported that children are at minimal risks as this infection affects primarily the elderly or patients who are immunocompromised. Is this statement true or false?

ANS: F

In 2005, the CDC reported an increase in the number of cases of Clostridium difficile in children who were previously thought to be at minimal risk. Children ages 1 to 4 are primarily affected.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1027

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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