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Flashcards in Final Exam Chapter 14 Deck (38):
1

1. Which is described as the time interval between infection or exposure to disease and appearance of initial symptoms?

a.

Incubation period

b.

Prodromal period

c.

Desquamation period

d.

Period of communicability

ANS: A

The incubation period is the interval between infection or exposure and appearance of symptoms. The prodromal period is the interval between the time when early manifestations of disease appear and the overt clinical syndrome is evident. Desquamation refers to the shedding of skin. The period of communicability is the time or times during which an infectious agent may be transferred directly or indirectly from an infected person to another person.

2

2. Airborne isolation is required for a child who is hospitalized with:

a.

mumps.

b.

chickenpox.

c.

exanthema subitum (roseola).

d.

erythema infectiosum (fifth disease).

ANS: B

Chickenpox is communicable through direct contact, droplet spread, and contaminated objects. Mumps is transmitted from direct contact with saliva of infected person and is most communicable before onset of swelling. The transmission and source of the viral infection exanthema subitum (roseola) is unknown. Erythema infectiosum (fifth disease) is communicable before onset of symptoms.

3

3. Acyclovir (Zovirax) is given to children with chickenpox to:

a.

minimize scarring.

b.

decrease the number of lesions.

c.

prevent aplastic anemia.

d.

prevent spread of the disease.

ANS: B

Acyclovir decreases the number of lesions; shortens duration of fever; and decreases itching, lethargy, and anorexia. Treating pruritus and discouraging itching minimizes scarring. Aplastic anemia is not a complication of chickenpox. Strict isolation until vesicles are dried prevents spread of disease.

4

4. The single parent of a 3-year-old child who has just been diagnosed with chickenpox tells the nurse that she cannot afford to stay home with the child and miss work. The parent asks the nurse if some medication will shorten the course of the illness. Which is the most appropriate nursing intervention?

a.

Reassure the parent that it is not necessary to stay home with the child.

b.

Explain that no medication will shorten the course of the illness.

c.

Explain the advantages of the medication acyclovir (Zovirax) to treat chickenpox.

d.

Explain the advantages of the medication VCZ immune globulin (VariZIG) to treat chickenpox.

ANS: C

Acyclovir is effective in treating the number of lesions; shortening the duration of fever; and decreasing itching, lethargy, and anorexia. It is important the parent stay with the child to monitor fever. Acyclovir lessens the severity of chickenpox. VariZIG is given only to high-risk children.

5

5. Which may be given to high-risk children after exposure to chickenpox to prevent varicella?

a.

Acyclovir (Zovirax)

b.

Varicella globulin

c.

Diphenhydramine hydrochloride (Benadryl)

d.

VCZ immune globulin (VariZIG)

ANS: D

VariZIG is given to high-risk children to prevent the development of chickenpox. Acyclovir decreases the severity, not the development, of chickenpox. Varicella globulin is not effective because it is not the immune globulin. Diphenhydramine may help pruritus but not the actual chickenpox.

6

6. Vitamin A supplementation may be recommended for the young child who has which disease?

a.

Mumps

b.

Rubella

c.

Measles (rubeola)

d.

Erythema infectiosum

ANS: C

Evidence shows vitamin A decreases morbidity and mortality in measles. Mumps is treated with analgesics for pain and antipyretics for fever. Rubella is treated similarly to mumps. Erythema infectiosum is treated similarly to mumps and rubella.

7

7. A nurse is teaching parents about caring for their child with chickenpox. The nurse should let the parents know that the child is considered to be no longer contagious when which occurs?

a.

When fever is absent

b.

When lesions are crusted

c.

24 hours after lesions erupt

d.

8 days after onset of illness

ANS: B

When the lesions are crusted, the chickenpox is no longer contagious. This may be a week after onset of disease. Chickenpox is still contagious when child has fever. Children are contagious after lesions erupt. If lesions are crusted at 8 days, the child is no longer contagious.

8

8. A nurse is assessing a child and notes Koplik spots. In which of these communicable diseases are Koplik spots present?

a.

Rubella

b.

Measles (rubeola)

c.

Chickenpox (varicella)

d.

Exanthema subitum (roseola)

ANS: B

Koplik spots are small irregular red spots with a minute, bluish white center found on the buccal mucosa 2 days before systemic rash. Rubella occurs with rash on the face, which rapidly spreads downward. Varicella appears with highly pruritic macules, followed by papules and vesicles. Roseola is seen with rose-pink macules on the trunk, spreading to face and extremities.

9

9. Which is a common childhood communicable disease that may cause severe defects in the fetus when it occurs in its congenital form?

a.

Erythema infectiosum

b.

Roseola

c.

Rubeola

d.

Rubella

ANS: D

Rubella causes teratogenic effects on the fetus. There is a low risk of fetal death to those in contact with children affected with fifth disease. Roseola and rubeola are not dangerous to the fetus.

10

10. Which is the causative agent of scarlet fever?

a.

Enteroviruses

b.

Corynebacterium organisms

c.

Scarlet fever virus

d.

Group A β-hemolytic streptococci (GABHS)

ANS: D

GABHS infection causes scarlet fever. Enteroviruses do not cause the same complications. Corynebacterium organisms cause diphtheria. Scarlet fever is not caused by a virus.

11

11. A parent reports to the nurse that her child has inflamed conjunctivae of both eyes with purulent drainage and crusting of the eyelids, especially on awakening. These manifestations suggest:

a.

viral conjunctivitis.

b.

allergic conjunctivitis.

c.

bacterial conjunctivitis.

d.

conjunctivitis caused by foreign body.

ANS: C

Bacterial conjunctivitis has these symptoms. Viral or allergic conjunctivitis has watery drainage. Foreign body causes tearing and pain, and usually only one eye is affected.

12

12. Which is an important nursing consideration when caring for a child with herpetic gingivostomatitis (HGS)?

a.

Apply topical anesthetics before eating.

b.

Drink from a cup, not a straw.

c.

Wait to brush teeth until lesions are sufficiently healed.

d.

Explain to parents how this is sexually transmitted.

ANS: A

Treatment for HGS is aimed at relief of pain. Drinking bland fluids through a straw helps avoid painful lesions. Mouth care is encouraged with a soft toothbrush. HGS is usually caused by herpes simplex virus type 1, which is not associated with sexual transmission.

13

13. A parent has asked the nurse about how her child can be tested for pinworms. The nurse responds by stating that which is the most common test for diagnosing pinworms in a child?

a.

Lower gastrointestinal (GI) series

b.

Three stool specimens, at intervals of 4 days

c.

Observation for presence of worms after child defecates

d.

Laboratory examination of a fecal smear

ANS: D

Laboratory examination of substances containing the worm, its larvae, or ova can identify the organism. Most are identified by examining fecal smears from the stools of persons suspected of harboring the parasite. Fresh specimens are best for revealing parasites or larvae. Lower GI series is not helpful for diagnosing enterobiasis. Stool specimens are not necessary to diagnose pinworms. Worms will not be visible after child defecates.

14

14. The nurse suspects that a child has ingested some type of poison. Which clinical manifestation would be most suggestive that the poison was a corrosive product?

a.

Tinnitus

b.

Disorientation

c.

Stupor, lethargy, coma

d.

Edema of lips, tongue, pharynx

ANS: D

Edema of lips, tongue, and pharynx indicates a corrosive ingestion. Tinnitus is indicative of aspirin ingestion. Corrosives do not act on the central nervous system (CNS).

15

15. A young boy is found squirting lighter fluid into his mouth. His father calls the emergency department. The nurse taking the call should know that the primary danger is which result?

a.

Hepatic dysfunction

b.

Dehydration secondary to vomiting

c.

Esophageal stricture and shock

d.

Bronchitis and chemical pneumonia

ANS: D

Lighter fluid is a hydrocarbon. The immediate danger is aspiration. Acetaminophen overdose, not hydrocarbons, causes hepatic dysfunction. Dehydration is not the primary danger. Esophageal stricture is a late or chronic issue of hydrocarbon ingestion.

16

16. Which is a clinical manifestation of acetaminophen poisoning?

a.

Hyperpyrexia

b.

Hepatic involvement

c.

Severe burning pain in stomach

d.

Drooling and inability to clear secretions

ANS: B

Hepatic involvement is the third stage of acetaminophen poisoning. Hyperpyrexia is a severe elevation in body temperature and is not related to acetaminophen poisoning. Acetaminophen does not cause burning pain in stomach or pose an airway threat.

17

17. Acute salicylate (ASA, aspirin) poisoning results in:

a.

chemical pneumonitis.

b.

hepatic damage.

c.

retractions and grunting.

d.

disorientation and loss of consciousness.

ANS: D

ASA poisoning causes disorientation and loss of consciousness. Chemical pneumonitis is caused by hydrocarbon ingestion. Hepatic damage is caused by acetaminophen overdose. ASA does not cause airway obstruction.

18

18. A young child has just arrived at the emergency department after ingestion of aspirin at home. The practitioner has ordered activated charcoal. The nurse administers charcoal in which way?

a.

Administer through a nasogastric tube because the child will not drink it because of the taste.

b.

Serve in a clear plastic cup so the child can see how much has been drunk.

c.

Give half of the solution, and then give the other half in 1 hour.

d.

Serve in an opaque container with a straw.

ANS: D

Although the activated charcoal can be mixed with a flavorful beverage, it will be black and resemble mud. When it is served in an opaque container, the child does not have any preconceived ideas about its being distasteful. The nasogastric tube should be used only in children without a gag reflex. The ability to see the charcoal solution may affect the child’s desire to drink it. The child should be encouraged to drink the solution all at once.

19

19. Which is the most frequent source of acute childhood lead poisoning?

a.

Folk remedies

b.

Unglazed pottery

c.

Lead-based paint

d.

Cigarette butts and ashes

ANS: C

Lead-based paint in houses built before 1978 is the most frequent source of lead poisoning. Some folk remedies and unglazed pottery may contain lead, but they are not the most frequent source. Cigarette butts and ashes do not contain lead.

20

20. Chelation therapy for lead poisoning is initiated when a child’s blood level is _____ g/dl.

a.

10 to 14

b.

15 to 19

c.

20 to 44

d.

>45

ANS: D

Chelation therapy is initiated if the child’s blood level is greater than 45 g/dl. At 10 to 14 g/dl, the family should have lead-poisoning education and follow-up level. At 15 to 19 g/dl, the family should have lead-poisoning education and follow-up level but if it persists, initiate environmental investigation. At 20 to 44 g/dl environmental investigation and lead hazard control are necessary.

21

21. Which describes a child who is abused by the parent(s)?

a.

Unintentionally contributes to the abusing situation

b.

Belongs to a low socioeconomic population

c.

Is healthier than the nonabused siblings

d.

Abuses siblings in the same way as child is abused by the parent(s)

ANS: A

Child’s temperament, position in the family, additional physical needs, activity level, or degree of sensitivity to parental needs unintentionally contribute to the abusing situation. Abuse occurs among all socioeconomic levels. Children who are ill or have additional physical needs are more likely to be abused. The abused child may not abuse siblings.

22

22. Which is a common characteristic of those who sexually abuse children?

a.

Pressure victim into secrecy

b.

Are usually unemployed and unmarried

c.

Are unknown to victims and victims’ families

d.

Have many victims that are each abused once only

ANS: A

Sex offenders may pressure the victim into secrecy regarding the activity as a “secret between us” that other people may take away if they find out. The offender may be anyone, including family members and persons from any level of society. Sex offenders are usually trusted acquaintances of the victims and victims’ families. Many victims are abused many times over a long period.

23

23. A 3-month-old infant dies shortly after arrival to the emergency department. The infant has subdural and retinal hemorrhages but no external signs of trauma. The nurse should suspect:

a.

unintentional injury.

b.

shaken-baby syndrome.

c.

sudden infant death syndrome (SIDS).

d.

congenital neurologic problem.

ANS: B

Shaken-baby syndrome causes internal bleeding but may have no external signs. Unintentional injury would not cause these injuries. SIDS and congenital neurologic problems would not appear this way.

24

24. Which is probably the most important criterion on which to base the decision to report suspected child abuse?

a.

Inappropriate parental concern for the degree of injury

b.

Absence of parents for questioning about child’s injuries

c.

Inappropriate response of child

d.

Incompatibility between the history and injury observed

ANS: D

Conflicting stories about the “accident” are the most indicative red flags of abuse. Inappropriate response of caregiver or child may be present, but is subjective. Parents should be questioned at some point during the investigation.

25

25. A nurse is admitting a child to the hospital with a diagnosis of giardiasis. Which medication should the nurse expect to be prescribed?

a.

Metronidazole (Flagyl)

b.

Amoxicillin clavulanate (Augmentin)

c.

Clarithromycin (Biaxin)

d.

Prednisone (Orapred)

ANS: A

The drugs of choice for treatment of giardiasis are metronidazole (Flagyl), tinidazole (Tindamax), and nitazoxanide (Alinia). These are classified as antifungals. Amoxicillin and clarithromycin are antibiotics that treat bacterial infections. Prednisone is a steroid and is used as an anti-inflammatory medication.

26

26. A nurse is beginning chelation therapy on a child for lead poisoning. Which intervention should the nurse implement during the time the child is receiving chelation therapy?

a.

Calorie counts

b.

Strict intake and output

c.

Telemetry monitoring

d.

Contact isolation

ANS: B

Because calcium disodium edetate (EDTA) and lead are toxic to the kidneys, a nurse should keep strict records of intake and output to monitor renal functioning. Adequate hydration is essential during therapy because the chelates are excreted via the kidneys. Calorie counts, telemetry, or contact isolation would not be nursing interventions appropriate for a child undergoing chelation therapy.

27

27. A child has been admitted to the emergency department with an acetaminophen (Tylenol) poisoning. An antidote is being prescribed by the health care provider. Which antidote should the nurse prepare to administer?

a.

Naloxone (Narcan)

b.

N-acetylcysteine (Mucomyst)

c.

Flumazenil (Romazicon)

d.

Digoxin immune Fab (Digibind)

ANS: B

Antidotes available to treat toxin ingestion include N-acetylcysteine for acetaminophen poisoning, naloxone for opioid overdose, flumazenil (Romazicon) for benzodiazepines (diazepam [Valium], midazolam [Versed]) overdose, and digoxin immune Fab (Digibind) for digoxin toxicity.

28

1. A nurse is teaching parents methods to reduce lead levels in their home. Which should the nurse include in the teaching? (Select all that apply.)

a.

Plant bushes around the outside of the house.

b.

Ensure your child eats frequent meals.

c.

Use hot water from the tap when boiling vegetables.

d.

Food can be stored in ceramic in the refrigerator.

e.

Ensure that your child’s diet contains sufficient iron and calcium.

ANS: A, B, E

Methods to reduce lead levels in homes include: planting bushes around the outside of the house, if soil is contaminated with lead, so children cannot play there; ensuring that children eat regular meals because more lead is absorbed on an empty stomach; and ensuring that children’s diets contain sufficient iron and calcium. Cold water should only be used for drinking, cooking, and reconstituting powder infant formula. Hot water dissolves lead more quickly than cold water and thus contains higher levels of lead. Do not use pottery or ceramic ware that was inadequately fired or is meant for decorative use for food storage or service.

29

What is described as the time interval between early manifestations of a disease and the overt clinical syndrome?
a. Incubation period
b. Prodromal period
c. Desquamation period
d. Period of communicability

ANS: B
The prodromal period is defined as the symptoms that occur between early manifestations of the disease and overt clinical symptoms.
The incubation period is the time from exposure to the appearance of the first symptom.
The desquamation period refers to the shedding of skin when applicable for a syndrome or disorder.
The period of communicability describes the period when the child is infectious.

30

The nurse is concerned with the prevention of communicable disease. Primary prevention results from
a. Immunizations
b. Early diagnosis
c. Strict isolation
d. Treatment of disease

ANS: A
Communicable diseases are prevented through immunizations, which constitute primary prevention.
Early diagnosis can prevent the spread of communicable disease by initiating treatment and isolation if necessary; this would be considered secondary prevention.
Strict isolation would be considered part of the treatment regimen and would constitute tertiary prevention, which is the prevention of complications or sequelae.
Treatment of disease would not prevent communicable disease

31

The school nurse is concerned about an outbreak of chickenpox because two children at the school have cancer and are immunodeficient from chemotherapy. The most appropriate recommendation by the school nurse is that
a. no precautions necessary.
b. Acyclovir (Zovirax) should be taken to minimize the symptoms of chickenpox.
c. Varicella–zoster immune globulin (VZIG) to prevent chickenpox.
d. temporarily stopping chemotherapy will allow the immune system to recover.

ANS: C
VZIG is an antibody to the virus that causes chickenpox. Administration of VZIG can prevent development of the disease in immunocompromised children secondary to chemotherapy.
Chickenpox can be a life-threatening event for a child who is immunocompromised and must be addressed.
Acyclovir is effective in reducing the number of lesions from chickenpox, but in immunodeficient children the disease itself should be prevented.
The administration of VZIG does not place the child at any greater risk; therefore, there is no need to stop chemotherapy.

32

The most appropriate comfort intervention for a child with itching related to chickenpox is
a. encourage frequent warm baths.
b. give aspirin or acetaminophen (Tylenol).
c. apply thick coat of pramoxine (Caladryl) lotion over open lesions.
d. give an antipruritic medication such as diphenhydramine (Benadryl).

ANS: D
Antipruritic medicines such as diphenhydramine are useful for severe itching, which interferes with sleep and may contribute to secondary infection.
Cool baths, not warm ones, are recommended for relief of itching secondary to chickenpox.
Neither drug provides antipruritic effects, nor should aspirin ever be given to children with chickenpox, because there is an increased risk of developing Reye syndrome.
Caladryl lotion, which contains diphenhydramine, should be applied sparingly, not in thick coats, over open lesions to minimize absorption.

33

What is the causative agent for erythema infectiosum (fifth disease)?
a. Paramyxovirus Incorrect
b. Human parvovirus B19
c. Human herpesvirus type 6
d. Group A β-hemolytic streptococcus

ANS: B
Human parvovirus B19 is the causative agent of fifth disease.
Paramyxovirus causes mumps.
Human herpesvirus types 1 and 2 are the major causes of herpetic infections in humans.
Group A β-hemolytic streptococcus is the causative agent for scarlet fever.

34

An important nursing intervention in the care of a child with bacterial conjunctivitis is
a. intermittent warm, moist compresses to remove crusts on the eye area.
b. oral antihistamines to minimize itching.
c. continuous warm compresses to relieve discomfort.
d. application of optic corticosteroids to reduce inflammation.

ANS: A
The eye should be kept clean. Intermittent warm, moist compresses can soften the crusting for easier removal, maintaining the cleanliness of the eye.
Antihistamines are not usually necessary for bacterial conjunctivitis.
Continuous warm compresses would promote bacterial growth.
Antibiotics are the treatment of choice for bacterial infections; optic corticosteroids are not warranted.

35

The nurse is assessing a child with herpetic gingivostomatitis. The nurse wears gloves when examining the lesions. This nursing action is
a. unnecessary because the virus is sexually transmitted.
b. unnecessary because the virus is not easily spread.
c. necessary only if the nurse touches his or her own mouth after touching the child's mouth.
d. necessary because virus can easily enter breaks in the skin.

ANS: D
HSV easily enters breaks in the skin and can cause herpetic whitlow on the fingers.
Herpetic gingivostomatitis is usually caused by herpes simplex virus (HSV) 1. HSV 2 is usually transmitted through sexual activity.
Gloves are always necessary because the virus is easily spread.
Gloves are always necessary because the virus is easily spread

36

Which statement best represents infectious mononucleosis?
a. Human herpesvirus type 2 is the principal cause.
b. Herpes-like Epstein-Barr virus is the principal cause.
c. Diagnosis is established by a complete blood count, which reveals a characteristic leukopenia.
d. Diagnosis is established by clinical manifestations because diagnostic tests cannot confirm the diagnosis.

ANS: B
Herpes-like Epstein-Barr virus accounts for most cases of mononucleosis.
Herpes-like Epstein-Barr virus is the principal cause of mononucleosis.
A complete blood count in an adolescent with mononucleosis would indicate a lymphocytic leukocytosis with atypical lymphs, not leukopenia.
The monospot test is a highly specific test for mononucleosis.

37

Which statement is correct about young children who report sexual abuse by one of their parents?
a. They may exhibit various behavioral manifestations.
b. In most cases, the child has fabricated the story.
c. Their stories are not believed unless other evidence is apparent.
d. They should be able to retell the story the same way to another person.

ANS: A
There is no diagnostic profile of the child who is being sexually abused. Many different behavioral manifestations may be exhibited, from outward sexual behaviors with others to withdrawal and introversion.
It is never appropriate to assume that a child has fabricated the story of sexual abuse. Adults are reluctant to believe children, and sexual abuse often goes unreported.
Physical examination is normal in approximately 80% of abused children.
The child will usually try to protect their parents and may accept responsibility for the act.

38

A child is brought to the emergency department after falling down the basement stairs. On assessment, what findings may cause the nurse to suspect child abuse? (Select all that apply.)
a. The child’s bruises are located only on the right arm and leg.
b. The child is brought to the emergency department by an unrelated adult.
c. The child has a history of a broken arm last year from falling off a swing.Incorrect
d. The child’s caregiver is anxious that the child get immediate medical attention.
e. The child has red, green, and yellow bruises on more than one plane of the body.

ANS: B,E A child brought to a healthcare provider for a trauma or suspicious injury by an unrelated adult or if the primary care provider is totally unavailable is a warning sign of abuse. Varying degrees of healing of bruises in more than one plane of the body is a warning of abuse. Falling down stairs can be an unintentional injury. A child with an isolated documented injury is not a warning sign of abuse. Multiple fractures of differing ages are a warning sign of abuse. An anxious caregiver is a normal response for an injured child. A delay in seeking care is a warning sign of abuse.