Silvestri Chapter 38 Ed#562

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 038 (edited file)—"Communicable Diseases and Acquired Immunodeficiency Syndrome" 10/14/08, Page 1 of 10, 0 Figure(s), 0 Table(s), 7 Box(es)

38: Communicable Diseases and Acquired Immunodeficiency Syndrome PRACTICE QUESTIONS 1. A child with rubeola (measles) is being admitted to the hospital. In preparing for the admission of the child, the nurse plans to institute which precaution for this child? 1. Contact 2. Enteric 3. Respiratory 4. Protective Answer: 3 Rationale: Rubeola is transmitted via airborne particles or direct contact with infectious droplets. Respiratory precautions are required and a mask is worn by those in contact with the child. Gowns and gloves are not indicated. Articles that are contaminated should be bagged and labeled. Options 1, 2, and 4 are not indicated in rubeola. Test-Taking Strategy: Use the process of elimination. Recalling that rubeola is transmitted via the airborne route will direct you to option 3. Review the route of transmission and therapeutic management of rubeola if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Planning Content Area: Child Health References: McKinney, E., James, S., Murray, S., & Ashwill, J. (2005). Maternal-child nursing (2nd ed.). St. Louis: Elsevier, p. 1020. Wong, D., & Hockenberry, M. (2003). Nursing care of infants and children (7th ed.). St. Louis: Mosby, p. 655. 2. Several children have contracted rubeola (measles) in a local school and the school nurse conducts a teaching session for the mothers of the schoolchildren. Which statement made by a mother indicates a need for further teaching regarding this communicable disease? 1. “Respiratory symptoms such as a very runny nose, cough, and fever occur before the development of a rash.” 2. “Small blue-white spots with a red base may appear in the mouth.” 3. “The rash usually begins behind the ears and spreads downward toward the feet.” 4. “The communicable period ranges from 10 days before the onset of symptoms to 15 days after the rash appears.” Answer: 4 Rationale: The communicable period for rubeola ranges from 4 days before to 5 days after the rash appears, mainly during the prodromal (catarrhal) stage. Options 1, 2, and 3 are accurate descriptions of rubeola. The small blue-white spots found in this communicable disease are called Koplik spots. Option 4, the incorrect option, describes the incubation period for rubella, not rubeola.

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Test-Taking Strategy: Note the key words, need for further teaching. These words indicate a false response question and that you need to select the incorrect client statement. Remember that the communicable period for rubeola ranges from 4 days before to 5 days after the rash appears. Review the clinical manifestations associated with rubeola if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Child Health Reference: Price, D., & Gwin, J. (2005). Thompson’s pediatric nursing (9th ed.). Philadelphia: W.B. Saunders, p. 254. 3. A mother of a 15-month-old child brings the child to the clinic and reports that the child has a fever and has developed a rash on the neck and trunk. Roseola is diagnosed, and the mother is concerned that her other children will contract the disease. The nurse provides which instruction to the mother regarding prevention of transmission of the disease? 1. The disease is transmitted through the urine and feces, so the other children should use a separate bathroom. 2. Disease transmission is unknown. 3. The disease is transmitted through the respiratory tract, so the child should be isolated from the other children as much as possible. 4. The disease is transmitted by contact with body fluids, so any items contaminated with body fluids need to discarded in a separate receptacle. Answer: 2 Rationale: The method of transmission of roseola is unknown. Options 1, 3, and 4 are not correct transmission routes of roseola. Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 4 first because they are similar. From the remaining options, recall that the method of transmission of roseola is unknown. Review the characteristics of roseola if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Child Health Reference: Price, D., & Gwin, J. (2005). Thompson’s pediatric nursing (9th ed.). Philadelphia: W.B. Saunders, p. 254. 4. The nurse provides instructions regarding respiratory precautions to the mother of a child with mumps. The mother asks the nurse about the length of time required for the respiratory precautions. The nurse tells the mother that: 1. Respiratory isolation in not necessary. 2. Mumps is not transmitted by the respiratory system. 3. Respiratory precautions are indicated during the period of communicability. 4. Respiratory precautions are indicated for 18 days following the onset of parotid swelling. Answer: 3 Rationale: Mumps is transmitted via direct contact or droplet spread from an infected person and

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 038 (edited file)—"Communicable Diseases and Acquired Immunodeficiency Syndrome" 10/14/08, Page 3 of 10, 0 Figure(s), 0 Table(s), 7 Box(es)

possibly by contact with urine. Respiratory precautions are indicated during the period of communicability. Options 1, 2, and 4 are incorrect. Test-Taking Strategy: Use the process of elimination. Options 1 and 2 can be eliminated first because they are similar. From the remaining options, select option 3, because it is the umbrella (global option), and addresses communicability. Also, the time frame indicated in option 4 seems rather lengthy. Review the infectious period related to mumps if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Teaching/Learning Content Area: Child Health Reference: Price, D., & Gwin, J. (2005). Thompson’s pediatric nursing (9th ed.). Philadelphia: W.B. Saunders, p. 255. Wong, D., & Hockenberry, M. (2003). Nursing care of infants and children (7th ed.). St. Louis: Mosby, p. 657. 5. The mother brings her 6-year-old child to the clinic because the child has developed a rash on the trunk and on the scalp. The mother reports that the child has had a low-grade fever, has not felt like eating, and has been generally tired. The child is diagnosed with chickenpox, and the mother inquires about the communicable period associated with chickenpox. The nurse plans to base the response on which of the following? 1. The communicable period is unknown. 2. The communicable period is 1 to 2 days before the onset of the rash to 6 days after the onset and crusting of lesions. 3. The communicable period is 10 days before the onset of symptoms to 15 days after the rash appears. 4. The communicable period ranges from 2 weeks or less up to several months. Answer: 2 Rationale: The communicable period for chickenpox is 1 to 2 days before the onset of the rash to 6 days after the onset and crusting of lesions. In roseola, the communicable period is unknown. Option 3 describes rubella. Option 4 describes diphtheria. Test-Taking Strategy: Use the process of elimination. Option 1 can be easily eliminated first. Eliminate options 3 and 4 next because the time frames in these two options seem rather lengthy and are similar. If you had difficulty with this question, review the communicable period for chickenpox. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Teaching/Learning Content Area: Child Health Reference: Price, D., & Gwin, J. (2005). Thompson’s pediatric nursing (9th ed.). Philadelphia: W.B. Saunders, p. 250. 6. The nurse reinforces home care instructions to the parents of a child hospitalized with pertussis who is in the convalescent stage and is being prepared for discharge. Which statement by the parents indicates a need for further instructions?

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 038 (edited file)—"Communicable Diseases and Acquired Immunodeficiency Syndrome" 10/14/08, Page 4 of 10, 0 Figure(s), 0 Table(s), 7 Box(es)

1. “We need to maintain respiratory precautions and a quiet environment for at least 2 weeks.” 2. “Coughing spells may be triggered by dust or smoke.” 3. “We need to encourage an adequate fluid intake.” 4. “Good hand washing techniques must be instituted to prevent spreading the disease to others.” Answer: 1 Rationale: Pertussis is transmitted by direct contact or respiratory droplets from coughing. The communicable period occurs primarily during the catarrhal stage. Respiratory precautions are not required during the convalescent phase. Options 2, 3, and 4 are components of home care instructions. Test-Taking Strategy: Note the key words, convalescent and need for further instructions. These words indicate a false response question and that you need to select the incorrect statement. Options 3 and 4 can be easily eliminated because they are general interventions associated with convalescence. Knowing that coughing spells are associated with pertussis will assist in directing you to option 1 from the remaining options. Additionally, a 2-week period of respiratory precautions is not required. If you had difficulty with this question, review home care instructions for the child with pertussis. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Child Health Reference: Leifer, G. (2003). Introduction to maternity and pediatric nursing (4th ed.). Philadelphia: W.B. Saunders, p. 744. 7. A 6-month-old infant receives a DTaP (diphtheria, tetanus, and acellular pertussis) immunization at the well-baby clinic. The mother returns home and calls the clinic to report that the infant has developed swelling and redness at the site of injection. The nurse tells the mother to: 1. Leave the injection site alone because this always occurs 2. Bring the infant back to the clinic 3. Apply an ice pack to the injection site 4. Monitor the infant for a fever Answer: 3 Rationale: Occasionally, tenderness, redness, or swelling may occur at the site of the injection. This can be relieved with ice packs for the first 24 hours, followed by warm compresses if the inflammation persists. It is not necessary to bring the infant back to the clinic. Option 4 may be an appropriate intervention but is not specific to the issue of the question. Test-Taking Strategy: Use the process of elimination. Eliminate option 1 first because of the absolute word “always.” Option 4 can be eliminated next because it does not relate specifically to the issue of the question, and then eliminate option 2 as an unnecessary intervention. Review interventions following immunizations and injections if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Implementation Content Area: Child Health

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Reference: Wong, D., & Hockenberry, M. (2003). Nursing care of infants and children (7th ed.). St. Louis: Mosby, pp. 534-535. 8. A child is diagnosed with scarlet fever. The nurse collects data on the child, knowing that which of the following is a clinical manifestation associated with this disease? 1. Pastia’s sign 2. Foul smelling mucopurulent nasal drainage 3. Gray membrane on the tonsils and pharynx 4. Abdominal pain and flaccid paralysis Answer: 1 Rationale: Pastia’s sign describes a rash seen in scarlet fever that will blanch with pressure, except in areas of deep creases and the folds of joints. The tongue is initially coated with a white furry covering with red projecting papillae (white strawberry tongue). By the fourth to fifth day, the white strawberry tongue sloughs off, leaving a red swollen tongue (strawberry tongue). The pharynx is edematous and beefy red in color. Options 2 and 3 are characteristics of diphtheria. Option 4 is associated with poliomyelitis. Test-Taking Strategy: Focus on the issue, the clinical manifestation associated with scarlet fever. Remember that Pastia’s sign describes the rash noted in scarlet fever. Review the clinical manifestations associated with scarlet fever if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Child Health Reference: Leifer, G. (2003). Introduction to maternity and pediatric nursing (4th ed.). Philadelphia: W.B. Saunders, p. 746. 9. A child is diagnosed with infectious mononucleosis, and the nurse reinforces home care instructions to the parents about the care of the child. The nurse tells the parents to: 1. Maintain the child on bed rest for 2 weeks. 2. Maintain respiratory precautions for 1 week. 3. Notify the physician if the child develops a fever. 4. Notify the physician if the child develops abdominal pain or left shoulder pain occurs. Answer: 4 Rationale: The parents need to be instructed to notify the physician if abdominal pain, especially in the left upper quadrant, or left shoulder pain occurs, because this may indicate splenic rupture. Children with enlarged spleens are also instructed to avoid contact sports until splenomegaly resolves. Bed rest is not necessary, and children usually self-limit their activity. Respiratory precautions are not required, although transmission can occur via direct intimate contact or contact with infected blood. Fever is treated with acetaminophen (Tylenol). Test-Taking Strategy: Use the process of elimination and knowledge regarding the organs affected in mononucleosis. Options 1 and 2 can be eliminated first because they are unnecessary interventions in this disease. From the remaining options, knowledge that splenic rupture is a concern will direct you to option 4. Review the complications associated with mononucleosis if you had difficulty with this question. Level of Cognitive Ability: Application

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Client Needs: Physiological Integrity Integrated Process: Teaching/Learning Content Area: Child Health Reference: Price, D., & Gwin, J. (2005). Thompson’s pediatric nursing (9th ed.). Philadelphia: W.B. Saunders, p. 325. 10. The mother of a preschooler who attends day care calls the nurse and tells the nurse that the child is constantly itching the perianal area and that the area is irritated. The nurse suspects the possibility of pinworm infection (enterobiasis). The nurse instructs the mother to obtain a rectal specimen by the tape test and to obtain the specimen: 1. When the child is put to bed 2. After toileting 3. After bathing 4. In the morning when the child awakens Answer: 4 Rationale: Diagnosis is confirmed by direct visualization of the worms. Parents can view the sleeping child’s anus with a flashlight. The worm is white, thin, about ½-inch long, and moves. A simple technique, the tape test, is used to capture worms and eggs. Transparent tape is lightly touched to the anus and then applied to a slide for examination. The best specimens are obtained as the child awakens, before toileting or bathing. Test-Taking Strategy: Use the process of elimination. Thinking about the test and the purpose of the test (to obtain a specimen that contains worms and eggs) will direct you to option 4. Review the procedure for this test if you are unfamiliar with it. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Child Health Reference: Price, D., & Gwin, J. (2005). Thompson’s pediatric nursing (9th ed.). Philadelphia: W.B. Saunders, p. 192. 11. A nursing student is assigned to help administer immunizations to children in a clinic. The nursing instructor asks the student about the contraindications to receiving an immunization. The student responds correctly by telling the instructor that a contraindication for receiving an immunization is if a child has: 1. A cold 2. Otitis media 3. Mild diarrhea 4. A severe febrile illness Answer: 4 Rationale: A severe febrile illness is a reason to delay immunization, but only until the child has recovered from the acute stage of the illness. Minor illnesses such as a cold, otitis media, or mild diarrhea are not contraindications to immunization. Test-Taking Strategy: Use the process of elimination focusing on the issue of the question, a contraindication to receiving an immunization. Noting the word “severe” in option 4 will direct you to this option. If you had difficulty with this question, review the contraindications

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 038 (edited file)—"Communicable Diseases and Acquired Immunodeficiency Syndrome" 10/14/08, Page 7 of 10, 0 Figure(s), 0 Table(s), 7 Box(es)

associated with immunizations. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Teaching/Learning Content Area: Child Health Reference: Price, D., & Gwin, J. (2005). Thompson’s pediatric nursing (9th ed.). Philadelphia: W.B. Saunders, p. 122. 12. A mother with human immunodeficiency virus (HIV) infection brings her 10-month-old infant to the clinic for a routine checkup. The physician has documented that the infant is asymptomatic for HIV infection. After the checkup, the mother tells the nurse that she is so pleased that the infant will not get HIV. The nurse makes which response to the mother? 1. "I am so pleased also that everything has turned out fine." 2. "Everything looks great, but be sure that you return with your infant next month for the scheduled visit." 3. "Most children infected with HIV develop symptoms within the first 9 months of life, and some become symptomatic some time before the age of 3 years." 4. "Since symptoms have not developed, it is unlikely that the infant will develop HIV infection." Answer: 3 Rationale: Most children infected with HIV develop symptoms within the first 9 months of life. The remainder of these infected children become symptomatic sometime before the age of 3 years. Children, with their immature immune systems, have a much shorter incubation period than adults. Options 1, 2, and 4 are incorrect. Test-Taking Strategy: Use the process of elimination. Eliminate options 1, 2, and 4 because they are similar in content. Option 3 is the only option that provides specific and accurate data regarding HIV infection in the infant. Review assessment findings associated with HIV infection if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Child Health Reference: James, S., Ashwill, J., & Droske, S. (2002). Nursing care of children: Principles and practice (2nd ed.). Philadelphia; W.B. Saunders, p. 488. 13. The clinic nurse prepares to administer an MMR (measles, mumps, rubella) vaccine to a 5year-old child. The nurse administers this vaccine: 1. Intramuscularly in the anterolateral aspect of the thigh 2. Intramuscularly in the deltoid muscle 3. Subcutaneously in the outer aspect of the upper arm 4. Subcutaneously in the gluteal muscle Answer: 3 Rationale: MMR vaccine is administered subcutaneously in the outer aspect of the upper arm. The gluteal muscle is most often used for intramuscular injections. MMR vaccine is not administered by the intramuscular route.

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 038 (edited file)—"Communicable Diseases and Acquired Immunodeficiency Syndrome" 10/14/08, Page 8 of 10, 0 Figure(s), 0 Table(s), 7 Box(es)

Test-Taking Strategy: Use the process of elimination. Recalling that MMR vaccine is administered subcutaneously will assist in eliminating options 1 and 2. From the remaining options, recalling that the gluteal muscle is most often used for intramuscular injections will assist in directing you to option 3. Review the procedures related to the administration of MMR vaccine if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Child Health Reference: Price, D., & Gwin, J. (2005). Thompson’s pediatric nursing (9th ed.). Philadelphia: W.B. Saunders, p. 123. 14. A child is scheduled to receive an MMR (measles, mumps, rubella) vaccine. The nurse preparing to administer the vaccine reviews the child’s record and questions the order if which of the following is documented in the child’s record? 1. A local reaction at the site of a previous MMR vaccine injection 2. A history of an anaphylactoid reaction to neomycin 3. A history of frequent respiratory infections 4. Recent recovery from a cold Answer: 2 Rationale: MMR vaccine contains minute amounts of neomycin. A history of an anaphylactoid reaction to neomycin is considered a contraindication to the MMR vaccine. The general contraindication to all immunizations is a severe febrile illness. The presence of minor illnesses such as a common cold is not a contraindication. Additionally, a history of frequent respiratory infections is not a contraindication to receiving a vaccine. A local reaction to an immunization is treated with ice packs for the first 24 hours after injection, followed by warm compresses if the inflammation persists. Test-Taking Strategy: Use the process of elimination. Recalling that a general contraindication to all immunizations is a severe febrile illness will assist in eliminating options 3 and 4. From the remaining options, note that option 1 identifies a local reaction. This will direct you to option 2, the systemic reaction, and a potential life-threatening condition. Review the contraindications to receiving immunizations if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Child Health Reference: Schulte, E. Price, D., & Gwin, J. (2001). Thompson’s pediatric nursing (8th ed.). Philadelphia: W.B. Saunders, pp. 386-387. 15. A mother brings her 4-month-old infant to the well baby clinic for immunizations. The nurse would prepare to administer which of the following immunizations to this infant? 1. DTaP (diphtheria, tetanus, acellular pertussis), MMR (measles, mumps, rubella), IPV (inactivated poliovirus vaccine) 2. MMR, Hib (Haemophilus influenzae type b), DTaP 3. DTaP, Hib, IPV

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 038 (edited file)—"Communicable Diseases and Acquired Immunodeficiency Syndrome" 10/14/08, Page 9 of 10, 0 Figure(s), 0 Table(s), 7 Box(es)

4. Varicella and hepatitis B vaccines Answer: 3 Rationale: DTaP, Hib, IPV are administered at 4 months of age. DTaP is administered at 2 months, 4 months, 6 months, between 12 and 18 months, and between 4 and 6 years of age. Hib is administered at 2 months, 4 months, 6 months, and between 12 and 15 months of age. IPV is administered at 2 months, 4 months, 6 months, and between 4 to 6 years of age. The first dose of MMR is administered between 12 and 15 months of age; the second dose is administered at 4 to 6 years of age (if the second dose was not given by 4 to 6 years of age, it should be given at the next visit). The first dose of hepatitis B vaccine is administered between the birth and 2 months, the second dose is administered between 1 and 4 months, and the third dose is administered between 6 and 18 months of age. Varicella zoster vaccine is administered between 12 and 18 months of age. Test-Taking Strategy: Knowledge regarding the immunization schedule for infants and children is required to answer this question. Noting the age of the infant in the question will assist in directing you to option 3. Learn the immunization schedule if you are unfamiliar with it. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Planning Content Area: Child Health References: Centers for Disease Control and Prevention. (2005). Recommended childhood and adolescent immunization schedule. Atlanta: CDC. Retrieved April 29, 2005, from http://www.cdc.gov/nip. 16. Select the home care instructions that the nurse would provide to the mother of a child with acquired immunodeficiency syndrome (AIDS). ____Frequent hand washing is important. ____Fever, malaise, fatigue, weight loss, vomiting and diarrhea are expected to occur and do not require special intervention. ____The child should avoid exposure to other illnesses. ____The child’s immunization schedule will need revision. ____Kissing the child on the mouth will never transmit the virus. ____Clean up body fluid spills with bleach solution (10:1 ratio of water to bleach). Answers: Frequent hand washing is important. The child should avoid exposure to other illnesses. Clean up body fluid spills with bleach solution (10:1 ratio of water to bleach). Rationale: AIDS is a disorder caused by the human immunodeficiency virus (HIV) and is characterized by a generalized dysfunction of the immune system. Both cellular and humoral immunity are compromised. Horizontal transmission of HIV occurs through intimate sexual contact or parenteral exposure to blood or body fluids containing visible blood. Vertical (perinatal) transmission occurs when an HIV-infected pregnant woman passes the infection to her infant. Home care instructions include the following: frequent hand washing; monitoring for fever, malaise, fatigue, weight loss, vomiting and diarrhea, altered activity level, and oral lesions, and notifying the physician if these occur; monitoring for signs and symptoms of opportunistic infections; administering antiretroviral medications as prescribed; avoiding exposure to other

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 038 (edited file)—"Communicable Diseases and Acquired Immunodeficiency Syndrome" 10/14/08, Page 10 of 10, 0 Figure(s), 0 Table(s), 7 Box(es)

illnesses; keeping immunizations up to date; avoiding kissing the child on the mouth; monitoring weight and providing a high-calorie and high-protein diet; and washing eating utensils in the dishwasher and avoiding sharing of eating utensils. Gloves are worn for care, especially when in contact with body fluids and changing diapers (diapers are changed frequently and away from food areas) and soiled disposable diapers are folded inward, tabbed, and disposed of in a tightly covered plastic-lined container. Any body fluid spills are cleaned with a bleach solution (10:1 ratio of water to bleach). Test-Taking Strategy: Focus on the issue, care of the child with AIDS. Recalling that this disorder is characterized by a generalized dysfunction of the immune system and recalling the modes of transmission of the virus will assist in selecting the home care instructions. Review these instructions if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Teaching/Learning Content Area: Child Health Reference: James, S., Ashwill, J., & Droske, S. (2002). Nursing care of children: Principles and practice (2nd ed.). Philadelphia; W.B. Saunders, p. 489.