Communicable Diseases Questions PDF

1. The pediatric nurse specialist provides an educational session to the nursing students about childhood communicable diseases, mumps. The pediatric nurse informs the students that which clinical manifestation is indicative of the most common complication of this communicable disease? 1. Pain 2. De...

1. The pediatric nurse specialist provides an educational session to the nursing students about childhood communicable diseases, mumps. The pediatric nurse informs the students that which clinical manifestation is indicative of the most common complication of this communicable disease? 1. Pain 2. Deafness 3. Nuchal rigidity 4. A red swollen testicle Answer: 3 Rationale: The most common complication of mumps is aseptic meningitis, with the virus being identified in the cerebrospinal fluid. Common signs include nuchal rigidity, lethargy, and vomiting. Muscular pain, parotid pain, or testicular pain may occur, but pain does not indicate a sign of a common complication. Although mumps is one of the leading causes of unilateral nerve deafness, it does not occur frequently. A red swollen testicle may be indicative of orchitis. Although this complication appears to cause most concern among parents, it is not the most common complication. Swollen and tender salivary glands under the ears on one or both sides of the head (parotitis) is the most common sign of the most common complication. Priority Nursing Tip: Transmission of mumps is via direct contact or droplet spread from an infected person. Test-Taking Strategy: Focus on the subject, mumps and the strategic word, most. Recalling that aseptic meningitis is the most common complication of mumps will direct you to the correct option. Review: mumps 2. The nurse provides home care instructions to the mother of a child with chickenpox about preventing the transmission of the virus. Which instruction should the nurse include? 1. Isolate the child until the skin vesicles have dried and crusted. 2. Ensure that the child uses a separate bathroom for elimination. 3. Bring all household members to the clinic immediately for a varicella vaccine. 4. Ask the health care provider for a prescription for antibiotics for all household members. Answer: 1 Rationale: Chickenpox is caused by the varicella-zoster virus. The communicable period is from 1 to 2 days before the onset of the rash to 6 days after the first crop of vesicles, when crusts have formed. Transmission occurs by direct contact with secretions from the vesicles or contaminated objects, and via respiratory tract secretions. It is not transmitted via urine or feces. The recommended preventative schedule for receiving the varicella vaccine is at 12 to 15 months of age (first dose) and 4 to 6 years of age (second dose). It is not administered at the time of exposure to the virus. Antibiotics are not used to treat a viral infection. Rather, they are used for treating bacterial infections. Priority Nursing Tip: The skin is the first line of defense against infec tion. Altered skin integrity can lead to a skin or systemic infection. Test-Taking Strategy: Focus on the subject, preventing the transmission of chickenpox. Eliminate option 4 first recalling that antibiotics are not used to treat a viral infection. Eliminate option 3 because of the word “immediately” in this option and recalling that recommended schedule for the administration of the varicella vaccine. Next, eliminate option 2 recalling the mode of transmission of the virus. Review: home care measures for the child with chickenpox. 3. An emergency department nurse is a member of an All-Hazards Disaster Preparedness planning group. The group is developing a specific emergency response plan in the event that a client with smallpox arrives in the emergency department. Which interventions should be included in the plan? Select all that apply. 1. Isolate the client. 2. Don protective equipment immediately. 3. Notify infectious disease specialists, public health officials, and the police. 4. Lock down the emergency department and the entire hospital immediately. 5. Identify all client contacts, including transport services to the emergency department and clients in the waiting room. 6. Administer smallpox vaccines to all hospital staff, client contacts, and clients sitting in the emergency department waiting room immediately. Answer: 1, 2, 3, 5 Rationale: An All-Hazards Disaster Preparedness group is a multi faceted internal and external disaster preparedness group that establishes action plans for every type of disaster or combination of disaster events. In the event of emergency department exposure to a communicable disease such as smallpox, the client would be isolated immediately and the staff would immediately don protective equipment. The emergency department would be locked down immediately. Locking down the entire hospital may not be necessary and infectious disease specialists and public health officials will determine whether it is necessary to take this action. Infectious disease specialists, public health officials, and the police are notified. All client contacts (name, addresses, telephone numbers), including transport services to the emergency department and clients in the waiting room, would be identified so that the public health department can follow through on notifying and treating these individuals appropriately. Although getting the vaccine within 3 days after exposure will help prevent the disease or make it less severe, it is unreasonable and unnecessary to administer smallpox vaccines to all hospital staff, client contacts, and clients sitting in the emergency department waiting room. Priority Nursing Tip: Smallpox is transmitted in air droplets and by handling contaminated materials and is highly contagious. Test-Taking Strategy: Focus on the subject, a client with smallpox in the emergency department. Next read each option carefully, noting that the client is in the emergency department. Eliminate option 4 because of the words entire hospital and option 6 because of the words all hospital staff. Review: disaster preparedness guidelines and small pox. 4. The nurse places a hospitalized client with active tuberculosis in a private, well-ventilated isolation room. In addition, which action should the nurse take before entering the client’s room? 1. Wash the hands. 2. Wash the hands and wear a gown and gloves. 3. Wash the hands and place a high-efficiency particulate air(HEPA)respirator over the nose and mouth. 4. The nurse needs no special precautions, but the client is instructed to cover his or her mouth and nose when coughing or sneezing. Answer: 3 Rationale: Tuberculosis is a highly communicable disease caused by Mycobacterium tuberculosis. The nurse wears a HEPA respirator when caring for a client with active tuberculosis. Hands are always thoroughly washed before and after caring for the client. Option 1 is an incomplete action. Option 2 is also inaccurate and incomplete. Gowning is only indicated when there is a possibility of contaminating clothing. Option 4 is an incorrect statement because special precautions are needed. Priority Nursing Tip: A positive Mantoux skin test reaction does not mean that active tuberculosis is present, but it does indicate previous exposure to tuberculosis or the presence of inactive (dormant) disease. Test-Taking Strategy: Focus on the subject, caring for the client with tuberculosis. Recalling the route of transmission and the need for airborne precautions will direct you to the correct option. Review: airborne precautions and tuberculosis. 5. A hospitalized child develops exanthema (rash) that covers the trunk and extremities. The nurse reviews the child’s health history and notes that the child was exposed to varicella 2 weeks ago. Which nursing intervention is most appropriate to implement? 1. Immediately admit the client to any available bed. 2. Place the child in a private room on strict isolation. 3. Assess the progression of the exanthema and report it to the health care provider. 4. Allow the child to play in the playroom until the health care provider can be contacted. Answer: 2 Rationale: The child with undiagnosed exanthema needs to be placed on strict isolation. Varicella causes a profuse rash on the trunk with a sparse rash on the extremities. The incubation period is 14 to 21 days. It is important to prevent the spread of this communicable disease by placing the child in isolation until further diagnosis and treatment are made. Options 1 and 4 are inaccurate, and option 3 is not the most appropriate intervention. Priority Nursing Tip: Varicella-zoster virus can be transmitted via direct contact, droplet(airborne) spread, or contaminated objects. Test-Taking Strategy: Noting the strategic words most appropriate and the subject, exposure to varicella will direct you to option 2. This action will prevent exposure of this communicable disease to others. Review: care of the child with varicella. 6. Which clients require contact precautions? Select all that apply. CLIENTS 1. A child with mumps 2. A client with scabies 3. A child with streptococcal pharyngitis 4. A client with pulmonary tuberculosis 5. A child with respiratory syncytial virus (RSV) 6. A client infected with a multidrug-resistant organism Answer: 2, 5, 6 Rationale: Contact precautions are initiated when disease transmission occurs from direct contact with the client or his or her environment. Diseases that require the use of contact precautions include colonization or infection with multidrug-resistant organisms, respiratory syncytial virus, shigella and other enteric pathogens, wound infections, herpes simplex, scabies, and disseminated varicella zoster. Clients with mumps or streptococcal pharyngitis require droplet precautions. A client with pulmonary tuberculosis requires airborne precautions. Priority Nursing Tip: Contact precautions require placing the client in a private room or with a cohort client. Test-Taking Strategy: Focus on the subject, clients who require contact precautions. Read each client diagnosis. Determining the mode of transmission for each illness will assist in answering this question correctly. Review: the modes of transmission for communicable diseases and the diseases that require contact precautions. 7. The nurse is caring for a client diagnosed with brain death who is a potential organ donor. Before approaching the family to discuss organ donation, the nurse reviews the client’s medical record for potential contraindications to organ donation. Which finding is a contraindication to organ donation? 1. Allergy to penicillin 2. Hepatitis B infection 3. Older than 20 years old 4. History of foreign travel Answer: 2 Rationale: A decedent who had a hepatitis B infection cannot donate organs because the organ recipient may contract the infection. Contraindications to organ donation do not include penicillin allergies or foreign travel. Although foreign travel increases the risk of contracting certain communicable diseases, foreign travel alone does not constitute a contraindication. Age may or may not be a contraindication depending on the organ involved. Priority Nursing Tip: An individual who is at least 18 years old may indicate a wish to become a donor on his or her driver’s license (state specific) or in an advance directive. Test-Taking Strategy: Focus on the subject, contraindications to organ donations. Noting the word infection in option 2 will direct you to this option. Review: the contraindications for organ donation. 8. A child is seen in the health care clinic, and testing for human immunodeficiency virus (HIV) is performed because of the child’s exposure to HIV infection. Which home care instruction should the nurse provide to the parents of the child? 1. Avoid sharing toothbrushes. 2. Avoid all immunizations until the diagnosis is established. 3. Wipe up any blood spills with a rag, and allow them to air dry. 4. Wash your hands with half-strength bleach if they come in contact with the child’s blood. Answer: 1 Rationale: Parents are instructed that toothbrushes are not to be shared. Immunizations must be kept up to date. Blood spills are wiped up with a paper towel; the area is then washed with soap and water, rinsed with bleach and water, and allowed to air dry. Hands are washed with soap and water if they come in contact with blood. Priority Nursing Tip: Human immunodeficiency virus (HIV) infects CD4 + T cells. A gradual decrease in the count occurs, and this results in a progressive immunodeficiency. The risk for opportunistic infections is present. Test-Taking Strategy: Note the subject, a child exposed to HIV infection. Eliminate option 2 first because of the closed-ended word “all.” Eliminate option 3 next on the basis of the knowledge that blood spills must be cleaned with a bleach solution. Eliminate option 4 because bleach would be irritating and caustic to the skin. Review: the home care instructions for the child exposed to human immunodeficiency virus (HIV) 9. A hospitalized client with active pulmonary tuberculosis has been receiving multidrug therapy for the past month and is being prepared for discharge. Which indicates that respiratory isolation is no longer required and that medication therapy has been effective? 1. Stools are clay colored. 2. The Mantoux test is negative. 3. Sputum cultures are negative. 4. Nausea and vomiting have stopped. Answer: 3 Rationale: The primary diagnostic tool for pulmonary tuberculosis is a sputum culture. A negative culture indicates the effectiveness of treatment. Nausea, vomiting, and clay-colored stools are side effects of the medication that is used to treat tuberculosis; their presence or absence does not measure the therapeutic effectiveness of the medication. The Mantoux test is a screening tool rather than a diagnostic test for tuberculosis. Because the Mantoux test indicates exposure to the organism but not active disease, the test results will remain positive. Priority Nursing Tip: Tuberculosis has an insidious onset and many clients are not aware of symptoms until the disease is well advanced. Test-Taking Strategy: Note the strategic word, effective. Remember that the absence of infectious organisms is a desired outcome in clients with communicable diseases. The sputum is the only diagnostic test that will determine the absence of infectious organisms. Review: pulmonary tuberculosis 10. The home care nurse visits a child with scarlet fever who is being treated with penicillin G potassium (Pfizerpen). The mother tells the nurse that the child has only voided a small amount of tea-colored urine since the previous day. The mother also reports that the child’s appetite has decreased and that the child’s face was swollen this morning. How should the nurse interpret these new symptoms? 1. Nothing to be concerned about 2. Signs/symptoms of acute glomerulonephritis 3. Signs/symptoms of the normal progression of scarlet fever 4. Symptoms of an allergic reaction to penicillin G potassium Answer: 2 Rationale: Scarlet fever is an infectious and communicable disease caused by group A beta- hemolytic streptococci. The symptoms identified in the question indicate acute glomerulonephritis, indicative of nephrotoxicity. These symptoms are not normal and should not be ignored. Although the child is receiving penicillin G potassium, these are not symptoms of an allergic reaction. Priority Nursing Tip: Scarlet fever is transmitted by direct contact with an infected person or droplet spread or indirectly by contact with contaminated articles or the ingestion of contaminated milk or other foods. Test-Taking Strategy: Eliminate options 1 and 3 because they are comparable or alike. From the remaining options, recalling the complications of scarlet fever and the symptoms of a medication reaction will direct you to the correct option. Review the complications of scarlet fever and the symptoms of acute glomerulonephritis. 11. A nursing instructor asks a nursing student to describe live or attenuated vaccines. What should the student tell the instructor about these types of vaccines? 1. Live or attenuated vaccines contain bacterial toxins that have been made inactive by either chemicals or heat. 2. Live or attenuated vaccines contain pathogens made inactive by either chemicals or heat. 3. Live or attenuated vaccines have their virulence (potency) diminished so as to not produce a full-blown clinical illness. 4. Live or attenuated vaccines have been obtained from the pooled blood of many people and provide antibodies to a variety of diseases. Answer: 3 Rationale: Live or attenuated vaccines have their virulence (potency) diminished so as to not produce a full-blown clinical illness. In response to vaccination, the body produces antibodies and causes immunity to be established. Option 1 identifies toxoids. Option 2 identifies killed or inactivated vaccines. Option 4 identifies human immune globulin. Priority Nursing Tip: An immunocompromised individual should not receive a vaccine without first consulting with the health care provider. Test-Taking Strategy: Focus on the subject, live or attenuated vaccines. Noting the word live in the question will assist you in eliminating options 1, 2, and 4. Review the different types of vaccines. 12. The nurse is performing an assessment on a 3-year-old child with chickenpox. The child’s mother tells the nurse that the child keeps scratching at night, and the nurse teaches the mother about measures that will prevent an alteration in skin integrity. Which statement by the mother indicates that teaching was effective? 1. “I need to place white gloves on my child’s hands at night.” 2. “I will apply generous amounts of a cortisone cream to prevent itching.” 3. “I will give my child a glass of warm milk at bedtime to help my child sleep.” 4. “I need to keep my child in a warm room at night so that the covers will not cause my child to scratch.” Answer: 1 Rationale: Gloves will keep the child from causing an alteration in skin integrity from scratching. Generous amounts of any topical cream can lead to medication toxicity. Warm milk will have no effect on itching. A warm room will increase the child’s skin temperature and make the itching worse. Priority Nursing Tip: Isolate high-risk children, such as children who have immunosuppressive disorders, from a child with a communicable disease. Test-Taking Strategy: Note the strategic word, effective. Note the subject preventing an alteration in skin integrity in a 3-year-old child with chickenpox. Eliminate option 4 first because this action will promote itching. Option 3 is eliminated next because it is unrelated to skin integrity. From the remaining options, the words generous amounts in option 2 should provide you with a clue that this option is incorrect. Review the measures related to the child with chickenpox. Reference(s): Hockenberry, Wilson (2013), p. 424. 13. A preschooler has just been diagnosed with impetigo. The child’s mother tells the nurse, “But my children take baths every day.” Which therapeutic response should the nurse make to the mother? 1. “You are concerned about how your child got impetigo?” 2. “There is no need to worry. We will not tell your day care provider why your child is absent.” 3. “Not only do you have to do a better job of keeping your children clean, you must also wash your hands more frequently.” 4. “You should have seen the doctor before the wound became infected, and then you would not have had to worry about the child having impetigo.” Answer: 1 Rationale: By paraphrasing what the parent tells the nurse, the nurse is addressing the parent’s thoughts. Option 1 demonstrates the therapeutic technique of paraphrasing. Options 2, 3, and 4 are blocks to communication because they make the parent feel guilty for the child’s illness. Priority Nursing Tip: A child with an integumentary disorder needs to be monitored for signs of a skin infection or a systemic infection. Test-Taking Strategy: Use therapeutic communication techniques to answer the question. Option 1 is the only therapeutic technique, and it demonstrates paraphrasing. This is the only option that will provide the client with an opportunity to verbalize her concerns. Options 2, 3, and 4 are blocks to communication. Review: therapeutic communication techniques and impetigo. 14. The nurse is planning care for a child with an infectious and communicable disease. The nurse should identify which as the primary goal? 1. The child will experience mild discomfort. 2. The public health department will be notified. 3. The child will not spread the infection to others. 4. The child will experience only minor complications. Answer: 3 Note the strategic word, primary. The primary goal for a child with an infectious and communicable disease is to prevent the spread of the infection to others. It is also important for the nurse to prevent discomfort as much as possible, but this is not the primary goal based on the options provided. Although the health department may need to be notified at some point, it is not the primary goal. The child should experience no complications. Review: goals of care for a child with an infectious and communicable disease. Nursing Process: Implementation 15. The nurse in the postpartum unit checks the temperature of a client who delivered a healthy newborn 4 hours ago. The mother’s temperature is 100.8 °F. The nurse provides oral hydration to the mother and encourages fluid intake. Four hours later, the nurse rechecks the temperature and notes that it is still 100.8 ° F. Which appropriate nursing action should the nurse take at this time? 1. Document the temperature. 2. Increase the intravenous fluids. 3. Notify the health care provider. 4. Continue hydration and recheck the temperature in 4 hours. Answer: 3 Focus on the subject, a temperature of 100.8 ° F in a postpartum client. In the postpartum client, a temperature of more than 100.4 ° F at two consecutive readings is considered febrile, and the health care provider should be notified. Options 1, 2, and 4 are inappropriate actions at this time. Although the nurse should document the temperature, this action delays necessary intervention. A health care provider’s prescription is needed to increase intravenous fluids. Continuing hydration and rechecking the temperature in 4 hours also delays necessary intervention. Review: normal postpartum assessment finding. 16. The nurse is planning discharge teaching for a client diagnosed and treated for tuberculosis (TB). Which instruction should be included in order to minimize the spread of TB? Select all that apply. 1. All used dishes should be sterilized. 2. Close contacts should be tested for TB. 3. Soiled tissues should be disposed of properly. 4. House isolation is required for at least 8 months. 5. The mouth should always be covered when coughing. Answer: 2, 3, 5 Rationale: Tuberculosis is a communicable disease, and the nurse must teach the client measures to prevent its spread. Any close contacts with the client must be tested and treated if the results of the screening test are positive. Because it is an airborne disease, the client must properly dispose of used tissues and needs to cover the mouth when coughing. There is no evidence to suggest that sterilizing dishes would break the chain of infection with pulmonary TB. It is not necessary for the client to isolate herself or himself to the house. Once the client is treated and results of three sputum cultures are negative, she or he will not spread the infection. Priority Nursing Tip: Multidrug resistant strains of tuberculosis can result from improper compliance, noncompliance with treatment programs, or development of mutations in tubercle bacillus; the nurse must include the importance of medication compliance when teaching the client with tuberculosis (TB). Test-Taking Strategy: Focus on the subject, minimizing the spread of tuberculosis. Also focusing on the pathophysiology of TB and the associated communicability factors and risks will assist you in answering correctly. Review: the home care principles related to tuberculosis (TB) and airborne disease transmission precautions. 17. The nurse caring for a child diagnosed with rubeola (measles) notes that the health care provider has documented the presence of Koplik’s spots. On the basis of this documentation, which observation is expected? 1. Pinpoint petechiae noted on both legs 2. Whitish vesicles located across the chest 3. Petechiae spots that are reddish and pinpoint on the soft palate 4. Small, blue-white spots with a red base found on the buccal mucosa Answer: 4 Rationale: In rubeola (measles), Koplik’s spots appear approximately 2 days before the appearance of the rash. These are small, blue-white spots with a red base that are found on the buccal mucosa. The spots last approximately 3 days, after which time they slough off. Options 1, 2, and 3 are incorrect. Priority Nursing Tip: Rubeola (measles) is transmitted via airborne particles, direct contact with infectious droplets, or transplacental contact. The nurse must implement airborne precautions when caring for the hospitalized client with rubeola. Test-Taking Strategy: Eliminate options 1 and 3 first because they are comparable or alike and address petechiae spots. Focusing on the subject of Koplik’s spots will direct you to the correct option. Review: the presentation of Koplik’s spots and rubeola (measles). 18. The nurse is performing an assessment of a child who is to receive a measles, mumps, and rubella (MMR) vaccine. The nurse notes that the child is allergic to eggs. Which intervention has priority? 1. Eliminating this vaccine from the immunization schedule 2. Administering epinephrine (Adrenalin) before the administration of the MMR 3. Administering diphenhydramine (Benadryl) and acetaminophen (Tylenol) before administering the MMR vaccine 4. Taking a careful history about the allergy and reporting this to the health care provider before administering the MMR vaccine Answer: 4 Rationale: Live measles vaccine is produced by chick embryo cell culture, so the possibility of an anaphylactic hypersensitivity in children with egg allergies should be considered. The nurse should take a thorough history of the allergy to a previous MMR and report this to the health care provider. If this is the first MMR, the health care provider should be aware of the egg sensitivity before administering the vaccine or any pre-injection medication. Priority Nursing Tip: Contraindications of the measles, mumps, and rubella (MMR) vaccine include severe allergic reaction to a previous dose or vaccine component (gelatin, neomycin, eggs), pregnancy, or known immunodeficiency. Test-Taking Strategy: Use the steps of the nursing process and the strategic word, priority, to direct you to option 4. Option 1 can be eliminated first because a vaccine would not be eliminated from the immunization schedule. Options 2 and 3 can be eliminated next, knowing that the use of medications before a vaccine is not normal procedure. Review: the procedures related to the administration of vaccines and the measles, mumps, and rubella (MMR) vaccine. 19. A mother of a child with mumps calls the health care clinic to tell the nurse that the child has been lethargic and vomiting. What instruction should the nurse give to the mother? 1. To continue to monitor the child 2. That lethargy and vomiting are normal manifestations of mumps 3. To bring the child to the clinic to be seen by the health care provider 4. That, as long as there is no fever, there is nothing to be concerned about Answer: 3 Rationale: Mumps generally affects the salivary glands, but it can also affect multiple organs. The most common complication is septic meningitis, with the virus being identified in the cerebrospinal fluid. Common signs include nuchal rigidity, lethargy, and vomiting. The child should be seen by the health care provider. Priority Nursing Tip: Inform the parents of a child with mumps that bed rest should be encouraged until the parotid swelling subsides. Test-Taking Strategy: Focus on the subject, a child with mumps who has been lethargic and vomiting. Recalling that meningitis is a complication of mumps will direct you to option 3. Review: the complications of mumps and the associated clinical manifestations. 20. A newborn infant receives the first dose of hepatitis B vaccine (Recombivax HB, Engerix-B) within 12 hours of birth. The nurse instructs the mother regarding the immunization schedule for this vaccine and should tell the mother that the second vaccine is administered at which time periods? 1. 3 years of age and then during the adolescent years 2. 8 months of age and then 1 year after the initial dose 3. 6 months of age and then 8 months after the initial dose 4. 1 to 2 months of age and then 6 months after the initial dose Answer: 4 Rationale: The vaccination schedule for an infant whose mother tests negative for hepatitis B consists of a series of 3 immunizations given at 0 months (birth), 1 to 2 months of age, and then 6 months after the initial dose. An infant whose mother tests positive receives hepatitis B immune globulin (HepaGam B) along with the first dose of the hepatitis vaccine within 12 hours of birth. Priority Nursing Tip: Immunization schedules must be followed. The nurse needs to document immunization administration on a vaccination card for parents to maintain a record of immunizations administered. Test-Taking Strategy: Focus on the subject, the hepatitis B vaccine schedule. Knowledge regarding the immunization schedule for hepatitis B vaccine is required to answer this question. Remember that the vaccination schedule consists of a series of three immunizations given at 0 months (birth), 1 to 2 months of age, and then 6 months after the initial dose. Review the hepatitis B vaccine schedule if you are unfamiliar with it. 21. A child is brought to the emergency department after being bitten in the arm by a neighborhood dog. The nurse performs a focused assessment, cleanses the wound as prescribed, and continues to perform a thorough assessment on the child. Which is the priority question for the nurse to ask the mother of the child? 1. “How old is the dog?” 2. “Did the dog have rabies?” 3. “Are the child’s immunizations up-to-date?” 4. “Did the dog have all of its recommended shots?” Answer: 3 Rationale: When a bite occurs, the injury site of the bite should be cleansed carefully and the child should be given tetanus prophylaxis if immunizations are not up-to-date. Option 3 is the priority consideration. Options 1, 2, and 4 identify information that may have to be obtained, but are not the priority questions. Additionally the mother may not have the answers to these questions. Priority Nursing Tip: Always obtain an immunization history from the parent when the child is brought to the emergency department. Test-Taking Strategy: Note the strategic word, priority. Option 3 is the only option that focuses on the needs of the child. Review: care of a child who receives a dog bite. 22. The parents of a child with mumps express concern that their child will develop orchitis as a result of having mumps and ask the nurse about the signs of this complication. What should the nurse tell the parents is a sign of this complication? 1. Fever 2. Facial swelling 3. Swollen glands 4. Difficulty urinating Answer: 1 Rationale: Unilateral orchitis occurs more frequently than bilateral orchitis. About 1 week after the appearance of parotitis, there is an abrupt onset of testicular pain, tenderness, fever, chills, headache, and vomiting. The affected testicle becomes red, swollen, and tender. Atrophy, resulting in sterility, occurs only in a small number of cases. Facial swelling and swollen glands normally occur in mumps. Difficulty urinating is not a sign of this complication. Priority Nursing Tip: Warmth and local support with snug, fitting underpants can be used to relieve orchitis. Test-Taking Strategy: Focus on the subject, orchitis. Eliminate options 2 and 3 first because they are comparable or alike. Recalling that “-itis" indicates inflammation will direct you to option 1. Review: the characteristics of orchitis. 22. The clinic nurse provides home care instructions to an adult client diagnosed with influenza. Which instructions should the nurse provide to the client? Select all that apply. 1. Practice frequent hand washing. 2. Remain at home until feeling better. 3. Sneeze or cough into the upper sleeve. 4. Return in 1 week for an influenza vaccine.  5. Take acetaminophen (Tylenol) for myalgia. 6. Completely isolate self in a room from other family members and use a separate bathroom until feeling better. Answer: 1, 2, 3, 5 Rationale: Influenza (commonly known as the flu) refers to an acute viral infection of the respiratory tract. It is a communicable disease spread by droplet infection, and measures are instituted to prevent its spread. The client is instructed to practice frequent handwashing, remain at home, and cover the nose and mouth when sneezing and coughing. Supportive measures to relieve fever and myalgia such as the use of acetaminophen are also encouraged. It is unrealistic to completely isolate oneself in a room from other family members, and there is no useful reason to use a separate bathroom because the infection is spread through droplets. Influenza immunization is administered before the start of the “flu” season, not after developing the infection. Priority Nursing Tip: For controlling the spread of influenza, the client is taught to sneeze or cough into the upper sleeve on the arm rather than into the hand. Respiratory droplets on the hands can contaminate surfaces and cause transmission to other people. Test-Taking Strategy: Focus on the subject, the client’s diagnosis, influenza. Recalling that this infection is spread by droplets will assist you in selecting the correct instructions. Also remember that the influenza immunization is administered before the start of the “flu” season, not after developing the infection. Review: home care measures for treating influenza. Malcolm is newly assigned as a triage nurse, on his first day of work, the following clients arrive at the ED. Which among the clients require the most rapid action to protect other clients in the ED from infection? A. An infant with a runny nose and whose older brother has pertussis. B. A travel blogger who needs tuberculosis testing after exposure to a person with TB during his trip. C. An elderly woman who has a history of a methicillin-resistant Staphylococcus aureus (MRSA) leg wound infection. D. A pregnant woman with a blister-like rash on the face and is possibly having varicella. Correct Answer: D. A pregnant woman with a blister-like rash on the face and is possibly having varicella.  Option D: Chickenpox (Varicella) is transmitted by airborne and can be easily transferred to the other clients in the emergency unit. The pregnant woman with the rash should be isolated right away from other clients through placement in a negative- pressure room.  Options A and C: Droplet and contact precautions should be instituted for the clients with pertussis and MRSA infection, but this can be done after isolating the client with possible varicella.  Option B: The client who has been exposed to TB does not place the other clients at risk for infection because there are no symptoms of active TB. 24. Nurse Kelly is teaching the parents of a young child how to handle poisoning. If the child ingests poison, what should the parents do first? 1. Call an ambulance immediately  2. Administer ipecac syrup 3. Punish the child for being bad 4. Call the poison control center Correct Answer: D. Call the poison control center  Option D: Before interviewing in any way, the parents should call the poison control center for specific directions to avoid death or permanent disability associated with ingestion of poisonous substances.  Option A: The parents may have to call an ambulance after calling the poison control center.  Option B: Ipecac syrup is no longer used and recommended by the poison control center.  Option C: Punishment for being bad isn’t appropriate because the parents are responsible for making the environment safe. 25. While working in a pediatric clinic, you receive a telephone call from the parent of a 10-year-old who is receiving chemotherapy for leukemia. The client’s sibling has chickenpox. Which of these actions will you anticipate taking next? 1. Administer varicella-zoster immune globulin to the client 2. Educate the parent about the correct use of acyclovir (Zovirax) 3. Prepare the client for admission to a private room in the hospital 4. Teach the parents regarding contact and airborne precaution Correct Answer: A. Administer varicella-zoster immune globulin to the client  Option A: Varicella-zoster immune globulin administration can prevent the development of chickenpox in high-risk clients and will typically be prescribed.  Options B and C: Hospitalization and acyclovir therapy may be required if the child develops a varicella-zoster virus infection.  Option D: Contact and airborne precautions will be implemented to prevent the spread of infection to other children if the child develops varicella. 5.