NCLEX-PN › Symptoms and Tests for Pediatric Conditions
A 3-day-old infant is diagnosed with hyperbilirubinemia. A bilirubin test is required by capillary heel puncture. The nurse does all of the following except __________.
squeezing the infants heel while collecting the sample
wiping away the first drop of blood
using an antiseptic wipe to cleanse the foot
applying heel warmers to increase capillary blood flow
turning off the bilirubin treatment lights before collecting the sample
Avoid squeezing the infant's heel if possible. Squeezing causes hemolysis of the specimen. Too much pressure may also result in damage to the tissue. Turning off the bilirubin treatment lights is also important because exposure to the light may alter the bilirubin in the sample. Cleansing the site of puncture is important, and warming the area will increase the capillary blood flow.
Parotid gland enlargement, fever, myalgia, and tender salivary glands would indicate which of the following conditions?
Mumps
Measles
Herpangina
Rubella
Parotid gland enlargement, fever, myalgia, and tender salivary glands are all indicative of infection with the mumps virus. Symptoms typically last for 7-10 days, though sequelae such as hearing damage and testicular disorders can be long-lasting or even permanent.
Strawberry tongue and maculopapular ("sandpaper") rash are commonly seen in what childhood exanthem?
Scarlet fever
Varicella
Impetigo
Roseola
Strawberry tongue (glossitis) and maculopapular ("sandpaper") rash are commonly seen in scarlet fever, a condition caused by group A Streptococcus bacteria, often after a bout of strep throat. The other exanthems listed can all cause erythematous rash, though none are associated with glossitis.
A mother brings her child in for paroxysmal bouts of 10-15 coughs followed by 1-2 deep gasping breaths. It started as a simple cold and cough, which seemed to be getting better before the gasping paroxysmal coughing started. The coughing is severe enough that he has vomited several times. What is the most likely diagnosis?
Pertussis
Croup
Pneumonia
Bronchitis
The most likely diagnosis in this case is pertussis, also known as whooping cough. This is caused by Bordetella pertussis, a gram-negative encapsulated coccobacillus. It begins as a seemingly normal upper respiratory infection, which progresses two weeks after onset into paroxysms of 5-15 violent coughs followed by a forceful inspiratory gasp, often described as a "whoop." Coughing is often forceful enough to induce vomiting, nosebleeds, or subconjunctival hemorrhage. Croup, pneumonia, and bronchitis are all conditions that include cough, though none of them will generally present with this degree of gasping, vomiting, or blood vessel damage due to cough.
A nurse working in labor and delivery is responsible to assessing a newborn according to the APGAR scale. The newborn infant is noted to have a vigorous good cry, a heart rate of 97, with good reflexes, and acrocyanosis.
What is the newborn's APGAR scale according to these findings?
8
7
6
9
3
The APGAR score is 8, the child has received a score of 2 under respiration for good cry, a score of 2 under cry reflex for vigorous crying, a score of 2 under reflexes for good reflexes, a score of 1 for heart rate of 97 (under 100 bpm), and and score of 1 for color for acrocyanosis (blue limbs, pink body).
You are the nurse taking care of a 19-year old patient at a primary care clinic who complains of fever, tonsillar exudates, tender anterior cervical lymph nodes, and a sore throat without a cough. How many of the Centor criteria for streptococcal pharyngitis does this patient exhibit?
Four
Three
Two
One
None of these
The correct answer is "4." This is correct because the patient exhibits four out of the four Centor criteria for streptococcal pharyngitis. The Centor criteria are as follows:
Tonsillar exudates
Lack of cough
Fever
Tender anterior cervical lymphadenopathy
The Centor criteria are used to generate a score based upon the patient's age and number of positive criteria. This score can then be used to assess the likelihood that the patient's condition is due to streptococcal pharyngitis, and therefore to guide the decision of whether or not to treat with antibiotics for streptococcal pharyngitis. In this patient's case, since they are older than 14 and younger than 45, they do not gain or lose points for their age. They get four points total for having all of the positive criteria. Therefore, it is highly likely that they are infected with streptococcal pharyngitis and should be treated empirically with antibiotics.
A school nurse is holding a question and answer meeting for parents following a recent outbreak of scarlet fever. Which of the following would the nurse confirm as false?
Scarlet fever is a viral infection
Children over two years of age are higher risk than children under two years of age
A rash develops secondary to toxin sensitivity
Scarlet fever is transmitted through the air
A child may or may not develop a rash after exposure
Scarlet fever is a bacterial infection caused by group A S_treptococcus_ that is transmitted through the air. Children who are sensitive to the bacterial toxin may develop a rash, although some will not. Infants and toddlers under the age of two are rarely seen with the disease.