Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is admitting a child who has pertussis. Which of the following isolation precautions should the nurse initiate?
A. Droplet
Droplet:Pertussis is primarily transmitted through respiratory droplets when an infected person coughs or sneezes. Droplet precautions involve placing the child in a private room or with another child with the same infection. Healthcare workers should wear a mask or respirator when entering the room to protect against droplet transmission.
B. Contact
Contact:Contact precautions are used for infections that can be spread by direct or indirect contact with the patient or their environment. Pertussis is not typically spread through contact with contaminated surfaces or objects.
C. Airborne
Airborne: Airborne precautions are used for infections that are transmitted through small droplet nuclei that remain in the air for long periods. Pertussis is primarily transmitted through larger respiratory droplets rather than tiny airborne particles.
D. Protective environment
Protective environment:Protective environment precautions are used for patients who have weakened immune systems, such as those undergoing bone marrow transplants. These precautions are not applicable for a child with pertussis.
This question is an excerpt from Nurse Dive's nursing test bank - Ati Nursing Care Of Children Proctored Exam. Take the full exam now
Full Explanation
A. Droplet:
Pertussis is primarily transmitted through respiratory droplets when an infected person coughs or sneezes. Droplet precautions involve placing the child in a private room or with another child with the same infection. Healthcare workers should wear a mask or respirator when entering the room to protect against droplet transmission.
B. Contact:
Contact precautions are used for infections that can be spread by direct or indirect contact with the patient or their environment. Pertussis is not typically spread through contact with contaminated surfaces or objects.
C. Airborne:
Airborne precautions are used for infections that are transmitted through small droplet nuclei that remain in the air for long periods. Pertussis is primarily transmitted through larger respiratory droplets rather than tiny airborne particles.
D. Protective environment:
Protective environment precautions are used for patients who have weakened immune systems, such as those undergoing bone marrow transplants. These precautions are not applicable for a child with pertussis.
Similar Questions
A nurse is providing teaching to the parent of an infant about car seat safety. Which of the following statements by the parent indicate an understanding of the teaching?
A. "I should place the shoulder harness above the level of my baby's shoulders."
"I should place the shoulder harness above the level of my baby's shoulders."This statement is incorrect. Placing the shoulder harness above the baby's shoulders could lead to improper restraint in the event of a crash. The harness should be positioned at or slightly below the level of the baby's shoulders to provide effective protection.
B. "I should place the car seat rear-facing until my baby is 2 years old."
"I should place the car seat rear-facing until my baby is 2 years old."This statement is correct. The American Academy of Pediatrics recommends that infants and toddlers ride in a rear-facing car seat until they are at least 2 years old or until they reach the maximum height and weight limit specified by the car seat manufacturer. This position provides optimal protection for the baby's head, neck, and spine in the event of a crash.
C. "I will place the retainer clip over my baby's abdomen."
"I will place the retainer clip over my baby's abdomen." This statement is incorrect. The retainer clip, also known as the chest clip, should be positioned at armpit level to secure the harness straps. Placing it over the baby's abdomen could result in serious injuries in the event of a crash.
D. "I should position my baby at a 30-degree angle in the car seat."
"I should position my baby at a 30-degree angle in the car seat."This statement is incorrect. Infants should be positioned at a 45-degree angle in their car seats. This angle helps to keep the baby's airway open and prevents the head from flopping forward, which could restrict breathing. Placing the baby at a 30-degree angle may not provide adequate support and protection.
Full Explanation
A. "I should place the shoulder harness above the level of my baby's shoulders."
This statement is incorrect. Placing the shoulder harness above the baby's shoulders could lead to improper restraint in the event of a crash. The harness should be positioned at or slightly below the level of the baby's shoulders to provide effective protection.
B. "I should place the car seat rear-facing until my baby is 2 years old."
This statement is correct. The American Academy of Pediatrics recommends that infants and toddlers ride in a rear-facing car seat until they are at least 2 years old or until they reach the maximum height and weight limit specified by the car seat manufacturer. This position provides optimal protection for the baby's head, neck, and spine in the event of a crash.
C. "I will place the retainer clip over my baby's abdomen."
This statement is incorrect. The retainer clip, also known as the chest clip, should be positioned at armpit level to secure the harness straps. Placing it over the baby's abdomen could result in serious injuries in the event of a crash.
D. "I should position my baby at a 30-degree angle in the car seat."
This statement is incorrect. Infants should be positioned at a 45-degree angle in their car seats. This angle helps to keep the baby's airway open and prevents the head from flopping forward, which could restrict breathing. Placing the baby at a 30-degree angle may not provide adequate support and protection.
A nurse is providing discharge teaching to the parent of a school-age child who has pharyngitis caused by group A B-hemolytic streptococci (GABHS). Which of the following instructions should the nurse include in the teaching? (Select all that apply.)
A. "Schedule a time for your child to receive the pneumococcal vaccine within 2 weeks."
"Schedule a time for your child to receive the pneumococcal vaccine within 2 weeks."This statement is incorrect. Pharyngitis caused by group A beta-hemolytic streptococci (GABHS) is typically treated with antibiotics, but it does not necessitate pneumococcal vaccination. Pneumococcal vaccination is recommended for other purposes, such as preventing pneumonia and invasive pneumococcal disease.
B. "Provide your child with their own towel for drying their face and hands at home."
"Provide your child with their own towel for drying their face and hands at home."This statement is correct. Group A streptococci (GAS) can be transmitted through respiratory droplets or by direct contact with infected secretions. Providing the child with their own towel can help prevent the spread of the infection to other family members.
C. "Replace your child's toothbrush 24 hours after beginning antibiotic therapy."
"Replace your child's toothbrush 24 hours after beginning antibiotic therapy."This statement is correct. It is recommended to replace the child's toothbrush after starting antibiotic therapy to reduce the risk of re-infection with group A streptococci (GAS).
D. "Your child can return to school 24 hours after their first does of antibiotics."
"Your child can return to school 24 hours after their first dose of antibiotics."This statement is correct. After initiating antibiotic therapy for GABHS pharyngitis, the child is usually considered non-contagious and can return to school after completing 24 hours of antibiotic treatment.
E. "Replace your child's orthodontic appliances prior to beginning antibiotic therapy."
This statement is incorrect. There is no specific recommendation to replace orthodontic appliances before starting antibiotic therapy for GABHS pharyngitis unless otherwise advised by a dentist or healthcare provider.
Full Explanation
A. "Schedule a time for your child to receive the pneumococcal vaccine within 2 weeks."
This statement is incorrect. Pharyngitis caused by group A beta-hemolytic streptococci (GABHS) is typically treated with antibiotics, but it does not necessitate pneumococcal vaccination. Pneumococcal vaccination is recommended for other purposes, such as preventing pneumonia and invasive pneumococcal disease.
B. "Provide your child with their own towel for drying their face and hands at home."
This statement is correct. Group A streptococci (GAS) can be transmitted through respiratory droplets or by direct contact with infected secretions. Providing the child with their own towel can help prevent the spread of the infection to other family members.
C. "Replace your child's toothbrush 24 hours after beginning antibiotic therapy."
This statement is correct. It is recommended to replace the child's toothbrush after starting antibiotic therapy to reduce the risk of re-infection with group A streptococci (GAS).
D. "Your child can return to school 24 hours after their first dose of antibiotics."
This statement is correct. After initiating antibiotic therapy for GABHS pharyngitis, the child is usually considered non-contagious and can return to school after completing 24 hours of antibiotic treatment.
E. "Replace your child's orthodontic appliances prior to beginning antibiotic therapy."
This statement is incorrect. There is no specific recommendation to replace orthodontic appliances before starting antibiotic therapy for GABHS pharyngitis unless otherwise advised by a dentist or healthcare provider.
A nurse in a pediatric clinic is discussing the pathophysiology of Reye syndrome with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicate an understanding of the disorder?
A. "Reye syndrome causes fatty changes in the liver."
"Reye syndrome causes fatty changes in the liver."This statement is correct. Reye syndrome is characterized by acute non-inflammatory encephalopathy and fatty changes in the liver, which can lead to liver dysfunction and failure.
B. "Reye syndrome leads to venous thrombus formation."
"Reye syndrome leads to venous thrombus formation."This statement is incorrect. Reye syndrome primarily affects the brain and liver, leading to cerebral edema and liver dysfunction. It does not typically involve venous thrombus formation.
C. "Reye syndrome is associated with misuse of acetaminophen."
"Reye syndrome is associated with misuse of acetaminophen." This statement is incorrect. While the exact cause of Reye syndrome is not fully understood, it is not associated with the misuse of acetaminophen. However, there is a well-established association between Reye syndrome and the use of aspirin (salicylates) during viral infections, particularly in children and adolescents.
D. "Reye syndrome is linked to decreased serum ammonia levels."
"Reye syndrome is linked to decreased serum ammonia levels."This statement is incorrect. Reye syndrome is associated with increased serum ammonia levels due to liver dysfunction and impaired ammonia metabolism. Elevated ammonia levels can contribute to the encephalopathy seen in Reye syndrome.
Full Explanation
A. "Reye syndrome causes fatty changes in the liver."
This statement is correct. Reye syndrome is characterized by acute non-inflammatory encephalopathy and fatty changes in the liver, which can lead to liver dysfunction and failure.
B. "Reye syndrome leads to venous thrombus formation."
This statement is incorrect. Reye syndrome primarily affects the brain and liver, leading to cerebral edema and liver dysfunction. It does not typically involve venous thrombus formation.
C. "Reye syndrome is associated with misuse of acetaminophen."
This statement is incorrect. While the exact cause of Reye syndrome is not fully understood, it is not associated with the misuse of acetaminophen. However, there is a well-established association between Reye syndrome and the use of aspirin (salicylates) during viral infections, particularly in children and adolescents.
D. "Reye syndrome is linked to decreased serum ammonia levels."
This statement is incorrect. Reye syndrome is associated with increased serum ammonia levels due to liver dysfunction and impaired ammonia metabolism. Elevated ammonia levels can contribute to the encephalopathy seen in Reye syndrome.
