VIRAL EXANTHEM INFECTIONS

AND
EMERGING DISEASES
By Dr. Elizabeth delos Santos RN MAN PhD
German Measles/Rubella
Rubella is a childhood viral infection
producing minimal systemic upset. After an
incubation period of 10-21 days, the prodromal
symptoms of mild to moderate fever, catarrhal
manifestations, anorexia and lymphadenopathy
usually occur for 1 to 5 days duration.
1.Petechia lesions that occur in the
buccal mucosa which are reddish in
color is termed as ___________. Mrs.
Divinagracia brought her 6 year old son
to San Lazaro Hospital due to fever,
cough and colds, and skin rashes which
occur after few days. The staff nurse
reviewed the physicians physical
assessment with documented
Forscheimer. Based on this finding,
which of the following sign would the
nurse expect to observe in this child?
a. Slapped face appearance
b. Skin rashes with vesicles
c. Skin rashes with neuritic
involvement
d. Petechial lesions on soft palate
Ap/RM
Forscheimer

1. The hallmark of Rubella is
_____________, accompanied with
catrrhal manifestations. Nurse Cielo
performs physical assessment to the
child. What assessment finding would
support the medical diagnosis of
Rubella.

a. Strawberry tongue
b. Sub-occipital
lymphadenopathy
c. Tiny, whitish spots in the buccal
cavity
d. Presence of rose spots on
abdominal area
An/RM
Hallmark of Rubella
1. Rubella rashes would initially
occur in a particular part of the body
which is the ____________. Mrs.
Gonzalo, a clinical instructor
assesses the knowledge of her
students prior to their clinical
exposure at the Eruptive Ward. The
C.I would correct her student
Grace if she states which of the
following:
a. Rubella may lead to serious
fetal defect if infection occurs on
3
rd
trimester of pregnancy
b. Viral transmission occurs
through direct contact with
nasopharyngeal secretions
c. Rubella virus can be
documented on blood, stool, urine of
infected child
d. Fomites with freshly
contaminated nasopharyngeal
secretions may cause transmission
S/C
Teratogenic effects of Rubella virus

1. Typical rashes are
characterized to have different sizes,
shapes that are reddish to rose pink
in color termed as _________ rashes.
Bedside Clinic was conducted by the
Clinical Instructor at the Eruptive
Ward. She asked student Lara to
describe a child with Rubella
infection. Lara must not be corrected
if she states which of the ff.
a. Papulo rashes with vesicles
initially from the face
b. Maculo-papulo rashes with
neuritic pain
c. Maculo-papulo rashes
starting from the face
d. Maculo-papulo rashes initially
from the trunk
S/C
Typical Rubella rashes

1. Another student nurse responded
correctly base on her knowledge that
Rubella rashes would
a. Last for one day without
desquamation
b. Last for 3-4 days without
desquamation
c. Last for one week with
desquamation
d. Last for 3 days with
desquamation
Core: Communication
Blooms: Ap
Concept: Description of Rubella rashes
2. Rubella virus is transmitted
through contact with _________
secretions of the infected persons. Nurse
Janette a nurse affiliate is counseling the
mother. What statement by the mother
indicates that the teachings given by the
nurse affiliate was effective?

a. I should not allow my child to
return to school for two weeks
b. Playmates who live next door are
also at risk
c. I should isolate my child from
my siblings who had Rubella before
d. My daughter who recently got
married should limit association with
my child
E/ HE, SQC
Isolation of Rubella and Nursing Management

3. Exposure of pregnant women to
Rubella virus may lead to serious fetal
malformations/infections if exposure
occurs on _________ trimester of
pregnancy. Nursing student Niza was
assigned at the N.I.C.U isolation room.
Shes handling a newborn who was
born to a mother who had Rubella
during pregnancy. Niza was asked by
her C.I the reason of isolating the
newborn from the other babies. The
instructor would not have to correct
if she states
a. NB is susceptible to infection
b. NB autoimmune system is
depressed
c. NB develops meningitis, a
complication of Rubella
d. NB is actively shedding
Rubella Virus
E/ C, SQC
Rubella Isolation Measure and Nursing
Management

Measles/Rubeola
4. The classical symptoms of
Rubeola includes high fever, the 3
Cs- Cough, Coryza, and
Conjunctivitis and also __________,
documented at the oral mucosa.
Cynthia, a 4 year old child is
admitted at the pediatric unit with
history of high grade fever and
severe catarrhal symptoms with
photophobia. The admitting
physician gave an impression as
Rubeola case. Physical assessment
was performed by the pediatric
nurse. What clinical feature supports
the physicians diagnosis?
a. Child with yellowish spot on
hard palate
b. Child with rosy cheeks
c. Erythematous base with
whitish, bluish center inside the
mouth
d. With strawberry tongue
Ap/ RM
Kopliks Pathognomonic sign

5. Eruptive stage of Rubeola is
described as _________ rashes that
usually appear at the height of the fever.
On the second day of hospitalization the
pediatric nurse documented rashes
during physical assessment to Cynthia.
The pediatric nurse would expect the
mother to describe her child rashes as
a. Rashes occurred from face to
trunk
b. Rashes with fluid
c. Rashes appeared first from the
trunk
d. Rashes are itchy and painful
An/RM
Rubella rashes description

6. Isolation of client should be
emphasized to prevent spread of
infection by observing _______
transmission. The mother expressed her
concern as she has two siblings left at
home. She asked the nurse to the
possibility of her other children in
acquiring the disease. The nurse is
correct if she gave this response

a. Theres nothing to worry-anyway
they are not around
b. As long as Cynthia will not play
with your other two siblings then that
will be fine
c. Measles is considered
contagious even before rashes set in
d. Just offer Vit. C and antibiotic to
your other 2 siblings
S/ HE,SQC
Measles period of communicability

7. Patient should be assessed for
possible complications .
______________ is considered as the
most dreaded complication. Cynthia is
found to be Anorexic even prior to
hospitalization. Cynthia develops
deep mouth ulcers and also clouding
of the cornea. Base on Integrated
Management of Childhood
Illness(IMCI) the child is classified
as
a. Severe complicated measles
b. Measles with eye/mouth
complication
c. Measles with infection
d. Measles unlikely
E/RM
Management of measles base on IMCI protocol

8. There is no specific treatment
for Measles. Patients are usually
given Vitamin _____ per orem
regardless of with or without
complications. The health worker
manages childs disorder. Which of
the following treatment is not
consistent with IMCI protocol?

a. Administer the first dose of
appropriate antibiotic
b. Give vitamin A per Orem
c. Apply Tetracycline
ophthalmic ointment
d. Apply Gentian Violet to
mouth ulcers
Ap/HE,SQC
IMCI protocol on Measles Management
9. Exposed individuals are
usually given __________ within 3
to 5 days of exposure to prevent
infection. The public health worker
was alarmed due to Measles
epidemic that affected several
barangays. Because of the increase
incidence of Measles, a 7 month old
infant was given measles vaccine.
The PHN should help the mother
understand the importance of the
maximum protection against measles
by submitting her baby for re-
vaccination at approximately
a. 15 months of age
b. School entrance
c. 9 months of age
d. 12 months of age
An/HE, CT
Measles Vaccine

10. Following the DOH protocol,
Measles-Rubella vaccine was injected at
aparticular site which is the _________.
The DOH launched last April 4 to May
4, 2011 Iligtas sa Tigdas ang Pinas The
vaccinators conducted door to door
Measles, Rubella immunization. Who
among the following age group were
vaccinated
a. 6 months to 72 months
b. 9 months to 84 months
c. 9 months to 95 months
d. 6 months to 95 months
S/SQC,CT
DOH program Iligtas sa Tigdas ang Pinas

11. Teaching families as to the
importance of EPI is essential. Health
workers must observed storage of
measles vaccine at _______ degrees
centigrade. The mother verbalized to the
vaccinators that her 3 years old child has
already received measles vaccination
when she was 9 months. She asked if her
child be exempted from this campaign.
The vaccinator made an incorrect
response when she states which of the
following
a. Its advisable for your child to
receive this vaccine as an additional
protection against German Measles
b. It is safe for your child. Theres
no over dosage
c. It would be alright not to
submit your child for this
immunization since she had
received one
d. Its advisable for your child
to receive this vaccine as an
additional protection against Measles
E/ HE,SQC
Measles Rubella Immunization

Ruseola Infantum/Exanthema Subitum

12. Also known as 6
th
disease is
considered as an acute ______
infection caused by HHV type 6.A
young mother consulted the
physician at nearby Health Center.
History reveals that her child had
fever for five days with appearance
of rashes as the fever is diminishing.
The child is diagnosed by the
physician as having Exanthema
Subitum. The PHN is assessing the
child. The PHN would expect to
observe

a. Elevated rashes beginning
from the face
b. Erythematous rashes with
vesicles
c. Flat rashes with pruritus
initially on the face
d. Combination of flat and
elevated rashes, rose pink, that
fade on pressure
Ap/ RM
True nature of Roseola rashes

13. Exanthema Subitum is an
acute benign that affects the age
group among _________. The
anxious mother asked the PHN
regarding precautionary measures to
be implemented to prevent her other
siblings from acquiring the disease.
The nurse responded incorrectly if
she states
a. The disease can be transmitted
through direct contact of nasopharyngeal
secretions
b. Fomites that are freshly
contaminated with respiratory secretions
are infectious
c. An infected child rarely transmit
the virus to another sibling
d. An infected child is highly
contagious at the height of rashes. Use
gloves in giving direct care.
E/HE,SQC
Mode of Transmission of Roseola Virus

Erythema Infectiosum
14. Erythema Infectiosum is also
known as the Fifth disease and is caused
by Parvovirus B19.The disease has three
clinical stages. The first stage is
described as _______ appearance. A
worried mother brought her 10 year old
son to the Health Center physician due
to sons apparently ill and erythematous
face. After clinical assessment, the
physicians finding is Fifth disease. The
anxious mother asks the nurse as to the
possible treatment. Which of the
following response by the PHN is
appropriate?
a. Antibiotics are often prescribed
b. Steroids are helpful
c. Symptomatic and supportive
measures are helpful
d. ASA works well
E/HE
Clinical Management of Eryhtema Infectiosum

Chicken Pox/Varicella
15. Chicken pox is a highly
contagious illness caused primarily by
infection of Varicella Zoster virus. The
lesions start as 2-4 millimeter red papule
which develop into __________, dew
drop on a rose petal. A young mother
brought her 8 year old child to the
clinic because of rashes on the trunk
and scalp. The mother verbalized
that her child has had a low grade
fever, has not felt like eating and
generally has been tired. The
physicians diagnosis is Chicken
pox. The mother inquired about the
communicable period associated
with Chicken pox. The nurse plans to
base the response on which of the
following?
a. Researches still going on as
to the definite communicability
period
b. Vesicles do crust in 2 to 4
weeks. After this time your child is
considered safe
c. Prior to onset of rashes
chicken pox is already
communicable till 6 days after the
1s crop of vesicles form
d. A child is no longer
contagious once the fever diminish
Ap/C, HE, SQC
Chicken Pox Period of communicability

16. Varicella causes
exanthematous rashes. An attack of
the disease confers _______
immunity. The nurse provided
information about chicken pox.
Which of the following information
are appropriate?

a. Lesions are more profuse on
exposed areas than on covered areas
b. Nasopharyngeal secretions
are infectious
c. Lesions of skin are of little
consequence, scabs are not infectious
d. Exclusion from school for at
least 6 days
A. All except A
B. All except c
C. All except d
D. All choices
An/C,HE,SQC
Infectious sources of chicken pox virus

1. The nurse asked the mother to
repeat the information given. Which
statement by the mother indicates a need
for additional information?

a. Chicken pox is a viral infection
that can be spread to other children
b. My child should not be exposed
to my pregnant sister at this time
c. My child will have pox all over
his body during the prodromal period
d. I should monitor my child for
Reyes syndrome which is a possible
complication of chicken pox
An/ C,HE
Clinical picture of chicken pox
2. Severe pruritus may lead to
inflammation with infection caused by
staphylococcus termed as ___________.
The nurse emphasized appropriate
measures of care. Which of the
following complication is brought about
by scratching and severely irritating the
vesicles.
a. Neuritis
b. Dermatitis
c. Secondary bacterial infection
d. Lupus erythematous
S/C,SQC,CT
Possible complication of chicken pox
3. Supportive treatment is
imperative to prevent complications of
the disease. Specific medication like
____ and ____ are not advisable to
administer. A staff nurse informs the
Clinical manager that she has a sibling
who is sick at home with Varicella. Who
among the clients must the Clinical
Manager assign to the staff nurse
a. Any client in the Unit as long
as the nurse wears a face mask while
rendering nursing care
b. Clients who are not
immune compromised
c. Clients who previously had
chicken pox
d. No client, because the staff
nurse must be sent home
E/SQC,PPD
Nursing Management

Herpes Zoster/Shingles

4. Herpes Zoster commonly
known as Shingles is a viral disease
characterized by a painful skin rash
with blisters resulting in a
_____________ pattern that is
limited to one side of the body. A
staff nurse assigned at SLH
documented a diagnosis of Herpes
Zoster in an adult clients chart.
Based on nurses understanding of
the cause of this disorder, the nurse
would determine that this definitive
diagnosis was made following which
diagnostic test
a. Patch test
b. Skin biopsy
c. Culture of lesion
d. Wood light examination
Ap/C,R
Diagnostic Exam of Herpes Zoster

5. Some Herpes lesions may
appear on the ear canal and sensory
portion of facial nerve coupled with
pain, the so called ________. While
performing assessment to Herpes the
client staff nurse would observe;
a. Generalized macula-papulo
rashes
b. Vesicles all over the trunk
c. Edematous rashes
d. Unilateral, clustered vesicle
E/C,R
Clinical picture of Herpes Rashes

6. Symptomatic treatment is
administered to relieve signs and
symptoms. Acyclovir is given to shorten
the course of the disease. The action of
this drug is ______. The adult client
complains vesicular pain and with
burning sensation. Which of the
following intervention provides
temporary relief?
a. Applying warm moist compress
b. Application of topical steroid
c. Antifungal ointment application
d. Blowing cool air over affected
area
An/ C,SQC,HE
Nursing Measure for vesicular and neuritic pain

Reyes Syndrome

7. Reyes Syndrome is an acute
encephalitis associated with fatty
infiltration of the liver, pancreas with an
idiopathic cause although it usually
occurs post viral infection that was
managed with ________ medication.
Clinical history and physical assessment
is performed by a staff nurse to a client
diagnosed with Reyes Syndrome. The
mother verbalized I gave my son over
the counter medicine to treat my childs
fever and pain. Which medication as
stated by the mother is essential to report
to the physician by the nurse

a. Tylenol
b. Iterax
c. Acyclovir
d. Bismuth subsalicylate
Ap/ SQC, C
Medication that is contributory factor to Reyes
Syndrome

8. Treatment measures to
decrease intracranial pressure and
cerebral edema would include
osmotic diuretics, anticonvulsant and
decreased fluids. Prior to Manitol
administration, it is critical for the
nurse to check first the client's vital
signs specifically the ________. The
client exhibits signs of increased
intracranial pressure. The nurse is
planning care for this client. Which
of the following nursing measures is
contraindicated?
a. Scheduled cluster care
b. Chest physiotherapy
c. Avoid neck vein compression
d. Mouth care
E/SQC,LR
Nursing Management of client with increased
intracranial pressure

EMERGING Diseases
Bird Flu/Avian Flu
9. Bird flu is an infectious
disease of birds caused by
______________ virus. Infection
with this virus had cause illness to
humans. However the spread of bird
flu viruses from one ill person to
another is inefficient and un-
sustained. A PHN conducted health
education on Bird flu with emphasis
on preventive measures. Which of
the following preventive measures in
human is inappropriate?

a. Proper cooking of poultry
b. Seasonal influenza vaccine
should be given to those directly or
indirectly involved with handling live
poultry
c. Children should be discouraged
from handling poultry
d. None of these
AP/ HE,SQC
Bird flu preventive measures
10. Incubation period of Avian
influenza would range from 2 to 4 days
with influenza like illness symptoms.
Management for H9N1 infection is
essentially the same as with other
Influenza viruses. Health workers and
visitors are advised to wear ______
when entering the room. Clinical
management of the disease is focused on
supportive care. Early treatment is
essential to prevent progression of
disease to;
a. Kidney failure
b. Liver failure
c. Respiratory failure
d. Cardiac failure
E/ SQC,QI
Bird flu complication

Novel Influenza A [H
1
N
1
]
Novel influenza A [H
1
N
1
] is a new flu
virus that had caused outbreak in multiple areas
of the world. The clinical features of the disease
are similar to the clinical manifestations of
seasonal flu.
11. [H
1
N
1
] virus is a re-assortment of
viruses from birds, chicken and pigs.
Scientist call this virus a _______
reassortment virus.The DOH continues
to take aggressive action in controlling
community outbreak. Method of
transmission is essential to prevent
others from transmitting the disease. The
infection control measure that should be
observed.
a. Droplets precaution
b. Airborne precaution
c. Vector borne precaution
d. Blood borne precaution
Ap/ SQC,HE
H1N1 Influenza A Infection control

12. The antiviral medication that
is widely used for H1N1 is
________. In planning care, which
of the following is least likely to be
observed by the nurse and other
Health Care Provider
a. Utilized PPE [Personal
Protective Equipment]
b. Apply the principles of hand
washing
c. Implement appropriate
isolation measures
d. Isolate at least one foot
away
E/ SQC,HE
H1n1 Influenza A preventive measures and
Nursing Management

S.A.R.S
.
13. Severe Acute Respiratory
Syndrome is a newly identified
respiratory illness caused by a
Corona virus which is associated
with ____________virus. The PHN
is conducting health education to a
group of mothers about emerging
diseases. One of the participants
made query as to the supportive
management of SARS to prevent
possible complications. The nurse
responded appropriately if she states
that the management therapy would
include

a. Steroid, salicylate, antiviral
b. Antiviral, salicylate, antibiotic
c. Antibiotic, aspirin, steroid
d. Antiviral, antibiotic, steroid,
bronchodilator
Ap/C,HE
Clinical Management of SARS

ANTHRAX/Ragpicker Disease
14. Anthrax also known as
Woolsorter disease is an acute bacterial
disease caused by ___________. The
PHN is alarmed about a reported case of
an Anthrax in their barangay. She
decided to conduct health education to
the community with emphasis on the
clinical forms of Anthrax. Which of the
ff. is/are appropriate information by the
nurse to the community.

a. Pulmonary form is contracted by
inhalation of the causative agent leading
to respiratory infection with high
mortality risk
b. Cutaneous form is contracted
through contact with infected animals
which causes vesicles that are itchy,
evolving into deep black eschar.
c. Gastrointestinal form is
contracted by ingestion of infected meat
of an animal causing severe
gastroenteritis
d. Cutaneous form is contracted by
ingestion of infected meat of an animal
which causes vesicles that are itchy
evolving into deep black

A. All choices except D
B. A only
C. B only
D. C only
Ap/HE, SQC
Anthrax Clinical forms

1. Understanding the chain of
Infection is essential in order to
prevent the development of infection
and control its spread. The weakest
link of the chain of infection is the
____________. Breaking this chain
of infection is imperative to prevent
others from acquiring the disease.
The infection control should focus
on
a. Not to sell the hides of
animals nor intake the meat
b. Never necropsy the animal
but aseptically collect blood sample
for culture
c. Promptly immunize and
annually re-immunize all animals at
risk
d. Immunizing high-risk
persons with cell free vaccine
A. All but A
B. All but B
C. All but C
D. A, b, c, d
E/HE, SQC
Anthrax preventive measures and Nursing
Management

IMMUNITY
1. The human body has the
ability to develop extremely
powerful specificimmunity against
individual invading agents. It usually
develops as a result of prior exposure
toan antigen through immunization
or by contrac ting a disease. The
human body has the ability to resist
all types of organisms that tend to
damage the tissues and organs , this
is called __________. Preconference
was conducted by the clinical
instructor Mrs Perez to nursing
affiliates assigned at the Health
Center. The instructor asked one of
her students about the contraindication
in receiving an immunization. The
student responds correctly that one
contraindication of receiving an
immunization is if a child has
a. Malnutrition
b. Mild respiratory infection
c. Severe febrile illness
d. Mild diarrhea
Ap/C,SQC
Relative contraindication of live attenuated vaccine

2. To protect infants from commoin
communicable diseases, there should be
an adherence to the schedule of
compulsory immunization of children
under 8 years old as provided by PD
_________ . Mrs Perez, the clinical
instructor assessed the knowledge of her
students prior to immunization
administration. The instructor would not
have to correct her student if she states

a. Immunization will provide
natural immunity from diseases
b. Immunization gives innate
immunity from different diseases
c. Immunization will protect a child
from all diseases
d. Immunization will provide
acquired immunity.
An/SQC,C
Importance of receiving immunization

3. Compulsory immunization
against Hepatitis B is embodied in RA
______. A child is scheduled to receive
series of Hepatitis B vaccine. Prior to
administering the vaccine, the PHN
performs an assessment and ask about a
history of an allergy pertaining to
a. Bakers yeast
b. Penicillin
c. Eggs
d. ASA
S/ SQC, C
Hepatitis B vaccine assessment prior to
immunization

4. An early administration of
Hepa B vacine reduces the chance of
being infected, and prevents Liver
cirrhosis and liver cancer. First dose
to secodn dose is given in six weeks
interval and a ______ weeks interval
from second dose to third dose.
Student nurse Clarisse is assisting
the PHN in administering
immunization. She understand that
hepatitis B vaccine will provide
a. Artificial active immunity
b. Artificial passive immunity
c. Natural active immunity
d. Natural passive immunity
S/ CT, SQC
Hepatits B vaccine significance

5. Giving doses of a vaccine at
less than the recommended weeks
interval may lessen the antibody
response. Local reaction like pain
and swelling, fever and systemic
symptoms may occur as part of
_____ immune response. Mrs Cruz,
an anxious mother went back to the
Health Center a day after her baby
received Hep. B vaccine and DPT
immunization due to swelling of
injection site. In providing teaching
to the mother the nurse should best
emphasize to;

a. Massage and elevate thigh
b. Apply steroid to injection site
c. Apply warm compress
d. Massage and apply cold
compress

E/HE, SQC
Nursing Measures post Hep B vaccine and DPT
immunization