A school nurse is examining the family history of a school-age child who has fractured their ulna for the second time. Which of the following findings place the child at risk for child abuse? (Select all that apply.)

Choice A rationale: Herpes zoster, also known as shingles, is not a notifiable disease. It is caused by the varicella-zoster virus, the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays dormant in the body and can reactivate years later, causing shingles.

Choice B rationale: Elevated lead levels in a child is a notifiable condition. Lead poisoning can cause serious health problems, particularly in children, and public health departments track cases to identify sources of lead and prevent further exposure.

Choice C rationale: Streptococcus pyogenes, also known as Group A Streptococcus, can cause a variety of infections, some of which are notifiable diseases. These include invasive Group A Streptococcal disease and streptococcal toxic shock syndrome.

Choice D rationale: Tuberculosis is a notifiable disease. The Mantoux tuberculin skin test is used to detect tuberculosis infection. A reddish induration greater than 10mm, especially in a client with symptoms of tuberculosis and a history of travel to an area where tuberculosis is endemic, is suggestive of tuberculosis infection.

Choice A rationale

Reviewing the immunization records of the child’s classmates might be a subsequent step after confirming the diagnosis and reporting to the health department. However, the immediate action should be to contact the local health department.

Choice B rationale

Advising the caregivers to increase the child’s Vitamin B intake is not relevant in this context. Koplik spots are a sign of measles, a viral infection, and increasing Vitamin B intake would not affect the course of this disease.

Choice C rationale

Examining the child’s classmates for enlargement of the parotid gland is not appropriate because enlargement of the parotid gland is a symptom of mumps, not measles.

Choice D rationale

Contacting the local health department is the correct action. Koplik spots are a characteristic sign of measles, a highly contagious and reportable disease. The local health department can provide guidance on further steps, including confirmation of the diagnosis, treatment, and measures to prevent the spread of the disease.