A 15-year-old male presents to the school nurse with complaints of persistent itching and redness in the groin area for the past two weeks.
Upon assessment, the nurse observes a well-demarcated, erythematous rash with a scaly border extending from the inguinal folds to the upper inner thighs, sparing the scrotum and penis.
The student reports being on the school's wrestling team and frequently wearing tight-fitting athletic gear.
Which of the following interventions should the nurse prioritize?
Instruct the student to avoid all physical activity until the rash has completely resolved.
Advise the student to apply an over-the-counter topical antifungal cream to the affected area twice daily for two weeks.
Refer the student to a healthcare provider for oral antibiotic therapy to treat the infection.
Recommend the student use a topical corticosteroid to reduce inflammation and itching.
The Correct Answer is B
Choice A rationale
Instructing the student to avoid all physical activity is not the priority intervention. While reducing friction and sweating can be beneficial, completely ceasing activity may not be necessary with appropriate treatment and hygiene measures. The rash is likely a fungal infection, not exacerbated by moderate activity if properly managed.
Choice B rationale
Advising the student to apply an over-the-counter topical antifungal cream is the most appropriate initial intervention. The presentation of a well-demarcated, erythematous, scaly rash in the groin, sparing the scrotum and penis, in a wrestler wearing tight athletic gear strongly suggests tinea cruris, a fungal infection. Topical antifungals are the first-line treatment for this condition.
Choice C rationale
Referring the student for oral antibiotic therapy is not indicated at this stage. The clinical presentation is highly suggestive of a fungal infection, for which antibiotics are ineffective. Antibiotics are used to treat bacterial infections, which typically present with different characteristics such as pus or systemic symptoms.
Choice D rationale
Recommending a topical corticosteroid is not the priority. While corticosteroids can reduce inflammation and itching, they do not treat the underlying fungal infection and can sometimes worsen it by suppressing the local immune response. Antifungal treatment should be initiated first to address the cause of the rash.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Projectile vomiting and confusion are highly concerning symptoms in a child with suspected Reye syndrome. Projectile vomiting indicates increased intracranial pressure, and confusion reflects encephalopathy, both of which are hallmark signs of the severe neurological involvement in Reye syndrome.
Choice B rationale
Fever and cough are common symptoms of many childhood illnesses, particularly respiratory infections. While Reye syndrome can sometimes follow a viral illness, fever and cough alone are not specific indicators of this condition.
Choice C rationale
Mild headache is a relatively non-specific symptom and can be associated with various conditions. While headache may occur in the early stages of some illnesses, it is not the most concerning symptom suggestive of Reye syndrome.
Choice D rationale
Muscle aches can be associated with viral infections, which sometimes precede Reye syndrome. However, muscle aches alone are not as concerning as the neurological symptoms of confusion and increased intracranial pressure indicated by projectile vomiting.
Correct Answer is ["B","C","E","G"]
Explanation
Choice A rationale
Nephrotic syndrome typically has a gradual onset of symptoms, developing over days to weeks, as protein loss in the urine accumulates. An abrupt onset is less characteristic.
Choice B rationale
Proteinuria, the presence of abnormally high levels of protein in the urine (normal range is less than 150 mg/24 hours), is a defining characteristic of nephrotic syndrome. Damage to the glomeruli in the kidneys leads to increased permeability and leakage of protein into the urine.
Choice C rationale
Hypoalbuminemia in the blood (normal range is 3.5 to 5.5 g/dL) is a key feature of nephrotic syndrome. The excessive loss of protein in the urine leads to a decrease in serum albumin levels.
Choice D rationale
Fever is not typically a primary symptom of nephrotic syndrome. While children with nephrotic syndrome can develop infections, fever is not a direct consequence of the underlying kidney dysfunction.
Choice E rationale
Hyperlipidemia, an elevated level of lipids (fats) in the blood (normal total cholesterol is less than 200 mg/dL), is commonly associated with nephrotic syndrome. The liver increases lipoprotein synthesis in response to the decreased serum albumin levels.
Choice F rationale
While a positive Group A beta-hemolytic streptococcal infection can lead to post-streptococcal glomerulonephritis, which can sometimes present with nephrotic features, it is not a common finding directly associated with the primary diagnosis of nephrotic syndrome itself.
Choice G rationale
Anasarca, which is severe generalized edema characterized by widespread swelling due to fluid retention, is a common finding in nephrotic syndrome. The low serum albumin levels reduce oncotic pressure in the blood vessels, leading to fluid shifting into the interstitial spaces. .
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