A 7-year-old child is admited to the hospital with a diagnosis of acute rheumatic fever. In obtaining a health history from the child's mother, the recent occurrence of which illness is most significant?
Mumps.
Chickenpox.
Sore throat.
Influenza.
The Correct Answer is C
Acute rheumatic fever is a serious inflammatory condition that can develop after a streptococcal infection, particularly if the infection is not treated or resolved properly. The most common initial symptom of acute rheumatic fever is a sore throat, which is usually accompanied by a fever and swollen lymph nodes.
While mumps, chickenpox, and influenza are all infectious diseases, they are not directly linked to the development of acute rheumatic fever. However, a recent or untreated streptococcal infection (such as strep throat) can lead to the development of acute rheumatic fever.
Therefore, when obtaining a health history from a child with a diagnosis of acute rheumatic fever, it is most significant to inquire about recent or untreated sore throat, as this is the most likely cause of the condition.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Hypoparathyroidism is a disorder in which the parathyroid glands produce insufficient amounts of parathyroid hormone, which regulates calcium and phosphorus levels in the body. In hypoparathyroidism, there is a decreased level of calcium in the blood, which can result in carpal spasm or tetany when pressure is applied to the upper arm.
Therefore, the nurse should review the child's calcium level (D) to determine if it is within the normal range. Low calcium levels can cause muscle spasms, seizures, and cardiac arrhythmias. Hypocalcemia may also result in other symptoms such as numbness, tingling, and muscle cramps.
Potassium (A), chloride (B), and sodium (C) are electrolytes that play important roles in various physiological processes in the body, but they are not directly related to the development of carpal spasm in a child with hypoparathyroidism. While hypokalemia (low potassium) or hyponatremia (low sodium) can cause muscle weakness or cramps, these conditions are not typically associated with carpal spasm in hypoparathyroidism.
Correct Answer is A
Explanation
Peripheral intravenous (IV) infusion is a common procedure performed on infants in a hospital setting. The selection of the IV site is critical to ensure proper placement and to prevent complications.
When starting a peripheral IV infusion on an infant, the nurse should select a site that is least restrictive to the infant. This involves selecting a site that will not restrict the infant's movement and cause discomfort. The site should be accessible, visible, and easily palpable, such as the hand, wrist, or antecubital fossa.
Assessing the dorsal surface of the feet for an IV site is not recommended as it is an area of high risk for infiltration and may restrict the infant's movement.
Instructing parents to sing or croon to the infant may provide comfort and distraction, but it is not a critical intervention when starting a peripheral IV infusion.
Applying soft restraints to all four extremities is not recommended as it may cause physical and emotional distress to the infant. It should only be used as a last resort if the infant is at high risk of self-injury or if the procedure cannot be safely performed without restraints.
Therefore, the nurse should implement the intervention of selecting a site that is least restrictive to the infant when starting a peripheral IV infusion.
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