A mother is concerned about what might have caused a heat rash on her infant. The nurse observes tiny pinhead-sized reddened papules on the infant's neck and axilla. What does the nurse explain as the most likely cause of this rash?
Sun exposure
Allergic reaction
Infection
Heat and moisture
The Correct Answer is D
A. Sun exposure: Sun exposure typically causes sunburn rather than tiny pinhead-sized papules.
B. Allergic reaction: Allergic reactions often present with different types of lesions or hives, not typically tiny papules.
C. Infection: Infections might cause different types of lesions or pustules rather than the described tiny papules.
D. Heat and moisture: Heat rash (miliaria) results from blocked sweat ducts, leading to tiny red papules due to overheating and trapped sweat, commonly occurring in areas like the neck and axilla.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Test the stool for occult blood: Testing for occult blood in the stool is not relevant for diagnosing pinworms.
B. Perform a tape test: The tape test involves applying transparent tape to the perianal area to collect pinworm eggs, which is the appropriate diagnostic method for Enterobius vermicularis.
C. Initiate IV fluids: IV fluids are not indicated for the diagnosis or treatment of pinworms unless the child is severely dehydrated, which isn't suggested by the scenario.
D. Collect stool specimens for culture: Stool culture is not used to diagnose pinworms; the tape test is more appropriate.
Correct Answer is C
Explanation
A. Keep edematous areas moist and covered. Keeping edematous areas moist and covered can worsen edema by trapping moisture and heat, leading to increased swelling.
B. Reach the child to minimize body movement. Minimizing body movement is not appropriate as it can lead to muscle weakness and stiffness. Encouraging gentle movement and position changes is beneficial.
C. Change the child's position frequently. Changing the child's position frequently helps prevent complications such as pressure ulcers and improves circulation, which can aid in reducing edema.
D. Keep the head of the child's bed flat. Elevating the head of the bed can help reduce edema by promoting venous return and reducing fluid accumulation in dependent areas.
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