A nurse in an assisted-living facility reinforcing teaching with staff members about preparing for an external chemical disaster. Which of the following instructions should the nurse include?

A) "Relax your arm across your chest and I will test your elbow extension.": This instruction is not relevant to testing the plantar Babinski reflex. The Babinski reflex involves the lower extremities, specifically the foot, not the arm or elbow. This instruction pertains to testing the upper extremity and is incorrect for this context.

B) "Place your foot in my hand and I will tap the back of your heel.": This is not the correct method for testing the plantar Babinski reflex. The Babinski reflex is tested by stroking the sole of the foot, not by tapping the back of the heel. The test is designed to elicit a response from the foot, not by applying pressure to the heel.

C) "Sit on the edge of the bed while I tap your knee.": This instruction relates to testing the patellar reflex (knee jerk), not the plantar Babinski reflex. The Babinski reflex involves stroking the bottom of the foot, not tapping the knee, so this is not appropriate for the test in question.

D) "Lie down and I will stroke the bottom of your foot.": This is the correct instruction for testing the plantar Babinski reflex. The client should be in a comfortable position, typically lying down, and the nurse should gently stroke the sole of the foot from the heel to the toes to assess the reflex. A normal response in adults is for the toes to curl downward, while an abnormal response (Babinski sign) would be the extension of the big toe and fanning of the other toes.

A) Beefy, red tongue: The beefy, red tongue is typically associated with scarlet fever, a bacterial infection caused by group A Streptococcus. This condition can lead to a red, "strawberry" tongue, often accompanied by a rash. While measles can involve a variety of symptoms, including a red rash, conjunctivitis, and cough, the beefy red tongue is not characteristic of measles. In measles, the more notable symptoms are a high fever, cough, runny nose, and the development of Koplik spots inside the mouth.

B) Paroxysmal cough: Paroxysmal cough, which is a sudden, severe, and uncontrollable cough often followed by a "whooping" sound, is more characteristic of pertussis (whooping cough). While a cough is indeed present with measles, it is generally not paroxysmal. In measles, the cough is more persistent and associated with other typical symptoms such as fever and a characteristic rash. The coughing in measles may also be dry and harsh but does not tend to occur in violent, paroxysmal episodes like those seen in pertussis.

C) Peeling of the hands and feet: Peeling of the skin, particularly of the hands and feet, is more commonly observed in conditions such as scarlet fever, Kawasaki disease, or after a viral infection like hand-foot-and-mouth disease. It is not a classic finding of measles. In measles, the skin rash usually starts as maculopapular spots on the face and spreads down the body. While some skin sloughing can occur after the rash resolves, especially in severe cases, it is not the characteristic sign of measles, and it is not typically seen on the hands and feet.

D) Fever: Fever is one of the earliest and most prominent symptoms of measles. It typically appears about 2-4 days before the characteristic measles rash. The fever in measles can be quite high, often exceeding 104°F (40°C), and is associated with other symptoms such as cough, conjunctivitis, and photophobia. The fever usually persists for several days, and it is one of the critical signs that lead to the diagnosis of measles, particularly when combined with the characteristic rash and other respiratory symptoms.