A nurse is assessing a child who has rubeola. Which of the following findings should the nurse expect?
Lymphadenopathy
Steatorrhea
Koplik spots
Paroxysmal coughing
The Correct Answer is C
A. Lymphadenopathy. While some viral infections cause lymph node swelling, lymphadenopathy is not a hallmark sign of rubeola (measles).
B. Steatorrhea. Steatorrhea (fatty stools) is associated with conditions like cystic fibrosis and celiac disease, not rubeola.
C. Koplik spots. Koplik spots are small, white lesions with a red base found on the buccal mucosa, and they are a classic early sign of measles (rubeola).
D. Paroxysmal coughing. Paroxysmal coughing is characteristic of pertussis (whooping cough), not rubeola.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. "Capillary refill less than 2 seconds." A capillary refill time of less than 2 seconds indicates adequate hydration and perfusion, showing that the fluid replacement therapy has been effective.
B. "Potassium 5.6 mEq/L (3.4 to 4.7 mEq/L)." A potassium level of 5.6 mEq/L is elevated (hyperkalemia) and suggests an imbalance, which can result from inadequate kidney function or excessive potassium intake rather than effective rehydration.
C. "Voiding less than 1 mL/kg/hr." Decreased urine output is a sign of persistent dehydration or kidney dysfunction. Effective fluid therapy should restore normal urine output, typically greater than 1 mL/kg/hr in children.
D. "Tachycardia." Tachycardia is a sign of dehydration. If fluid replacement were effective, heart rate should normalize, not remain elevated.
Correct Answer is B
Explanation
A. "I will seal nonwashable items in a plastic bag for 1 week." Nonwashable items (e.g., stuffed animals, pillows) should be sealed in a plastic bag for at least 2 weeks, not just 1 week, to ensure all lice and nits die.
B. "I will place hairbrushes, combs, and hair accessories in boiling water for 10 minutes." Boiling these items in water for at least 5–10 minutes effectively kills lice and nits.
C. "I will wash my child's clothing and bedding using a double rinse." Clothing and bedding should be washed in hot water (at least 130°F or 54°C) and dried on high heat, but a double rinse is not necessary.
D. "I will use the medicated shampoo on my child's hair daily for 3 days." Medicated lice shampoos should be used once, followed by a repeat application in 7–10 days if needed. Daily use is not recommended due to potential toxicity and irritation.
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