A nurse is caring for a 3-year-old child who has viral meningitis. Which of the following findings should the nurse expect?
Koplik spots
Decreased protein in the cerebrospinal fluid
Nuchal rigidity
Decreased glucose in the cerebrospinal fluid
The Correct Answer is C
A. Koplik spots: These are small, white lesions on the buccal mucosa associated with measles, not meningitis.
B. Decreased protein in cerebrospinal fluid (CSF): Viral meningitis typically causes normal or slightly elevated protein levels in CSF.
C. Nuchal rigidity. Nuchal rigidity (stiff neck) is a classic sign of meningitis due to inflammation of the meninges.
D. Decreased glucose in cerebrospinal fluid: Decreased glucose in CSF is associated with bacterial meningitis, not viral.
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Related Questions
Correct Answer is ["A","B"]
Explanation
A. Assess for changes in level of consciousness. Abdominal trauma can lead to internal bleeding, which might increase intracranial pressure if bleeding occurs in the brain. Monitoring for neurological changes is essential.
B. Administer factor VIII. Hemophilia A results from factor VIII deficiency, and replacing it prevents further bleeding.
C. Perform passive range of motion hourly. Movement may exacerbate bleeding into the joints or injured tissues. Rest is essential during acute bleeding episodes.
D. Administer factor IX. Factor IX is used for hemophilia B, not hemophilia A.
E. Apply a warming blanket over the child. Hypothermia management may be necessary in some trauma cases, but there is no indication it is needed here based on the scenario provided.
Correct Answer is D
Explanation
A. "Flat anterior fontanel." A sunken anterior fontanel, not flat, is a sign of severe dehydration in infants.
B. "Dry, hot skin." Dry skin is a symptom of dehydration, but "hot" skin may indicate fever rather than severe dehydration.
C. "Loss of 5% of weight." A 5% weight loss indicates mild dehydration; severe dehydration is characterized by a weight loss of 10% or more.
D. "Absence of tears when crying." Absence of tears is a reliable indicator of severe dehydration in infants.
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