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A nurse is caring for an 8-year-old client who has been diagnosed with acute rheumatic fever. Which action is the nurse's priority for a client with this presentation?

Reviewing the client's complete blood count (CBC).

Using a pain-rating tool to determine the severity of the joint pain.

Assessing the client's erythematous rash.

Auscultating the rate and characteristics of the child's heart sounds.

Answer and Explanation

The Correct Answer is D

A. While reviewing the CBC is important, it is not the priority.

B. Assessing joint pain is necessary for managing symptoms, but it is not the most critical initial action.

C. Evaluating the erythematous rash is part of the assessment, but it does not take precedence.

D. Auscultating the heart is the priority because acute rheumatic fever can lead to carditis, which can cause significant and potentially life-threatening heart complications. Early detection of abnormal heart sounds is crucial.

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Correct Answer is ["23"]

Explanation

To calculate the IV fluid rate, first, convert the infant's weight from pounds and ounces to kilograms. There are 2.2 pounds in one kilogram. The infant weighs 16 pounds and 8 ounces, which is 16.5 pounds or approximately 7.5 kilograms when converted (16.5 pounds ÷ 2.2 pounds per kilogram). Next, multiply the infant's weight in kilograms by the prescribed amount of IV fluid, which is 6 mL/kg. This results in 45 mL (7.5 kg × 6 mL/kg). Since the fluid is to be infused over 2 hours, divide the total volume of 45 mL by 2 hours to find the rate per hour. The IV pump should be set to deliver approximately 22.5 mL/hr. After rounding to the nearest whole number, the IV pump should be set to deliver 23 mL/hr.

A. A child who is recovering from nasopharyngitis B. A child who has nephrotic syndrome C. A child who has gastroenteritis D. A child who has rheumatic fever

Correct Answer is B

Explanation

A. A child recovering from nasopharyngitis could still be contagious, and since children with leukemia have compromised immune systems, they are at higher risk of infections.

B. A child with nephrotic syndrome, although potentially needing special care, does not pose the same infection risk as a child recovering from an infectious disease. Therefore, they are a more suitable roommate for a child with leukemia.

C. A child with gastroenteritis may still be infectious and could expose the child with leukemia to gastrointestinal pathogens.

D. A child with rheumatic fever does not have a contagious illness, but the specific needs of the child with leukemia and the potential for complications from infections make it less ideal compared to a non-infectious condition like nephrotic syndrome.

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A nurse is caring for an 8-year-old client who has been diagnosed with acute rheumatic fever. Which action is the nurse's priority for a client with this presentation?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is ["23"]

Explanation

A nurse is admitting a pediatric client to the unit who has leukemia. Which client should the nurse place in the same room with this child?

Correct Answer is B

Explanation

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