A nurse is collecting data from a child who has pertussis. Which of the following manifestations should the nurse expect?
Peeling of the hands and feet
Fever
Beefy, red tongue
Facial erythema
The Correct Answer is B
The correct answer is choice B. Fever.
Choice A rationale:
Peeling of the hands and feet is not a typical manifestation of pertussis. This symptom is more commonly associated with conditions like Kawasaki disease.
Choice B rationale:
Fever is a common symptom in the early stages of pertussis, along with a mild cough and runny nose.
Choice C rationale:
A beefy, red tongue is not associated with pertussis. This symptom is more characteristic of scarlet fever.
Choice D rationale:
Facial erythema is not a typical symptom of pertussis. Pertussis primarily affects the respiratory system, causing severe coughing fits.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Incorrect. While expressing empathy is important, the nurse should also provide practical information and support.
B. Incorrect. Delaying the discussion may leave the client feeling unheard and anxious about their upcoming chemotherapy.
C. Correct. This response acknowledges the client's concerns and provides a proactive solution to address the potential issue of hair loss. Offering information about head covering options demonstrates the nurse's support and willingness to help the client manage the physical and emotional impact of chemotherapy.
D. Incorrect. Dismissing the client's concern may contribute to their anxiety and apprehension about the chemotherapy process. It's important to address all aspects of the client's experience, including potential side effects like hair loss.
Correct Answer is C
Explanation
A. Assisting the client to the bathroom at regular intervals helps prevent falls due to toileting needs.
B. Locking the wheels on the bed prevents unwanted movement and reduces the risk of falls when the client is in bed.
C. Raising all four side rails is considered a restraint, which can increase the risk of falls or injury if the client tries to climb over them. Restraints should be avoided unless absolutely necessary and prescribed by a healthcare provider. In most cases, raising two side rails is sufficient to prevent the client from accidentally rolling out of bed while allowing them to safely exit the bed.
D. Clearing the path from obstacles and furniture reduces the risk of falls by providing a safe and unobstructed route to the bathroom.
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