A nurse is reinforcing teaching about performing a glucose test with an adolescent client who has diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching?

Rationale:

• Red rash on the face: The red rash on the face is common in all three viral infections but presents differently in each. In Fifth disease, it appears as a "slapped cheek" rash, bright red on the cheeks. In Measles, the rash starts on the face, particularly behind the ears, and spreads to the body. Rubella causes a mild pinkish-red rash that begins on the face and spreads down, but it is usually less intense than in the other two diseases.
• Koplik spots in the mouth: Koplik spots are a classic feature of Measles, appearing as small white spots inside the mouth, typically on the buccal mucosa opposite the molars, and are present before the rash. Fifth disease and Rubella do not present with Koplik spots.
• Fever: Fever is common in all three diseases but varies in severity. Fifth disease usually presents with a low-grade fever. Measles often causes a high fever that spikes before the characteristic rash. Rubella typically causes a mild fever, especially in the early stages.
• Lymphadenopathy: Lymphadenopathy is prominent in Measles and Rubella, where it often affects the cervical and postauricular lymph nodes. Fifth disease does not typically cause significant lymphadenopathy.

Rationale for Correct Choices:

• Fontanel finding: The sunken fontanel indicates signs of dehydration, which is the primary concern for this infant. Dehydration can lead to severe complications and should be addressed first through appropriate fluid resuscitation (IV fluids) to prevent further deterioration.
• Temperature: The infant has a fever of 38.4°C (101.1°F), which needs to be managed with acetaminophen as prescribed. While dehydration is the priority, the temperature should also be controlled to prevent worsening of the infant's condition and to make the child more comfortable.

Rationale for Incorrect Choices:

• Diaper area: While the excoriated diaper area is concerning, it is not the most urgent issue compared to dehydration, which can quickly worsen. Dehydration and fever management should be prioritized before addressing skin irritation.
• Stool culture results: The positive stool culture for Shigella is important for determining the infection, but addressing the infant's hydration status and fever is more urgent to stabilize the child. The results will guide further treatment but do not need immediate intervention over dehydration.
• Appetite history: While the infant's poor feeding history is significant, addressing dehydration and fever management should take precedence to stabilize the infant before evaluating feeding patterns in more detail.
• Activity tolerance finding: The infant’s fatigue is likely due to dehydration and fever. Stabilizing hydration and controlling the fever will improve the infant’s activity tolerance, making this secondary to the more urgent issues.