A nurse suspects that a three-year-old child may have rubella based on presenting symptoms. Which of the following questions asked by the nurse (directed at the parents) will be most effective in determining how the child was exposed to the virus?
Whom has the child come into contact with over the last three weeks?
Are your child's immunizations up to date?
What medications have you given your child?
When did you first notice the rash?
The Correct Answer is A
Choice A reason: This statement is correct, as asking about the child's contacts over the last three weeks can help the nurse identify the possible source of infection and the risk of transmission. Rubella is a viral infection that spreads through respiratory droplets or direct contact with an infected person. The incubation period of rubella is 14 to 21 days, meaning that the child could have been exposed to the virus up to three weeks before developing symptoms.
Choice B reason: This statement is incorrect, as asking about the child's immunizations is not the most effective way to determine how the child was exposed to the virus. Although immunization can prevent rubella infection, it is not 100% effective, and some children may still get the disease despite being vaccinated. The nurse should also consider other factors, such as the child's medical history, travel history, and exposure to other people with rash or fever.
Choice C reason: This statement is incorrect, as asking about the medications given to the child is not the most effective way to determine how the child was exposed to the virus. Medications can help relieve the symptoms of rubella, such as fever, rash, or joint pain, but they do not affect the transmission or the course of the infection. The nurse should focus on the epidemiological aspects of the disease, such as the mode of transmission, the incubation period, and the contagious period.
Choice D reason: This statement is incorrect, as asking about the onset of the rash is not the most effective way to determine how the child was exposed to the virus. The rash of rubella usually appears 14 to 17 days after exposure, and lasts for about three days. However, the child can be contagious from seven days before to seven days after the rash appears, meaning that the child could have been exposed to the virus up to four weeks before or after the rash. The nurse should ask about the child's contacts during this period, not just the rash.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: This statement is incorrect, as maceration is not a clinical manifestation of scabies, but a condition of softening and breaking down of the skin due to prolonged exposure to moisture. Maceration can occur in areas where the skin folds or rubs together, such as the groin, armpits, or under the breasts.
Choice B reason: This statement is incorrect, as edema is not a clinical manifestation of scabies, but a condition of swelling due to excess fluid accumulation in the tissues. Edema can occur in various parts of the body, such as the legs, feet, hands, or face, due to various causes, such as heart failure, kidney disease, or allergic reactions.
Choice C reason: This statement is correct, as itching is the primary clinical manifestation of scabies, a contagious skin infection caused by the mite Sarcoptes scabiei. The mite burrows into the skin and lays eggs, causing an intense inflammatory response and pruritus. The itching is usually worse at night and affects the areas between the fingers, wrists, elbows, armpits, waist, buttocks, and genitals.
Choice D reason: This statement is incorrect, as severe pain is not a clinical manifestation of scabies, but a subjective sensation of physical discomfort or distress. Pain can occur in various parts of the body due to various causes, such as injury, inflammation, infection, or disease. Pain can be acute or chronic, and can be rated on a scale of 0 to 10.
Correct Answer is D
Explanation
Choice A reason: An axillary temperature of 37.3° C is within the normal range for a 10 month old child and does not indicate a complication of intussusception or its treatment.
Choice B reason: Mild abdominal pain is expected after an emergency reduction for intussusception and can be managed with analgesics and comfort measures.
Choice C reason: A BP of 100/54 is normal for a 10 month old child and does not reflect hypovolemia or shock, which are possible complications of intussusception.
Choice D reason: Currant jelly stools are a sign of intestinal bleeding and ischemia, which are serious complications of intussusception that require immediate medical attention. Currant jelly stools are red, mucus-like, and mixed with blood. They indicate that the intussusception has not been resolved or has recurred.
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