A preschool-aged child who is being treated for Streptococcal pharyngitis returns to the clinic for signs of scarlet fever. Which assessment finding provides the earliest indication to the nurse that the child is experiencing a reaction to the toxins that are created by the Streptococcus bacteria?

Flaky, peeling skin.

Red bumps across chest.

White coating on tongue.

High, protracted fever.

Answer and Explanation

The Correct Answer is B

A. Flaky, peeling skin (desquamation) occurs in later stages of scarlet fever, typically after the rash begins to fade. It is not an early sign of the disease.
B. A red, sandpaper-like rash that typically begins on the chest and spreads outward is one of the earliest indications of scarlet fever. This rash is caused by exotoxins produced by Streptococcus pyogenes and is a hallmark sign of the illness.
C. A white coating on the tongue, often followed by a characteristic “strawberry tongue,” develops later in the progression of scarlet fever rather than as an early symptom.
D. While fever is a common symptom of streptococcal infections, it is not the earliest indicator of scarlet fever. The rash usually appears within 12 to 48 hours of fever onset, making it a more specific early sign.

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Correct Answer is D

Explanation

A. Osmolality: Osmolality measures the concentration of solutes in the blood and is not typically affected by naproxen or indicative of the reported symptoms.

B. Serum calcium: While naproxen can cause gastrointestinal irritation and ulceration, it does not typically affect serum calcium levels. Monitoring serum calcium would not directly address the client's reported symptoms.

C. Erythrocyte sedimentation rate (ESR): ESR is a nonspecific marker of inflammation and is not directly related to the reported symptoms of stomach pain, weakness, and fatigue associated with naproxen use.

D. Hemoglobin: Naproxen, a nonsteroidal anti-inflammatory drug (NSAID), can cause gastrointestinal bleeding, which may lead to anemia and a decrease in hemoglobin levels. Monitoring hemoglobin levels can help assess for gastrointestinal bleeding in this client who is experiencing stomach pain and weakness/fatigue.

A. Keep the bed in the lowest position and initiate seizure and fall precautions. B. Place an indwelling urinary catheter and measure strict intake and output. C. Maintain elevated positioning of the dependent joints on affected side. D. Start two large bore IV catheters and review inclusion criteria for IV fibrinolytic therapy.

Correct Answer is D

Explanation

A. Keep the bed in the lowest position and initiate seizure and fall precautions: While seizure and fall precautions may be necessary for safety, the client's symptoms, including right-sided weakness and sluggish speech, are indicative of a potential stroke rather than a seizure. Immediate intervention to assess for and treat possible stroke is critical.

B. Place an indwelling urinary catheter and measure strict intake and output: Although urinary management may be necessary, it is not the priority in this situation. The client's symptoms suggest a neurological issue that requires urgent assessment and intervention.

C. Maintain elevated positioning of the dependent joints on affected side: Elevating the dependent joints is a strategy used in managing conditions like stroke to prevent complications such as edema, but it does not address the immediate need for stroke assessment and intervention.

D. Start two large bore IV catheters and review inclusion criteria for IV fibrinolytic therapy: Correct! The client's presentation with right-sided weakness and sluggish speech suggests a possible ischemic stroke. Starting IV access and reviewing inclusion criteria for IV fibrinolytic therapy (tPA is crucial for timely intervention to restore blood flow and minimize neurological damage.

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A preschool-aged child who is being treated for Streptococcal pharyngitis returns to the clinic for signs of scarlet fever. Which assessment finding provides the earliest indication to the nurse that the child is experiencing a reaction to the toxins that are created by the Streptococcus bacteria?

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Naxlex Comprehensive Predictor Exams

A client with arthritis has been receiving treatment with naproxen and now reports ongoing stomach pain, increasing weakness, and fatigue. Which laboratory test should the nurse monitor?

Correct Answer is D

Explanation

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Correct Answer is D

Explanation

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