An occupational health nurse is preparing to assess a work environment.
Which of the following should the nurse plan to use when identifying work processes and equipment hazards?

Choice A rationale

Securing electrical cords to the edges of the floor can create a tripping hazard, as cords can still be lifted or become loose, potentially causing falls for an older adult with impaired gait or balance. Instead, cords should be tucked away or routed along the baseboards to minimize any elevated surfaces that could obstruct movement and lead to injury. This prevents falls.

Choice B rationale

Using tape that is gray, a color often found on floors, can decrease visibility of the stair edges, making it difficult for an older adult to perceive the steps, especially if they have age-related vision changes. Markings should be in a contrasting, bright color to enhance visual cues and improve depth perception, thus reducing the risk of missteps and falls.

Choice C rationale

Bathmats with foam backing are generally not recommended because they can be slippery when wet and may not provide sufficient grip, increasing the risk of falls in the bathroom. Additionally, foam backing can degrade over time and lose its non-slip properties. A better option is a bathmat with a rubberized or suction-cup backing.

Choice D rationale

Keeping the water heater temperature below 49°C (120°F) is a crucial safety measure to prevent scalding and burns, which can be more severe in older adults due to thinner skin. At temperatures above this threshold, a third-degree burn can occur in as little as 5 seconds. This simple modification greatly reduces the risk of accidental thermal injury.

Rationale for correct answers

Kawasaki disease is an acute vasculitis of unknown etiology, most likely triggered by an autoimmune inflammatory process. It primarily affects children under 5 but can occur in school-aged children. Clinical features include prolonged fever (>5 days), mucocutaneous inflammation (strawberry tongue, cracked lips), conjunctivitis, rash, and cervical lymphadenopathy. Tachycardia (HR >100/min) and tachypnea (RR >20/min) may reflect systemic inflammation. Risk of coronary artery aneurysm necessitates early diagnosis and IVIG treatment. Lab findings often include:

• Elevated ESR/CRP
• Thrombocytosis (>450,000/mm³ in subacute phase)
• Sterile pyuria
• Mild transaminitis

Rationale for incorrect Response 1 options

A. Acute rheumatic fever follows untreated Group A Streptococcus pharyngitis and presents with migratory arthritis, carditis, and chorea—not mucocutaneous signs or persistent fever without sore throat.

B. Toxic epidermal necrolysis is a severe drug reaction with widespread epidermal detachment, not associated with systemic vasculitis or cardiovascular risk.

C. Hemolytic uremic syndrome presents with bloody diarrhea, anemia, and renal failure—none of which are noted here.

Rationale for incorrect Response 2 options

A. Group A beta-hemolytic streptococcus infection causes rheumatic fever and glomerulonephritis, not Kawasaki disease.

B. Adverse drug reaction may cause TEN or Stevens-Johnson syndrome, but not Kawasaki’s vasculitis.

C. Shiga toxin-producing E. coli causes HUS, not systemic vasculitis or mucocutaneous inflammation.

Take-home points

• Kawasaki disease is a pediatric vasculitis with risk of coronary artery aneurysm.
• Diagnosis is clinical; fever >5 days plus ≥4 mucocutaneous criteria.
• Differentiate from HUS, rheumatic fever, and drug reactions based on systemic and mucocutaneous findings.
• Early IVIG and aspirin reduce cardiac complications.