The nurse is caring for a child with suspected Reye syndrome.
Which symptom is most concerning?
Projectile vomiting and confusion.
Fever and cough.
Mild headache.
Muscle aches.
The Correct Answer is A
Choice A rationale
Projectile vomiting and confusion are highly concerning symptoms in a child with suspected Reye syndrome. Projectile vomiting indicates increased intracranial pressure, and confusion reflects encephalopathy, both of which are hallmark signs of the severe neurological involvement in Reye syndrome.
Choice B rationale
Fever and cough are common symptoms of many childhood illnesses, particularly respiratory infections. While Reye syndrome can sometimes follow a viral illness, fever and cough alone are not specific indicators of this condition.
Choice C rationale
Mild headache is a relatively non-specific symptom and can be associated with various conditions. While headache may occur in the early stages of some illnesses, it is not the most concerning symptom suggestive of Reye syndrome.
Choice D rationale
Muscle aches can be associated with viral infections, which sometimes precede Reye syndrome. However, muscle aches alone are not as concerning as the neurological symptoms of confusion and increased intracranial pressure indicated by projectile vomiting.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Myoclonic seizures are characterized by brief, sudden, involuntary muscle jerks or twitches. These movements are typically not associated with a complete loss of postural tone leading to a fall. The child's presentation of suddenly dropping to the floor without warning indicates a loss of muscle strength.
Choice B rationale
Atonic seizures, also known as drop attacks, involve a sudden loss of muscle tone, causing the individual to fall abruptly. This loss of tone can be localized or generalized, affecting the entire body, which aligns with the description of the child suddenly dropping to the floor.
Choice C rationale
Absence seizures are characterized by brief lapses of consciousness, often appearing as a staring spell. Individuals usually do not fall during an absence seizure; instead, they may have subtle motor movements like eye blinking or lip smacking.
Choice D rationale
Tonic seizures involve a sudden increase in muscle tone, causing stiffening of the body, arms, or legs. While a person might fall due to the rigidity, the primary characteristic is muscle stiffening, not a sudden loss of tone.
Correct Answer is B
Explanation
Choice A rationale
Pain is a common symptom in superficial and partial-thickness burns where nerve endings are still intact. While pain indicates tissue damage, the absence of pain in a burn area can signify deeper and more severe injury where nerve endings have been destroyed.
Choice B rationale
No pain with pale, leathery skin is a characteristic finding of a full-thickness (third-degree) burn. The destruction of nerve endings eliminates pain sensation, and the skin appears dry, leathery, and may be white, charred, or translucent due to damage to all skin layers and underlying tissue.
Choice C rationale
Mild erythema, or redness of the skin, is characteristic of a superficial (first-degree) burn, such as a sunburn. These burns involve only the epidermis and are typically painful and without blisters.
Choice D rationale
Blister formation is a hallmark of partial-thickness (second-degree) burns, which involve the epidermis and part of the dermis. These burns are typically painful and moist.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.