The nurse is caring for a child with suspected Reye syndrome.
Which symptom is most concerning?

Choice A rationale

Instructing the student to avoid all physical activity is not the priority intervention. While reducing friction and sweating can be beneficial, completely ceasing activity may not be necessary with appropriate treatment and hygiene measures. The rash is likely a fungal infection, not exacerbated by moderate activity if properly managed.

Choice B rationale

Advising the student to apply an over-the-counter topical antifungal cream is the most appropriate initial intervention. The presentation of a well-demarcated, erythematous, scaly rash in the groin, sparing the scrotum and penis, in a wrestler wearing tight athletic gear strongly suggests tinea cruris, a fungal infection. Topical antifungals are the first-line treatment for this condition.

Choice C rationale

Referring the student for oral antibiotic therapy is not indicated at this stage. The clinical presentation is highly suggestive of a fungal infection, for which antibiotics are ineffective. Antibiotics are used to treat bacterial infections, which typically present with different characteristics such as pus or systemic symptoms.

Choice D rationale

Recommending a topical corticosteroid is not the priority. While corticosteroids can reduce inflammation and itching, they do not treat the underlying fungal infection and can sometimes worsen it by suppressing the local immune response. Antifungal treatment should be initiated first to address the cause of the rash.

Choice A rationale

Currant jelly stools (stools mixed with blood and mucus) and drawing the knees to the chest are classic signs and symptoms of intussusception in infants. The telescoping of one part of the intestine into another leads to bowel obstruction, inflammation, and bleeding, resulting in the characteristic stool appearance and abdominal pain that causes the infant to draw their knees up in an attempt to relieve the discomfort.

Choice B rationale

Ribbon-like stools and visible peristalsis are more characteristic of Hirschsprung's disease (congenital aganglionic megacolon), a condition where a segment of the colon lacks nerve cells, impairing motility and leading to constipation and a narrowed segment of the bowel. Visible peristalsis can occur due to the bowel trying to push stool through the narrowed segment.

Choice C rationale

Explosive watery diarrhea and fever are typical signs of gastroenteritis, an inflammation of the gastrointestinal tract usually caused by a viral or bacterial infection. While vomiting can occur in both conditions, the stool characteristics and the presence of fever are more indicative of gastroenteritis rather than intussusception.

Choice D rationale

Bright red blood in the stool without other symptoms is less specific to intussusception. While blood can be present, it is usually mixed with mucus, giving the currant jelly appearance. Bright red blood alone might suggest other conditions like anal fissures or lower gastrointestinal bleeding. .