The nurse is caring for a school-age child with varicella. What should the nurse observe about the rash that is associated with this infection?
Dark red, macular lesions, and very pruritic
Various stages of lesions present at the same time, appear in successive crops, and very pruritic
Yellowish, scaly patches present on the scalp
A pink maculopapular rash starts at the hairline and spreads down the body
The Correct Answer is D
A. Dark red, macular lesions, and very pruritic:
Varicella lesions are typically pink or red and start as macules (flat, red spots) that develop into papules (raised bumps) and then vesicles (fluid-filled blisters). Dark red macular lesions are not commonly associated with varicella.
B. Various stages of lesions present at the same time, appear in successive crops, and very pruritic:
The presence of various stages of lesions (papules, vesicles, crusts) simultaneously, occurring in successive crops, and being intensely itchy are typical features of varicella.
C. Yellowish, scaly patches present on the scalp:
Yellowish, scaly patches on the scalp are not typical of varicella. This description is more indicative of conditions like seborrheic dermatitis rather than the rash associated with chickenpox.
D. A pink maculopapular rash starts at the hairline and spreads down the body.
Varicella rash usually begins as pink or red spots that develop into small, itchy, fluid-filled blisters (vesicles). These vesicles can then progress to form crusts and scabs. The rash often starts on the face, scalp, or trunk and then spreads to other parts of the body, gradually covering the entire body.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Dark red, macular lesions, and very pruritic:
Varicella lesions are typically pink or red and start as macules (flat, red spots) that develop into papules (raised bumps) and then vesicles (fluid-filled blisters). Dark red macular lesions are not commonly associated with varicella.
B. Various stages of lesions present at the same time, appear in successive crops, and very pruritic:
The presence of various stages of lesions (papules, vesicles, crusts) simultaneously, occurring in successive crops, and being intensely itchy are typical features of varicella.
C. Yellowish, scaly patches present on the scalp:
Yellowish, scaly patches on the scalp are not typical of varicella. This description is more indicative of conditions like seborrheic dermatitis rather than the rash associated with chickenpox.
D. A pink maculopapular rash starts at the hairline and spreads down the body.
Varicella rash usually begins as pink or red spots that develop into small, itchy, fluid-filled blisters (vesicles). These vesicles can then progress to form crusts and scabs. The rash often starts on the face, scalp, or trunk and then spreads to other parts of the body, gradually covering the entire body.
Correct Answer is ["-195"]
Explanation
The water intake is half of 900 mL, which is 450 mL. The soft drink intake is 12 oz, which is equivalent to 355 mL. Therefore, the total fluid intake is 450 + 355 = 805 mL.
The urine output is the sum of the two voids, which is 600 + 350 = 950 mL. The drainage output is 50 mL. Therefore, the total fluid output is 950 + 50 = 1000 mL.
The net I/O is the difference between the fluid intake and output, which is 805 - 1000 = -195 mL. This means that the patient had a negative fluid balance of 195 mL during the night.
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