The nurse is providing teaching to the parents of a child with varicella.
Which statement indicates that the parents have understood the instructions?
"He can go back to school 24 hours after we start the antibiotic.”.
"We need to make sure that he washes his hands frequently.”.
"His sister had the vaccine so she can't catch it.”.
"If he has a fever, we can give him some acetaminophen.”. — . . .
The Correct Answer is D
Choice A rationale
Varicella, or chickenpox, is caused by a virus, and therefore antibiotics are completely ineffective for treatment or reducing contagiousness. The child must be isolated until all lesions have scabbed over, which indicates the end of the contagious period. Returning to school based on starting an antibiotic regimen shows a misunderstanding of the required isolation period.
Choice B rationale
While good hand hygiene is generally important for preventing the spread of many diseases, the primary mode of transmission for varicella is airborne or direct contact with vesicular fluid. The main method of contagion control is strict isolation until all lesions are fully crusted over, not just frequent hand washing, making this statement incomplete for effective prevention.
Choice C rationale
The varicella vaccine is highly effective, but it does not offer 100 percent protection. Breakthrough infection can occur, though it is often a milder case. Therefore, the statement that the sister "can't catch it" is scientifically inaccurate and creates a false sense of security, showing the parents need further education on vaccine efficacy and breakthrough risk.
Choice D rationale
Acetaminophen is the recommended antipyretic for fever associated with varicella. Crucially, salicylates (aspirin) must be avoided due to the significant risk of Reye's syndrome, a serious and potentially fatal condition involving liver and brain swelling. Selecting acetaminophen confirms that the parents understand the correct and safe method for fever management.
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Naxlex Comprehensive Predictor Exams
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Correct Answer is D
Explanation
Choice A rationale
Varicella, or chickenpox, is caused by a virus, and therefore antibiotics are completely ineffective for treatment or reducing contagiousness. The child must be isolated until all lesions have scabbed over, which indicates the end of the contagious period. Returning to school based on starting an antibiotic regimen shows a misunderstanding of the required isolation period.
Choice B rationale
While good hand hygiene is generally important for preventing the spread of many diseases, the primary mode of transmission for varicella is airborne or direct contact with vesicular fluid. The main method of contagion control is strict isolation until all lesions are fully crusted over, not just frequent hand washing, making this statement incomplete for effective prevention.
Choice C rationale
The varicella vaccine is highly effective, but it does not offer 100 percent protection. Breakthrough infection can occur, though it is often a milder case. Therefore, the statement that the sister "can't catch it" is scientifically inaccurate and creates a false sense of security, showing the parents need further education on vaccine efficacy and breakthrough risk.
Choice D rationale
Acetaminophen is the recommended antipyretic for fever associated with varicella. Crucially, salicylates (aspirin) must be avoided due to the significant risk of Reye's syndrome, a serious and potentially fatal condition involving liver and brain swelling. Selecting acetaminophen confirms that the parents understand the correct and safe method for fever management.
Correct Answer is A
Explanation
Step 1 is: Calculate the minimum safe dose for 24 hours. 5 mcg/kg/24 hr × 16.1 kg = 80.5 mcg/24 hr.
Step 2 is: Calculate the maximum safe dose for 24 hours. 6 mcg/kg/24 hr × 16.1 kg = 96.6 mcg/24 hr.
Step 3 is: Compare the ordered dose to the safe range. The ordered dose is 150 mcg. The safe dose range is 80.5 mcg to 96.6 mcg. The ordered dose (150 mcg) is higher than the maximum safe dose (96.6 mcg). The ordered dose is NOT safe, so the initial answer is B. However, the question choices are A. Yes, B. No, C. The dose is too low for the client's weight, D. The safe dose range is too narrow to determine. Since the ordered dose is too high, the most accurate choice indicating it is NOT safe is "No".
Choice A rationale
The statement "Yes" is incorrect because the ordered dose of 150 mcg is significantly above the calculated safe range maximum of 96.6 mcg/24 hr. Administering an overdose of levothyroxine can lead to hyperthyroidism symptoms like tachycardia, heat intolerance, and anxiety, which is not a safe practice.
Choice B rationale
The statement "No" is correct because the ordered dose of 150 mcg is not within the therapeutic and safe range of 80.5 mcg to 96.6 mcg for a 16.1 kg child. Dosing levothyroxine accurately is crucial as it has a narrow therapeutic index, and excess dosage carries risks of serious cardiac side effects.
Choice C rationale
The statement "The dose is too low for the client's weight" is incorrect. The maximum safe dose is 96.6 mcg, and the ordered dose is 150 mcg, which makes the ordered dose too high, not too low. Giving an excessively high dose can cause adverse effects due to drug toxicity or an induced hypermetabolic state in the body systems.
Choice D rationale
The statement "The safe dose range is too narrow to determine" is incorrect. The safe dose range is clearly defined by the provided parameters as 80.5 mcg to 96.6 mcg/24 hr. The calculation provides a precise and sufficient range to determine that the ordered dose of 150 mcg is clearly unsafe and should be questioned by the nurse.
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