A client who is hypotensive is receiving dopamine, an adrenergic agonist, IV at the rate of 8 mcg/kg/min. Which intervention should the nurse implement while administering this medication?

The correct answer is A. Flushed, peeling skin

Choice A reason: Flushed, peeling skin is a classic sign of scarlet fever, which is a condition that can arise from Streptococcal pharyngitis. Scarlet fever is characterized by a red rash that can cover most of the body and may lead to the skin peeling. This symptom is a direct reaction to the toxins produced by the Streptococcal bacteria.

Choice B reason: Red bumps across the chest could be indicative of many conditions and are not specifically characteristic of the reaction to toxins produced by Streptococcal bacteria. While a rash is common in scarlet fever, it typically starts on the face or neck and spreads to the rest of the body, rather than presenting as isolated red bumps.

Choice C reason: A white coating on the tongue, often referred to as “strawberry tongue,” is indeed associated with scarlet fever. However, it is not the clearest indication of a reaction to the toxins. The white coating usually precedes the strawberry-like appearance, where the tongue becomes red and bumpy.

Choice D reason: While a high fever is a symptom of scarlet fever, it is not specific to the reaction to toxins from Streptococcal bacteria, as many infections can cause high fevers. The term “protracted” suggests a prolonged fever, which could be seen in various conditions.

Choice A reason: Feeding the infant every 4 hours is not a specific instruction for home phototherapy, which is a treatment that uses blue light to break down excess bilirubin in the skin and blood. However, feeding the infant frequently is important to promote hydration and elimination of bilirubin through urine and stool.

Choice B reason: Performing diaper changes under the light is not a recommended instruction for home phototherapy, which is a treatment that uses blue light to break down excess bilirubin in the skin and blood. The nurse should instruct the parents to turn off the light and cover the infant's eyes with protective goggles or patches during diaper changes to prevent eye damage or irritation.

Choice D reason: Covering with a receiving blanket is not an appropriate instruction for home phototherapy, which is a treatment that uses blue light to break down excess bilirubin in the skin and blood. The nurse should instruct the parents to keep the infant unclothed except for a diaper and eye protection during phototherapy to maximize skin exposure to the light and increase its effectiveness.