A nurse is caring for a child who has red marks across his cheeks. Which of the following actions should the nurse take?
Assess the rest of the child's body for a rash.
Refer the family to child protective services.
Question the parents about how the marks occurred on the child's cheeks.
Obtain the child's temperature.
The Correct Answer is A
Choice A reason: Assess the rest of the child's body for a rash.
The child's red marks across the cheeks are characteristic of fifth disease (also known as erythema infectiosum). Fifth disease is caused by parvovirus B19 and typically presents with a bright red rash on the cheeks, often referred to as "slapped cheek" appearance. The rash may eventually spread to other areas of the body, including the arms, trunk, thighs, and buttocks. It is usually mild and self-limiting.
Choice B reason: This option is not appropriate for a rash caused by fifth disease. There is no indication of child abuse or neglect.
Choice C reason: The rash is due to a viral infection and not related to trauma or injury. Questioning the parents is unnecessary.
Choice D reason: While assessing the child's temperature is important in general nursing care, it is not specifically related to the red marks on the cheeks in this case.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: This is a contraindication for the MMR immunization, which is a live attenuated vaccine. A child who has a congenital immunodeficiency may not be able to mount an adequate immune response to the vaccine and may be at risk of developing the diseases from the vaccine.
Choice B reason: This is not a contraindication for the MMR immunization. A mild fever after a previous immunization is not a sign of an allergic reaction or a serious adverse effect. The child can still receive the MMR immunization as long as they do not have a moderate or severe illness.
Choice C reason: This is not a contraindication for the MMR immunization. Taking antibiotics for otitis media does not interfere with the effectiveness or safety of the vaccine. The child can still receive the MMR immunization as long as they do not have a moderate or severe illness.
Choice D reason: This is not a contraindication for the MMR immunization. A mild cough and a low-grade fever are not signs of a moderate or severe illness that would prevent the child from receiving the vaccine. The child can still receive the MMR immunization as long as they do not have any other contraindications.
Correct Answer is B
Explanation
Choice A reason: Changes in the voice signal the beginning of puberty is incorrect, as voice changes usually occur in the middle or late stages of puberty, not the beginning. The first sign of puberty in boys is usually testicular enlargement, followed by pubic hair growth and penile enlargement.
Choice B reason: Growth spurts in height occur toward the end of mid-puberty is correct, as this is the typical pattern of growth for boys during puberty. Boys usually start their growth spurt later than girls, but grow faster and for a longer period of time.
Choice C reason: Puberty might be delayed if scrotal changes have not occurred by the age of 11 years is incorrect, as this is not a definitive indicator of delayed puberty. Puberty can vary widely among individuals, and some boys may start later than others without any underlying problem. Delayed puberty is usually diagnosed if there is no sign of puberty by the age of 14 years.
Choice D reason: Gynecomastia commonly occurs during late puberty is incorrect, as gynecomastia, or the enlargement of breast tissue in males, usually occurs in the early or middle stages of puberty, not the late stage. It is caused by hormonal changes and usually resolves on its own within a few months or years.
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