A nurse is collecting data from a 4-month-old infant who has meningitis. Which of the following manifestations should the nurse expect?
Constipation
Depressed anterior fontanel
Presence of the rooting reflex
High-pitched cry
The Correct Answer is D
D. A high-pitched cry, often described as a "crying in pain" or "irritable cry," can be a characteristic sign of meningitis in infants. The cry may sound different from the infant's usual cry and may be associated with irritability, discomfort, or pain. It can be indicative of increased intracranial pressure and neurological irritation caused by the inflammation of the meninges.
A. Constipation is not typically associated with meningitis in infants. Meningitis is an inflammation of the membranes surrounding the brain and spinal cord, which can cause symptoms such as fever, irritability, poor feeding, vomiting, and lethargy.
B. A depressed anterior fontanel (sunken soft spot on the baby's head) is not a typical manifestation of meningitis. Meningitis may cause signs of increased intracranial pressure, such as a bulging fontanel, rather than a depressed fontanel.
C. he presence of the rooting reflex is not specific to meningitis. The rooting reflex is a normal reflex present in infants, where they turn their head toward a stimulus (such as stroking the cheek or corner of the mouth) in search of nourishment (typically the breast or bottle).
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. The sweat chloride test is considered the most definitive diagnostic test for cystic fibrosis. In this test, sweat is collected from the skin and analyzed for chloride content. Elevated levels of chloride in the sweat are indicative of cystic fibrosis. This test is highly sensitive and specific for diagnosing the condition.
B. Stool fat content analysis can help assess pancreatic function and malabsorption, which are common manifestations of cystic fibrosis. However, it is not considered the most definitive test for diagnosing cystic fibrosis. Elevated stool fat content can be suggestive of cystic fibrosis but is not specific to the condition.
C. Sputum culture may be performed to identify respiratory pathogens and guide antibiotic therapy in individuals with cystic fibrosis, but it is not the most definitive test for diagnosing the condition. It helps identify infections and monitor lung health but does not confirm the diagnosis of cystic fibrosis.
D. Pulmonary function tests are used to assess lung function and airflow, which can be affected in individuals with cystic fibrosis. While these tests provide valuable information about lung health, they are not the most definitive test for diagnosing cystic fibrosis. They are used for monitoring disease progression and response to treatment rather than confirming the diagnosis.
Correct Answer is B
Explanation
B Kawasaki disease primarily affects medium-sized arteries, including the coronary arteries. The inflammation associated with Kawasaki disease can weaken the walls of the blood vessels, leading to the formation of aneurysms, particularly in the coronary arteries. Coronary artery aneurysms are a hallmark complication of Kawasaki disease and can increase the risk of myocardial infarction and other cardiovascular problems.
A This option describes a possible consequence of Kawasaki disease. Kawasaki disease can cause inflammation of the blood vessels, including the coronary arteries, which can lead to the formation of coronary artery aneurysms. These aneurysms can disrupt blood flow to the heart muscle, leading to ischemia and potentially heart failure.
C Mitral valve stenosis is not a typical complication of Kawasaki disease. While Kawasaki disease can affect the cardiovascular system and lead to complications such as coronary artery aneurysms, it does not typically cause mitral valve stenosis.
D Atherosclerosis is not a direct consequence of Kawasaki disease. Kawasaki disease primarily involves inflammation of the blood vessels rather than changes in lipid levels, which are more commonly associated with conditions such as hyperlipidemia or familial hypercholesterolemia.
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