A nurse is collecting data from a child who has pertussis. Which of the following manifestations should the nurse expect?

Peeling of the hands and feet

Fever

Beefy, red tongue

Facial erythema

Answer and Explanation

The Correct Answer is B

The correct answer is choice B. Fever.

Choice A rationale:

Peeling of the hands and feet is not a typical manifestation of pertussis. This symptom is more commonly associated with conditions like Kawasaki disease.

Choice B rationale:

Fever is a common symptom in the early stages of pertussis, along with a mild cough and runny nose.

Choice C rationale:

A beefy, red tongue is not associated with pertussis. This symptom is more characteristic of scarlet fever.

Choice D rationale:

Facial erythema is not a typical symptom of pertussis. Pertussis primarily affects the respiratory system, causing severe coughing fits.

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Correct Answer is A

Explanation

The correct answer is choicea. Obtain the client’s blood pressure in the other arm.

Choice A rationale:

Obtaining the client’s blood pressure in the other arm is crucial to avoid compromising the arteriovenous fistula. Measuring blood pressure in the arm with the fistula can damage the access site and impair its function.

Choice B rationale:

Encouraging the client to increase fluid intake is not appropriate for clients undergoing hemodialysis, as they often need to restrict fluid intake to prevent fluid overload.

Choice C rationale:

Reinforcing with the client to sleep on the side of the access site is incorrect. Clients should avoid sleeping on the arm with the fistula to prevent compression and potential damage to the access site.

Choice D rationale:

Obtaining the client’s weight is important for monitoring fluid balance, but it is not specific to the care of the arteriovenous fistula.

A. Oxygen saturation level B. Tremors C. Current level of consciousness D. Heart rate E. Chronic health condition F. Respiratory rate

Correct Answer is ["A","B","F"]

Explanation

A. Oxygen saturation level: The client is restless, not following commands, and has labored respirations with crackles and wheezes in the breath sounds. Monitoring the oxygen saturation level is essential to assess the client's respiratory status and oxygenation.
B. Tremors: The client has tremors in their hands. Considering the client's history of Parkinson's disease, changes in tremors should be monitored and addressed promptly.
C. The immediate concern is addressing the respiratory distress.
D. Heart rate may also be monitored, but it's not as critical in this context.
E. Chronic health conditions are relevant for the overall care plan, but they do not require immediate intervention as compared to respiratory and tremor issues.
F. Respiratory rate: The client has labored respirations and abnormal breath sounds (crackles and wheezes). Monitoring the respiratory rate is important to evaluate the client's breathing pattern and respiratory distress.

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A nurse is collecting data from a child who has pertussis. Which of the following manifestations should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assisting with the plan of care for a client who is scheduled for hemodialysis via an arteriovenous fistula in the arm. Which of the following actions should the nurse recommend?

Correct Answer is A

Explanation

Correct Answer is ["A","B","F"]

Explanation

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