A nurse is planning care for a child who has varicella. Which of the following interventions should the nurse plan to include?
Administer aspirin for fever.
Initiate airborne precautions,
Assess the oral cavity for Koplik spots.
Provide the child with a warm blanket
The Correct Answer is B
Choice A Reason:
Administer aspirin for fever is incorrect. Aspirin is contraindicated in children with varicella due to the risk of Reye's syndrome. Reye's syndrome is a rare but serious condition that can occur when aspirin is given to children with certain viral infections, including varicella.
Choice B Reason:
Initiate airborne precautions is correct. Varicella is transmitted via airborne droplets. Use airborne precautions (negative air-flow rooms) for patients with varicella. If negative air-flow rooms are not available, isolate patients in closed rooms with no contact with people without evidence of immunity
Choice C Reason:
Assess the oral cavity for Koplik spots is incorrect. Koplik spots are associated with measles, not varicella. Varicella typically presents with a rash that starts on the trunk and spreads to the rest of the body, along with other symptoms like fever and malaise.
Choice D Reason:
Varicella can cause fever and discomfort, and providing a warm blanket can offer comfort to the child, helping to alleviate chills or discomfort associated with fever. However, it is more important to initiate airborne precautions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
No explanation
Correct Answer is B
Explanation
Choice A Reason:
Hyperactive reflexes are incorrect. Gasoline inhalation tends to affect the central nervous system and might result in CNS depression rather than hyperactivity, so hyperactive reflexes are less likely.
Choice B Reason:
Ataxia is correct.
Ataxia, which refers to a lack of muscle coordination or unsteady movements, can be an expected finding in individuals who have inhaled gasoline fumes. Gasoline inhalation can affect the nervous system, leading to symptoms like ataxia, dizziness, confusion, and unsteady gait.
Choice C Reason:
Hypothermia is incorrect. Gasoline inhalation is not typically associated with hypothermia. Inhaling gasoline vapors might cause respiratory irritation or CNS effects but not hypothermia.
Choice D Reason:
Pinpoint pupils is incorrect. Pinpoint pupils are more commonly associated with opioid use or certain medications affecting the nervous system. Gasoline inhalation is not typically associated with this pupil reaction.
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