A school nurse is assessing a child and discovers Koplik spots on the child's buccal mucosa. Which of the following actions should the nurse take?
Check the child's classmates for parotid gland enlargement.
Ask the caregivers if the child recently used alcohol-based mouthwash.
Review the immunization records of the child's classmates.
Instruct the caregivers to increase the child's Vitamin B12 intake.
The Correct Answer is C
The correct answer is Choice C because, "Review the immunization records of the child's classmates." Koplik spots are a sign of measles, a highly contagious viral illness. Reviewing the immunization records of the child's classmates can help determine if there is an outbreak and assist in preventing further spread of the illness. Checking the child's classmates for parotid gland enlargement (Choice A is wrong because) is not relevant because it is a sign of mumps, a different illness. Asking the caregivers if the child recently used alcohol-based mouthwash (Choice B is wrong because) and instructing the caregivers to increase the child's Vitamin B12 intake (Choice D is wrong because) are not relevant because they do not relate to the presence of Koplik spots.
Choice A is wrong because: Checking the child's classmates for parotid gland enlargement is not relevant because it is a sign of mumps, not measles.
Choice B is wrong because: Asking the caregivers if the child recently used alcohol-based mouthwash is not relevant to the presence of Koplik spots.
Choice D is wrong because: Instructing the caregivers to increase the child's Vitamin B12 intake is not relevant to the presence of Koplik spots.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A is wrong because, "An adolescent who has scoliosis," Severe scoliosis may require treatment, such as a brace or surgery, but in general, scoliosis is not an acute health emergency. Early detection can help manage the condition effectively, but it is not a priority over more urgent health concerns.
Choice B is wrong because, "An adolescent who has psoriasis," is not the correct answer as it is not an urgent health issue that requires immediate attention.
Choice C is correctbecause, "A child who has nits," Nits are the eggs of lice, which are tiny parasitic insects that infest the scalp, causing itching and discomfort. While head lice infestation can be a nuisance, it is generally not dangerous. However, it is highly contagious, especially in a school setting, and can spread rapidly among children.
Choice D is wrong because, "A child who has a BMI of 18," is also not the correct answer as while it is important to address, it is not an urgent health issue that requires immediate attention.
Correct Answer is D
Explanation
The correct answer is Choice A because, Double-bag soiled dressings in polyethylene bags. The nurse should double-bag soiled dressings in polyethylene bags to contain the infection and prevent the spread of methicillin-resistant Staphylococcus aureus (MRSA). The bags should be securely tied and labeled as contaminated.
Choice B is wrong because, Encourage the client to use a HEPA filter in the house, is not the correct answer because a HEPA filter is not effective in controlling the spread of MRSA.
Choice C is wrong because, Wear a mask when within 3 feet of the client, is not the correct answer because wearing a mask is not necessary unless the nurse is providing direct care to the client and is within 3 feet of them.
Choice D is wrong because, Remove fresh flowers from the client's home, is not the correct answer because fresh flowers are not a source of MRSA.
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