The nurse caring for a child diagnosed with rubeola (measles) notes that the pediatrician has documented the presence of Koplik's spots. On the basis of this documentation, which observation is expected?
whitish vesicles located across the chest
Small blue-white spots with a red base found on the buccal mucosa
Pinpoint petechiae noted on both legs
Petechiae spots that are reddish and pinpoint on the soft palate
The Correct Answer is B
A. Whitish vesicles located across the chest:
Incorrect: This description does not match the characteristic appearance or location of Koplik's spots in measles.
B. Small blue-white spots with a red base found on the buccal mucosa:
Correct Answer: Koplik's spots are small, blue-white spots with a red base that typically appear on the buccal mucosa (inner lining of the cheeks). These spots are characteristic of measles and are considered a diagnostic feature.
C. Pinpoint petechiae noted on both legs:
Incorrect: Petechiae are small, reddish-purple spots that result from bleeding under the skin. They are not characteristic of Koplik's spots in measles.
D. Petechiae spots that are reddish and pinpoint on the soft palate:
Incorrect: While petechiae can occur in various conditions, they are not characteristic of Koplik's spots in measles. Koplik's spots specifically manifest as small blue-white spots on the buccal mucosa.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Cranberry juice
Explanation: Acidic and citrus juices, including cranberry and orange juice, should be avoided in the immediate postoperative period as they can be irritating to the surgical site and may increase the risk of bleeding.
B. Crushed ice
Explanation:
After a tonsillectomy, it's important to provide cold and clear fluids to soothe the throat and prevent bleeding. Crushed ice is a suitable option as it helps keep the throat cool and provides hydration without irritating the surgical site. Cold liquids can help minimize swelling and provide comfort.
C. Vanilla milkshake
Explanation: While milkshakes may be appealing, dairy products can coat the throat and may not be recommended immediately after surgery. Additionally, it's crucial to avoid using straws, as sucking can increase the risk of bleeding.
D. Orange juice
Explanation: As mentioned earlier, citrus juices like orange juice can be irritating to the surgical site and are not recommended in the early postoperative period after a tonsillectomy. It's essential to choose clear and non-acidic fluids to support healing and prevent complications.
Correct Answer is C
Explanation
A. A period of play in the playroom:
Incorrect: While play is generally therapeutic, simply engaging in general play may not directly address the child's distress related to the insulin injection.
B. A video game:
Incorrect: Playing a video game might serve as a distraction, but it may not specifically help the child cope with the distress of the injection in the way that hands-on play with a needleless syringe and a doll can.
C. A needleless syringe and a doll:
Correct Answer: Correct.
Explanation: Allowing the child to play with a needleless syringe and a doll provides a hands-on, interactive experience that can help the child become more familiar and comfortable with the idea of injections. This play activity allows the child to express and understand their feelings in a safe and controlled environment.
D. A story book about a child who has diabetes:
Incorrect: While a storybook can be educational and provide information, it may not directly address the child's immediate distress after an insulin injection. The hands-on play with a needleless syringe and a doll is more focused on the specific experience of receiving injections
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