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 ["260"]
Explanation
To calculate the total fluid intake, add the volumes of each item consumed:
Juice: ½ cup
1 cup = 240 mL
½ cup = 240 mL / 2 = 120 mL
Gelatin: 3 oz
1 oz ≈ 30 mL
3 oz = 3 * 30 mL = 90 mL
Ice pop: 1 oz
1 oz ≈ 30 mL
1 oz = 30 mL
Ginger ale: 20 mL
Now, add these values:
120 mL (juice) + 90 mL (gelatin) + 30 mL (ice pop) + 20 mL (ginger ale) = 260 mL
Therefore, the nurse should record 260 mL as the child's fluid intake.
Correct Answer is B
Explanation
A. Changes in the voice signal the beginning of puberty.
Explanation: Changes in the voice, specifically deepening, are associated with puberty, but they typically occur later in puberty. The voice change is related to the growth of the larynx (Adam's apple) and tends to happen after other physical changes.
B. Gynecomastia commonly occurs during late puberty.
Explanation:
Gynecomastia, the development of breast tissue in males, is a common occurrence during puberty. It is often temporary and tends to happen during late puberty. The enlargement of breast tissue can be a source of concern for adolescent boys, and providing information about the normalcy and temporary nature of gynecomastia can be reassuring for both parents and boys.
C. Puberty might be delayed if scrotal changes have not occurred by the age of 11 years.
Explanation: The timing of pubertal changes can vary among individuals. While certain age ranges are provided as general guidelines, the absence of scrotal changes by a specific age does not necessarily indicate delayed puberty. Puberty is a gradual process with individual variations.
D. Growth spurts in height occur toward the end of midpuberty.
Explanation: Growth spurts in height, known as the adolescent growth spurt, typically occur during midpuberty. This phase is marked by rapid growth in height, changes in body composition, and the development of secondary sexual characteristics.
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