The nurse is assessing a child admitted with a diagnosis of rheumatic fever. Which significant question would the nurse ask the child's parent during the assessment?
"Has your child been exposed to anyone with chicken pox
"Has any family member had a sore throat within the past few weeks?"
"Has any family member had a gastrointestinal disorder in the past few weeks?
"Has your child had difficulty urinating?
The Correct Answer is B
A. "Has your child been exposed to anyone with chicken pox?"
While chickenpox is caused by a different virus (varicella-zoster virus) and is not directly linked to rheumatic fever, the nurse might inquire about exposure to contagious illnesses as a general part of the assessment.
B. "Has any family member had a sore throat within the past few weeks?"
This question is relevant because rheumatic fever often follows an untreated or inadequately treated group A streptococcal infection, such as strep throat. A sore throat in a family member could indicate the presence of streptococcal infection, which is a crucial factor in the development of rheumatic fever.
C. "Has any family member had a gastrointestinal disorder in the past few weeks?"
Gastrointestinal disorders are not directly associated with the development of rheumatic fever. However, a comprehensive medical history might include questions about recent illnesses to understand the overall health context.
D. "Has your child had difficulty urinating?"
Difficulty urinating is not a typical symptom or risk factor associated with rheumatic fever. This symptom would likely prompt investigation into other potential issues but is not specifically related to rheumatic fever.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Sausage-shaped mass palpated in the upper right abdominal quadrant.
Explanation: A sausage-shaped mass in the upper right abdominal quadrant is more indicative of Hirschsprung's disease, not imperforate anus. In Hirschsprung's disease, there is a lack of ganglion cells in the rectum, leading to obstruction and a palpable mass.
B. The passage of currant jelly-like stools.
Explanation: The passage of currant jelly-like stools is characteristic of intussusception, a condition where one portion of the intestine telescopes into another. It is not associated with imperforate anus.
C. Bile-stained fecal emesis.
Explanation: Bile-stained fecal emesis suggests a possible intestinal obstruction or other gastrointestinal issue, but it is not a specific manifestation of imperforate anus. Imperforate anus is primarily characterized by the absence of a normal anal opening.
D. Failure to pass meconium stool in the first 24 hours after birth.
Explanation:
Imperforate anus refers to a congenital condition in which the opening to the anus is absent or improperly formed. One of the clinical manifestations is the failure to pass meconium stool within the first 24 hours after birth. Meconium is the thick, sticky, greenish-black substance that constitutes a newborn's first stools. The absence of meconium passage suggests a potential obstruction.
Correct Answer is C
Explanation
A. "The immunization schedule will need to be altered."
Incorrect: This is too vague and does not provide specific information about the child's immunization schedule.
B. "The child will receive all of the immunizations except for the polio series."
Incorrect: There is no indication that the child should not receive the polio vaccine. Children with cystic fibrosis are generally recommended to receive all appropriate vaccinations.
C. "The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination."
Correct Answer: Children with cystic fibrosis should receive the recommended basic series of immunizations, including vaccines for diseases such as diphtheria, pertussis, tetanus, measles, mumps, rubella, polio, Haemophilus influenzae type b (Hib), hepatitis B, and others. Additionally, they should receive a yearly influenza vaccination to help prevent respiratory complications.
D. "The child should not receive any hepatitis vaccines."
Incorrect: There is no general contraindication for children with cystic fibrosis to receive hepatitis vaccines. The nurse should recommend the appropriate vaccines, including those for hepatitis B, as per the standard immunization schedule.
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