The nurse is performing an assessment on a child and notes the presence of Koplik’s spots. In which communicable disease are Koplik’s spots present?
Rubella
Measles (rubeola)
Chickenpox (varicella)
Exanthema subitum (roseola)
The Correct Answer is B
Measles (rubeola) is a communicable disease that is characterized by Koplik’s spots, which are clustered, white lesions on the buccal mucosa opposite the lower molars. They appear two to three days before the measles rash and are pathognomonic for measles.
Choice A is wrong because rubella is a different viral infection that causes a mild rash and fever, but does not have Koplik’s spots.
Choice C is wrong because chickenpox (varicella) is caused by the varicella-zoster virus and produces fluid-filled blisters on the skin, not white spots in the mouth.
Choice D is wrong because exanthema subitum (roseola) is caused by the human herpesvirus 6 or 7 and causes a high fever followed by a pink rash on the trunk and neck, but no oral lesions.
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Correct Answer is D
Explanation
This pattern is called periodic breathing and it is characterized by 5 to 10 seconds of respiratory pauses followed by 10 to 15 seconds of compensatory rapid respiration. It is a normal phenomenon that occurs primarily in premature infants of more than 24 hours of age. It is usually not of pathologic significance and does not require intervention.
Choice A is wrong because sleep or wakeful apnea is defined as a cessation of breathing for more than 20 seconds or less than 20 seconds with bradycardia or cyanosis.
Choice B is wrong because severe swings in blood pressure are not associated with periodic breathing, but rather with intraventricular hemorrhage or patent ductus arteriosus.
Choice C is wrong because trying to maintain a neutral thermal environment does not affect the respiratory pattern of premature infants.
Normal ranges for respiratory rate in premature infants are 40 to 60 breaths per minute. Normal ranges for oxygen saturation in premature infants are 88% to 92%.
Correct Answer is C
Explanation
Uterine atony.
This is when the uterus does not contract enough to stop the bleeding from the placental site after delivery. It is the most common cause of postpartum hemorrhage, accounting for up to 80% of cases. Uterine atony can be caused by factors such as prolonged or augmented labor, large baby, multiple pregnancies, infection, or retained placenta.
The woman in question has some risk factors for uterine atony, such as a large baby and augmentation of labor with Pitocin.
The other choices are wrong because:
A . Retained placental fragments: This is when parts of the placenta remain attached to the uterine wall and prevent it from contracting properly. It is the second most common cause of postpartum hemorrhage.
However, there is no indication in the question that the woman had any difficulty with the delivery of the placenta or that it was incomplete
B. Unrepaired vaginal lacerations: This is when there are tears or cuts in the vagina or cervix that cause bleeding. It is a less common cause of postpartum hemorrhage.
However, there is no indication in the question that the woman had any trauma during delivery or that she was examined for lacerations
D. Puerperal infection: This is when there is an infection in the uterus or other parts of the reproductive tract after delivery.
It can cause fever, pain, and bleeding. It is a rare cause of postpartum hemorrhage.
However, there is no indication in the question that the woman had any signs or symptoms of infection, such as fever, chills, or foul-smelling discharge.
Normal ranges for blood loss after delivery are less than 500 mL for vaginal birth and less than 1000 mL for C-section.
Any amount above these thresholds can be considered postpartum hemorrhage and requires prompt evaluation and treatment.
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