The nurse performs an assessment of a child with pertussis (whooping cough). Which finding would the nurse identify as indicative of a potential complication?
A urinary output of 30 mL/hr
A white blood cell (WBC) count of 10.000 mm3 (10×109/L)
Decreased breath sounds in the lung bases
A weight gain
The Correct Answer is C
A. A urinary output of 30 mL/hr
Explanation: While decreased urinary output may indicate dehydration, it is not a specific finding related to pertussis. Dehydration can occur due to inadequate fluid intake or loss through vomiting or sweating.
B. A white blood cell (WBC) count of 10,000 mm3 (10×10^9/L)
Explanation: An elevated white blood cell count is a common finding in infections, including pertussis. It reflects the body's immune response to the infection. A WBC count of 10,000 mm3 is within the normal range, and while it indicates an inflammatory response, it does not specifically point to a complication.
C. Decreased breath sounds in the lung bases
Explanation:
Pertussis is a respiratory infection caused by the bacterium Bordetella pertussis. Complications can arise, including pneumonia. Decreased breath sounds in the lung bases may suggest the presence of pneumonia, which is a serious complication of pertussis. Pneumonia can lead to respiratory distress and requires prompt medical attention.
D. A weight gain
Explanation: Weight gain is not typically associated with pertussis. In fact, respiratory distress and difficulty feeding during coughing paroxysms can lead to weight loss in infants with pertussis. Weight gain may be indicative of other unrelated factors.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. "This test will confirm if your child had a recent streptococcal infection."
Explanation:
The anti-streptolysin O (ASO) titer is a blood test used to detect the presence of antibodies against streptolysin O, a toxin produced by group A Streptococcus bacteria. A rise in ASO titers indicates a recent streptococcal infection. It does not confirm rheumatic fever directly but helps in identifying a recent streptococcal infection, which is a predisposing factor for rheumatic fever.
B. "This test will indicate if your child has rheumatic fever."
Explanation: While a positive ASO titer may suggest a recent streptococcal infection, it does not directly indicate rheumatic fever. The diagnosis of rheumatic fever involves a combination of clinical criteria, including evidence of a recent streptococcal infection, along with specific signs and symptoms.
C. "This test will confirm if your child has immunity to streptococcal bacteria."
Explanation: The ASO titer does not measure immunity to streptococcal bacteria. It specifically detects antibodies produced in response to a recent streptococcal infection.
D. "This test will indicate if your child has a therapeutic blood level of an aminoglycoside."
Explanation: The ASO titer is not used to monitor therapeutic blood levels of aminoglycosides. It is specific to detecting antibodies related to streptococcal infections and is not related to aminoglycoside therapy.
Correct Answer is B
Explanation
A. "I will have my child wear soft fabric clothing under the brace."
Explanation: Wearing soft fabric clothing under the brace can enhance comfort and reduce the risk of irritation. This is a suitable practice.
B. "I need to apply lotion under the brace to prevent skin breakdown."
Explanation:
Applying lotion under the brace may lead to moisture accumulation and skin breakdown. It is generally recommended to keep the skin clean and dry under the brace to prevent irritation and pressure sores. Lotions or creams can contribute to moisture, potentially causing skin problems.
C. "I need to avoid the use of powder because it will cake under the brace."
Explanation: Powder can accumulate and cake under the brace, leading to skin issues. This statement is correct, emphasizing the importance of avoiding the use of powder.
D. "I will encourage my child to perform prescribed exercises."
Explanation: Encouraging the child to perform prescribed exercises is essential for maintaining flexibility and strength. This statement reflects a positive and supportive approach to managing scoliosis.
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