The nurse reviews the plan of care for a child with Reye's syndrome. The nurse plans to monitor for which priority complication of this syndrome?

The presence of protein in the urine

Signs of increased intracranial pressure

Signs of hyperglycemia

Signs of a bacterial infection

Answer and Explanation

The Correct Answer is B

B. Reye's syndrome is characterized by swelling of the brain (cerebral edema), which can lead to increased intracranial pressure (ICP). Monitoring for signs of increased ICP, such as changes in level of consciousness, headache, vomiting, and altered pupil size and reactivity, is crucial for early detection and intervention to prevent neurological deterioration.

A. Reye's syndrome primarily affects the liver and brain, leading to liver dysfunction and encephalopathy. While renal involvement can occur in some cases, the priority complication typically relates to liver dysfunction and neurological manifestations rather than renal impairment.

C. Hyperglycemia may be present due to liver dysfunction and altered glucose metabolism, but it is not the primary concern compared to neurological complications and hepatic failure.

D. Reye's syndrome is not caused by a bacterial infection; it is typically associated with viral illnesses, particularly influenza and varicella (chickenpox).

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Correct Answer is ["B","C","D"]

Explanation

B. Wheezing is a common symptom of asthma exacerbation and can indicate airway obstruction. Wheezing may worsen during an asthma attack, suggesting deterioration in respiratory status.

C. Nasal flaring is a sign of increased respiratory effort and can occur during respiratory distress. In a child with asthma, nasal flaring may indicate worsening airway obstruction and increased work of breathing, suggesting deterioration in respiratory status.

D. Retraction of sternal muscles, also known as intercostal retractions, occurs when the muscles between the ribs are drawn inward during inspiration, indicating increased effort to breathe. Intercostal retractions are a sign of respiratory distress and can occur in children with asthma during exacerbations, particularly when airway obstruction is severe.

A. Warm extremities are not typically indicative of deterioration in respiratory status in a child with asthma. In fact, warm extremities may suggest adequate peripheral perfusion.

E. An oxygen saturation of 95% is within the normal range for most children and may not necessarily indicate deterioration in respiratory status. However, oxygen saturation should be interpreted in conjunction with other clinical signs and symptoms.

A. The child may attend school if antibiotics have been started. B. Wipe any crusted material from the eye with a cotton ball soaked in warm water, starting at the outer aspect of the eye and moving toward the inner aspect. C. The child's towels and washcloths should not be used by other members of the household. D. Save any unused eye medication in case a sibling gets the eye infection.

Correct Answer is C

Explanation

This aligns with general guidelines for managing bacterial conjunctivitis, which emphasize the importance of cleanliness and avoiding the sharing of personal items to contain the infection.

A. Bacterial conjunctivitis is highly contagious, and the child should not attend school until they have been on antibiotics for at least 24 hours and their symptoms are improving. Allowing the child to attend school before this time could lead to the spread of the infection to other children.

B. Crusted material around the eye should be gently wiped away using a clean cotton ball soaked in warm water. It's important to start wiping from the inner aspect of the eye and move toward the outer aspect to prevent spreading any infectious material into the eye.

D. Eye medications, especially antibiotics prescribed for bacterial conjunctivitis, should not be saved for future use or shared with others. Each individual should have their own prescribed medication to avoid the risk of improper dosing or spread of infection.

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The nurse reviews the plan of care for a child with Reye's syndrome. The nurse plans to monitor for which priority complication of this syndrome?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is collecting data from a child who has asthma. Which of the following are indications of deterioration in the child's respiratory status? (Select All that Apply.)

Correct Answer is ["B","C","D"]

Explanation

The nurse is reinforcing home care instructions to the parent of a child with bacterial conjunctivitis. Which instruction would the nurse give the parent?

Correct Answer is C

Explanation

The nurse explained how to position an infant with tetralogy of Fallot if the infant suddenly becomes cyanotic. Which statement by the father leads the nurse to determine he understood the instructions?

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