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A nurse is performing an admission assessment of a preschooler who is in the acute phase of Kawasaki disease. Which of the following findings should the nurse expect?

A.

Decreased Heart Rate

B.

Peeling of the soles of the feet

C.

Pain in weight-bearing joints

D.

Fever unresponsive to antipyretics

E.

Determine whether the fundus is midline.

Answer and Explanation

The Correct Answer is D

Rationale:

 

A. Decreased heart rate is not typical; children with Kawasaki disease often experience tachycardia. 

 

B. Peeling of the soles of the feet is more commonly observed in the convalescent phase of Kawasaki disease rather than the acute phase. 

 

C. Pain in weight-bearing joints can occur in Kawasaki disease but is not the hallmark symptom during the acute phase. 

 

D. Fever unresponsive to antipyretics is a classic finding in the acute phase of Kawasaki disease, indicating ongoing inflammation and a need for further intervention.


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View Related questions

Correct Answer is B

Explanation

Rationale:

A. While a home health nurse visit is important, it is not an immediate safety concern for the client's discharge.

B. The need for assistance when transferring is critical information as it directly impacts the client's safety during discharge; the oncoming nurse must ensure proper support is arranged.

C. The fact that the client's partner will bring clothes is relevant but does not affect the immediate care of the client.

D. Encouragement for personal hygiene is important but is not as urgent as ensuring the client can safely transfer without risk of falls or injury.

Correct Answer is D

Explanation

Rationale:

A. A dry cough is not a common adverse effect associated with ibuprofen and is more related to respiratory issues.

B. An increase in urine output is not a typical adverse effect of ibuprofen; rather, it may indicate a different condition.

C. Muscle stiffness is a symptom of juvenile idiopathic arthritis itself and not specifically an adverse effect of ibuprofen.

D. Asking about stomach pain or bloody stools is crucial as ibuprofen can cause gastrointestinal irritation, ulcers, or bleeding, which are serious adverse effects of long-term use.

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