A 3-year-old child with a complex cardiac defect is admitted with infective endocarditis. Management (in what order) would be:
Watch for signs of cyanosis and administer high dose steroids
Obtain blood cultures, administer high dose antibiotics, assess for cardiac decompensation
Start high dose antibiotics, obtain serial blood cultures, put the child on high flow oxygen
Obtain CBC, CXR and start child on high dose aspirin
The Correct Answer is B
Choice A reason: This is not a good choice. Watching for signs of cyanosis and administering high dose steroids are not the first steps in managing infective endocarditis. Cyanosis is a late sign of hypoxia and steroids are not indicated for this condition.
Choice B reason: This is the correct choice. Obtaining blood cultures, administering high dose antibiotics, and assessing for cardiac decompensation are the priority interventions for a child with infective endocarditis. Blood cultures are needed to identify the causative organism and guide antibiotic therapy. High dose antibiotics are needed to eradicate the infection and prevent further damage to the heart valves. Cardiac decompensation is a serious complication of infective endocarditis that can lead to heart failure and shock.
Choice C reason: This is not a good choice. Starting high dose antibiotics, obtaining serial blood cultures, and putting the child on high flow oxygen are not the best order of management for infective endocarditis. Blood cultures should be obtained before starting antibiotics to avoid false negative results. High flow oxygen may not be necessary unless the child has signs of hypoxia or respiratory distress.
Choice D reason: This is not a good choice. Obtaining CBC, CXR and starting child on high dose aspirin are not the first steps in managing infective endocarditis. CBC and CXR are useful tests to monitor the infection and the cardiac function, but they are not as urgent as blood cultures. High dose aspirin is not recommended for infective endocarditis as it can increase the risk of bleeding.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: This statement is incorrect, as rechecking blood pressure and providing oxygen are not the immediate nursing priorities for a neonate with fever and signs of sepsis. Blood pressure is not a reliable indicator of perfusion in neonates, and oxygen saturation is already within normal range. The nurse should focus on identifying and treating the source of infection, preventing hypovolemia and shock, and monitoring the vital signs and blood glucose levels.
Choice B reason: This statement is incorrect, as administering aspirin and normal saline bolus are not the immediate nursing priorities for a neonate with fever and signs of sepsis. Aspirin is contraindicated in children under 18 years of age due to the risk of Reye syndrome, a rare but serious condition that affects the liver and brain. Normal saline bolus may be indicated for hypotension or shock, but only after obtaining blood cultures and starting antibiotics.
Choice C reason: This statement is incorrect, as administering antibiotics and oxygen are not the immediate nursing priorities for a neonate with fever and signs of sepsis. Antibiotics are essential for treating the infection, but they should be given after obtaining blood cultures to avoid false-negative results. Oxygen may be needed if the neonate develops hypoxia or respiratory distress, but it is not the first intervention for a neonate with normal oxygen saturation.
Choice D reason: This statement is correct, as obtaining blood cultures, providing IV fluids and antibiotics are the immediate nursing priorities for a neonate with fever and signs of sepsis. Blood cultures are necessary to identify the causative organism and guide the antibiotic therapy. IV fluids are needed to maintain hydration, perfusion, and electrolyte balance. Antibiotics are needed to eradicate the infection and prevent septic shock and organ failure.
Correct Answer is C
Explanation
Choice A reason: This statement is incorrect, as Airborne Precautions are not indicated for patients with LIP, unless they have other infections that are transmitted by airborne particles, such as tuberculosis, measles, or chickenpox. Airborne Precautions include wearing a respirator or N95 mask when entering the patient's room, placing the patient in a negative-pressure isolation room with the door closed, and limiting the movement of the patient outside the room.
Choice B reason: This statement is incorrect, as LIP is not rarely seen in children with AIDS, but rather one of the most common pulmonary complications of HIV infection in children. LIP affects about 30% to 40% of children with HIV, and is more prevalent in younger children than older children or adults.
Choice C reason: This statement is correct, as LIP is a common AIDS-defining condition in children with HIV. AIDS-defining conditions are illnesses that occur in people with advanced HIV infection and indicate a severe immunosuppression. LIP is a chronic inflammatory disorder of the lungs that causes lymphocytic infiltration of the interstitium and alveoli, leading to respiratory symptoms and impaired gas exchange.
Choice D reason: This statement is incorrect, as antibiotics are not the first-line treatment for LIP, unless there is a bacterial superinfection. Antibiotics do not target the underlying cause of LIP, which is the HIV infection and the associated immune dysfunction. The main treatment for LIP is antiretroviral therapy (ART), which suppresses the viral replication and improves the immune status of the patient. Corticosteroids may also be used to reduce the inflammation and improve the lung function.
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