A 5-year-old child falls from a tree and loses consciousness briefly. The child wakes up but appears drowsy and confused. What is the priority action by the nurse?
Apply a cold compress to the head
Administer pain medication
Monitor closely for signs of worsening condition
Transport the child to the emergency department immediately
The Correct Answer is D
A. Applying a cold compress can provide comfort but is not the priority action for a child with head trauma and altered mental status.
B. Administering pain medication is not the priority; the child needs a thorough evaluation and possible imaging studies to assess for head injury.
C. Monitoring closely is important, but with the history of head trauma, immediate medical evaluation is crucial to rule out any serious injury.
D. Transporting the child to the emergency department immediately is the priority to ensure proper assessment and management of head trauma.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Administering an antipyretic without further evaluation is not appropriate for a suspected case of bacterial meningitis.
B. Performing a lumbar puncture to analyze cerebrospinal fluid and starting antibiotics is the standard intervention for suspected bacterial meningitis.
C. Administering an antihistamine is not the appropriate intervention for bacterial meningitis, which is a bacterial infection of the meninges.
D. Ordering a head CT scan is not the first-line diagnostic test for suspected bacterial meningitis. A lumbar puncture is the diagnostic procedure of choice.
Correct Answer is A
Explanation
A. Administering a bronchodilator inhaler, such as albuterol, is the priority intervention for a child with asthma experiencing difficulty breathing, wheezing, and coughing.
B. Antihistamines are not the primary treatment for acute asthma exacerbations.
C. Mucolytic medications can help thin mucus but are not the first-line treatment for acute asthma symptoms.
D. Cough suppressants are not recommended for children with asthma as they can worsen respiratory distress.
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