A 6-month-old child presented to the Emergency Department with tachypnea, marked retractions, listlessness, and poor eating and drinking. Nasal swab was positive for respiratory syncytial virus (RSV) and she was just admitted to the hospital with the diagnosis of RSV bronchiolitis. What nursing interventions would be most appropriate, assuming you have a physician's order?
Administer Synagis® immediately and encourage fluids by mouth.
Administer antiviral medication, limit fluids and give antitussives.
Encourage fluids by mouth, IV antibiotics, and oxygen mist therapy.
Provide oxygen mist therapy, administer IV fluids, and hand washing.
The Correct Answer is D
Choice A reason: This is not the correct answer because Synagis® is a monoclonal antibody that is given as a prophylaxis to prevent severe RSV infection in high-risk infants. It is not effective as a treatment for RSV bronchiolitis.
Choice B reason: This is not the correct answer because antiviral medication is not routinely recommended for RSV bronchiolitis, as it has not been shown to improve outcomes. Limiting fluids and giving antitussives may also be harmful, as they can cause dehydration and suppress the cough reflex.
Choice C reason: This is not the correct answer because IV antibiotics are not indicated for RSV bronchiolitis, which is a viral infection. Antibiotics may increase the risk of antibiotic resistance and adverse effects.
Choice D reason: This is the correct answer because oxygen mist therapy can help humidify the air and relieve the respiratory distress. IV fluids can prevent dehydration and maintain electrolyte balance. Hand washing can prevent the spread of RSV infection to other patients and staff.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: This is correct because the ordered dose of Amoxicillin is within the safe range for a 3-year-old weighing 14 kg. The daily dose of Amoxicillin is 175 mg x 3 = 525 mg. The safe dose range for a 14 kg child is 20-40 mg/kg/day, which is 280-560 mg/day. Therefore, the ordered dose is safe.
Choice B reason: This is incorrect because the ordered dose of Amoxicillin is not above the safe range for a 3-year-old weighing 14 kg. It is not necessary to reduce the dose or report it to the prescriber.
Correct Answer is A
Explanation
Choice A reason: This is the most appropriate action because it respects the youth's autonomy and maturity, and allows for timely and necessary intervention. Assent is the agreement of a minor to participate in a medical decision, and it is usually sufficient in emergency situations when parental consent is not available.
Choice B reason: This is not the most appropriate action because it may delay the surgery and put the youth at risk of further complications. Another relative may not have the legal authority to consent for the youth, and may not be reachable in time.
Choice C reason: This is not the most appropriate action because it does not address the underlying problem of the injury. Pain medications may provide temporary relief, but they may also mask the symptoms and interfere with the surgery.
Choice D reason: This is not the most appropriate action because it may jeopardize the youth's health and safety. Waiting for parents to obtain consent may result in irreversible damage or even death. The youth's best interest should be the priority in this case.
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