A 9-year-old patient has been complaining of headache, coughing, and an aching chest. The care provider makes a diagnosis of a viral infection. The child’s mother tells the nurse that when she first said she had a headache, the child’s father gave her half of an adult aspirin. The mother has heard of Reye syndrome and asks the nurse if her child could get this. Which statement would be the best response by the nurse?
“This might or might not be a problem. Watch your daughter for signs of lethargy, unusual irritability, stupor, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome.”
“This might or might not be a problem. Watch your daughter for signs of nasal discharge, sneezing, itching of the nose, or dark circles under the eyes. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome.”
“This is a serious problem. Aspirin is likely to cause Reye syndrome, and she should be admitted to the hospital for observation as a precaution.”
“This is unlikely to be a problem. Half an aspirin is not enough to cause harm. Reye syndrome generally only develops from prolonged use of aspirin in connection with a virus.”
The Correct Answer is A
Choice A reason: Half an aspirin with a viral infection poses a small Reye syndrome risk, warranting monitoring for symptoms like lethargy or vomiting. This aligns with pediatric safety guidelines, making it the best response to inform the mother while ensuring vigilance for the 9-year-old’s health.
Choice B reason: Nasal discharge and sneezing are unrelated to Reye syndrome, which involves neurological symptoms like stupor. Monitoring for lethargy or vomiting is correct, making this incorrect, as it lists irrelevant symptoms for the mother’s concern about Reye syndrome in her child.
Choice C reason: Admitting for observation overstates the risk, as a single half aspirin rarely causes Reye syndrome. Monitoring for specific symptoms is sufficient, making this alarmist and incorrect compared to the nurse’s balanced response to the mother’s concern about the viral infection.
Choice D reason: Downplaying the risk as unlikely ignores the potential, though rare, link between aspirin and Reye syndrome in viral infections. Monitoring for symptoms is prudent, making this dismissive and incorrect compared to advising vigilance for the 9-year-old’s safety post-aspirin use.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: At birth, the infant’s right and left ventricles are nearly equal in size due to fetal circulation demands. This aligns with pediatric cardiology, making it the correct statement demonstrating understanding of the newborn’s cardiovascular system as discussed in the nurses’ review session.
Choice B reason: The heart matures earlier, with adult-like function by early childhood, not 8-10 years. Equal ventricle size at birth is accurate, making this incorrect, as it overestimates the timeline for cardiovascular maturation in the nurse’s understanding of the child’s heart development.
Choice C reason: Heart rate typically increases with fever in children, not decreases, due to metabolic demands. Equal ventricle size at birth is correct, making this inaccurate and incorrect compared to the true statement about the infant’s cardiovascular system in the nurses’ review.
Choice D reason: The left ventricle grows slightly larger but not twice the right’s size by 5-6 years. Equal ventricles at birth is accurate, making this incorrect, as it exaggerates ventricular growth in the nurse’s understanding of the child’s cardiovascular system development.
Correct Answer is C
Explanation
Choice A reason: Using tweezers risks ear canal injury or pushing paper deeper in a 2-year-old, potentially causing trauma. Professional evaluation ensures safe removal, making this dangerous and incorrect compared to advising immediate medical attention to address the potential foreign object in the child’s ear safely.
Choice B reason: Delaying care for irritation risks complications like infection or eardrum damage from a foreign object in a 2-year-old. Immediate provider assessment is safer, making this inadequate and incorrect compared to prioritizing prompt medical evaluation for the child’s potential ear issue.
Choice C reason: Immediate care provider evaluation ensures safe removal of any paper, preventing ear damage or infection in a 2-year-old. Advising against inserting objects protects the child, aligning with pediatric safety protocols, making this the correct response to address the caregiver’s concern effectively.
Choice D reason: Washing the ear with a syringe may push paper deeper or injure a 2-year-old’s delicate ear canal. Professional intervention is needed, making this risky and incorrect compared to seeking immediate medical evaluation to safely address the potential foreign object in the child’s ear.
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