A charge nurse on a pediatric unit is observing a newly licensed nurse provide care for a child diagnosed with acute epiglottis. Which of the following actions by the newly licensed nurse indicates that the charge nurse should intervene?
Assessing vital signs with temperature and oxygen saturation.
Gathering necessary supplies for possible intubation.
Assessing the child's throat using a tongue blade.
Reporting an elevated white blood count to the health care provider.
The Correct Answer is C
A. Assessing vital signs, including temperature and oxygen saturation, is appropriate for monitoring the child's condition and identifying any signs of respiratory distress or infection.
B. Gathering necessary supplies for possible intubation is a proactive measure in case the child experiences airway obstruction. Acute epiglottitis can lead to rapid deterioration in the child's airway.
C. Assessing the child's throat using a tongue blade can trigger airway obstruction in a child with acute epiglottitis, which is a medical emergency. The throat should not be examined visually due to the risk of causing a spasm or obstruction.
D. Reporting an elevated white blood count is a normal part of managing acute infections, such as epiglottitis, and should be done to inform the healthcare provider of the patient's condition.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Small pieces of banana are soft and typically pose a lower choking risk compared to firmer or rounder foods.
B. Cut-up grapes pose a high choking hazard due to their round shape and firm texture, which can obstruct the airway if not cut into small enough pieces.
C. Baked potato is soft and generally not a high choking risk unless it is served in large chunks.
D. Cut-up pieces of steak can be a choking hazard if not cooked or cut appropriately, but grapes present a more significant risk due to their shape and size.
Correct Answer is ["A","C","D","E"]
Explanation
A. Atlantoaxial instability is a condition that can occur in children with Down syndrome, where the upper spine is less stable, leading to potential neurological complications.
B. Normal developmental milestones are typically delayed in children with Down syndrome, making this option incorrect.
C. Congenital hypothyroidism is common in children with Down syndrome, and thyroid function should be regularly monitored.
D. Children with Down syndrome are at higher risk for frequent respiratory infections due to an altered immune system and other factors.
E. Congenital heart defects are present in a significant number of children with Down syndrome, making this a key clinical manifestation.
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