A nurse in an emergency department is assessing a 3-year-old child who has a high fever, severe dyspnea, and is drooling. Which action is the nurse's priority?
Insert an IV catheter.
Prepare for nasotracheal intubation.
Administer an antipyretic.
Obtain blood culture specimens.
The Correct Answer is B
Insert an IV catheter: While this might be necessary later, it’s not the immediate priority. The child’s breathing difficulty is the most urgent concern.
B. Prepare for nasotracheal intubation: This is the correct answer. The child’s severe dyspnea indicates a serious breathing problem. Nasotracheal intubation can help ensure the child’s airway remains open.
C. Administer an antipyretic: While this might help reduce the child’s fever, it won’t address the immediate life-threatening issue, which is the child’s difficulty breathing.
D. Obtain blood culture specimens: This could be helpful in diagnosing the cause of the child’s symptoms, but it’s not the immediate priority. The first concern should be stabilizing the child’s condition.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Inspect any dogs or cats at home for lice: This is not necessary because human lice cannot infest pets.
B. Soak all combs and hairbrushes in alcohol: While cleaning combs and brushes is important, soaking them in hot water is usually sufficient. Alcohol is not necessary and can damage some materials.
C. Seal non-washable items in airtight plastic bags: This is the correct answer. Lice cannot survive without a human host for more than 48 hours. Sealing non-washable items (like stuffed animals) in airtight bags for at least two weeks can help ensure any lice or nits are dead.
D. Spray countertops and sinks with insecticide: This is not recommended. Lice do not infest homes like other pests, and insecticides can be harmful to humans, especially children. Regular cleaning is usually sufficient.
Correct Answer is C
Explanation
A. Droplet: Measles is not primarily spread through large respiratory droplets that are expelled when a person coughs or sneezes. These droplets do not remain in the air and generally only travel a short distance.
B. Contact: While measles can be spread through direct contact with an infected person, it is not the primary mode of transmission.
C. Airborne: This is the correct answer. Measles is a highly contagious disease that is spread through the air by respiratory droplets. It can remain in the air for up to two hours after an infected person leaves an area.
D. Protective environment: This type of isolation is typically used for individuals who have weakened immune systems and are at high risk of infection, not for those with measles.
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