A nurse in the emergency department is caring for a preschooler who has epiglottitis. Which of the following actions should the nurse take?
Place the child in a left lateral position.
Obtain a specimen from the child's throat for a culture.
Inspect the child's throat with a padded tongue depressor.
Initiate droplet precautions for the child.
The Correct Answer is D
A. Place the child in a left lateral position: Placing the child in a left lateral position is not the priority action for a preschooler with epiglottitis. Epiglottitis is a potentially life-threatening condition characterized by inflammation and swelling of the epiglottis, which can rapidly progress to airway obstruction. The priority is to maintain a patent airway and ensure adequate oxygenation.
B. Obtain a specimen from the child's throat for a culture: While obtaining a throat culture may be necessary to identify the causative organism and guide antibiotic therapy, it is not the immediate priority in the management of epiglottitis. Airway management and stabilization take precedence.
C. Inspect the child's throat with a padded tongue depressor: Direct visualization of the throat with a padded tongue depressor is contraindicated in a child with suspected epiglottitis. This action can trigger a gag reflex and potentially cause airway obstruction or exacerbate respiratory distress. Epiglottitis is a medical emergency, and any manipulation of the airway should be performed cautiously by experienced healthcare providers in a controlled setting.
D. Initiate droplet precautions for the child: Droplet precautions are appropriate for a child with suspected or confirmed epiglottitis due to the risk of transmission of the causative organism, usually Haemophilus influenzae type B (Hib), through respiratory droplets. However, the immediate priority is to secure the airway and provide respiratory support. Once the child's airway is stabilized, appropriate infection control measures, including droplet precautions, should be implemented to prevent the spread of infection to others.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["4"]
Explanation
To calculate the dose of amoxicillin for a child, the nurse needs to use the following formula:
Dose (mL) = prescribed dose (mg) / concentration (mg/mL)
In this case, the prescribed dose is 320 mg and the concentration is 400 mg/5 mL. Plugging these values into the formula, we get:
Dose (mL) = 320 mg / (400 mg/5 mL)
Dose (mL) = 320 mg x (5 mL/400 mg)
Dose (mL) = 4 mL
Therefore, the nurse should administer 4 mL of amoxicillin suspension per dose.
Correct Answer is B
Explanation
A. Give the infant liquids using a small spoon with a long handle.
Give the infant liquids using a small spoon with a long handle.While feeding is essential, the method described is not specific to postoperative care after cleft palate repair.Feedings are resumed by bottle, breast/chest, or cup per surgeon preference; some surgeons prescribe the use of an Asepto syringe for feeding or a soft cup such as a soft-tipped sippy cup.
B. Apply elbow restraints to the infant.
Apply elbow restraints to the infant is correct.Elbow restraints would be used to prevent the infant from injuring or traumatizing the surgical site.
C. Gently check the infant's suture line using a padded tongue depressor.
It's important to assess the surgical site for signs of infection or bleeding, but using a padded tongue depressor may not be the most appropriate method. The nurse should follow the surgeon's orders regarding wound care and assessment techniques, which may include visual inspection without manipulation.
D. Place the infant in a supine position.
Placing the infant in a supine position is generally recommended after cleft palate repair surgery to minimize strain on the surgical site and promote healing. However, it's essential to ensure proper positioning to prevent aspiration and maintain airway patency.
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