A nurse in the emergency departments is caring for a toddler
Complete the following sentence by using the list of options.
The nurse should first
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}
Options 1:
A. Keeping the child NPO is crucial to prevent further ingestion or aspiration of the battery, which could lead to serious complications.
B. Teaching the child's parents the importance of inspecting the child's play area is important for future prevention but is not the immediate priority in this acute situation.
C. Obtaining an informed consent is not the priority in this scenario. It should be done after keeping the child NPO.
Options 2:
A. Encouraging parents to inspect toys for easily removable parts is important for prevention but is not the immediate priority when dealing with a child who has already ingested a foreign object.
B. Preparing the child for flexible endoscopy is the second action to visualize and safely remove the battery from the esophagus.
C. Waiting for return of the gag reflex without taking immediate action could delay potentially life-saving interventions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Nutritional management is crucial in cystic fibrosis due to malabsorption issues.
A dietitian can provide guidance on appropriate dietary intake and may recommend enzyme replacement therapy.
B. Occupational therapists may assist with activities of daily living, but their primary role may not be as critical initially as nutritional management.
C. Speech-language pathologists primarily focus on speech and swallowing disorders, which may not be the primary concern at the time of admission.
D. Physical therapists may assist with physical activity and mobility, but their primary role may not be as critical initially as nutritional management.
Correct Answer is []
Explanation
Condition Most Likely Experiencing
- Pyloric stenosis causes projectile vomiting, dehydration, and hunger.
- Cystic fibrosis causes chronic respiratory infections, steatorrhea, and failure to thrive.
- The condition that the infant is most likely experiencing is congestive heart failure, which can cause poor weight gain, tachypnea, decreased appetite, and periorbital edema.
- Respiratory syncytial virus bronchiolitis causes wheezing, coughing, and respiratory distress.
Actions to Take
- Digoxin is a medication commonly prescribed to manage congestive heart failure in infants by improving cardiac contractility and reducing heart rate.
- Elevating the head of the bed helps reduce venous return to the heart, thereby decreasing preload and relieving symptoms of congestion in congestive heart failure.
- Contact precautions are not indicated for congestive heart failure, but for infections that are transmitted by direct or indirect contact.
- Chest physiotherapy and postural drainage are not indicated for congestive heart failure, but for conditions that cause excessive mucus production and retention.
Parameters to Monitor
- Number of steatorrhea stools is not relevant for congestive heart failure, but for cystic fibrosis or other malabsorption disorders.
- Monitoring intake and output is crucial in assessing fluid balance, especially in congestive heart failure where fluid retention can lead to volume overload.
- Monitoring respiratory status is essential in congestive heart failure to assess for signs of pulmonary congestion and respiratory distress, such as tachypnea, retractions, and crackles.
- Presence of periorbital edema is not a parameter to monitor, but a sign of fluid overload.
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