A nurse is admitting a school-age child who has osteomyelitis. Which of the following actions should the nurse take first?
Obtain a blood culture.
Request a referral for physical therapy.
Administer IV antibiotics.
Record intake and output.
The Correct Answer is A
A. Obtain a blood culture. The first action is to obtain a blood culture to identify the causative organism before starting antibiotic therapy. This ensures that the appropriate antibiotic is selected.
B. Request a referral for physical therapy. Physical therapy may be needed later, but it is not the priority during admission.
C. Administer IV antibiotics. Antibiotics should be given after obtaining a blood culture to avoid altering the test results.
D. Record intake and output. While monitoring fluid balance is important, it is not the priority action during admission.
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Related Questions
Correct Answer is ["A","B","D","F","H"]
Explanation
A. Neurologic assessment. Neurologic changes can indicate worsening infection, sepsis, or other serious conditions, requiring immediate follow-up.
B. Hemoglobin. The child's hemoglobin level (9.5 g/dL) is below the normal range (10 to 15.5 g/dL), indicating anemia, which requires monitoring and possible intervention.
C. Peripheral pulses. There is no indication of circulatory compromise or perfusion issues in the given data.
D. WBC. The elevated WBC count (14,000 mm³) suggests an active infection or inflammation, which requires immediate follow-up.
E. Glucose. The glucose level (90 mg/dL) is within normal limits and does not require immediate attention.
F. Abdominal assessment. If the child has an infection, especially a serious bacterial infection, monitoring for abdominal distension, tenderness, or signs of peritonitis is crucial.
G. Pain assessment. While pain assessment is always important, it does not require immediate follow-up unless there are specific pain-related concerns in the provided data.
H. Temperature. Fever is a key sign of infection. Monitoring the child’s temperature is crucial in identifying worsening infection or sepsis.
Correct Answer is A
Explanation
A. Nause . Gastrointestinal side effects, such as nausea, vomiting, and diarrhea, are common with cefazolin and other cephalosporin antibiotics.
B. Constipation. Cefazolin is more likely to cause diarrhea rather than constipation.
C. Hypertension. Cefazolin does not typically cause hypertension; hypotension may occur in rare cases due to an allergic reaction.
D. Increased appetite. Cefazolin is not known to increase appetite; gastrointestinal discomfort may actually reduce appetite.
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