A nurse is assisting with planning care for a school-age child who has suspected pertussis. Which of the following interventions is the nurse's priority to include?
Implementing droplet precautions
obtaining a nasopharyngeal culture
Encouraging family members' compliance with antibiotic therapy
Offering small amounts of oral fluids frequently
The Correct Answer is A
A. Implementing droplet precautions: Pertussis (whooping cough) is highly contagious and spreads through respiratory droplets. Implementing droplet precautions is essential to prevent the transmission of the infection to others, especially in a school-age child.
B. Obtaining a nasopharyngeal culture: While obtaining a culture is important for confirming the diagnosis of pertussis, the priority is to prevent the spread of the disease to others. Droplet precautions should be implemented immediately to reduce transmission.
C. Encouraging family members' compliance with antibiotic therapy: Antibiotic therapy is important for treating pertussis, but this is secondary to preventing the spread of infection. Once precautions are in place, encouraging adherence to the prescribed antibiotic regimen is necessary for the child's recovery.
D. Offering small amounts of oral fluids frequently: Maintaining hydration is important for a child with pertussis, especially as coughing can cause discomfort. However, the priority action is preventing the spread of the infection through droplet precautions.
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Related Questions
Complete the following sentence by using the lists of options.
The nurse should recommend to
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"C"}
Explanation
Rationale for Correct Choices:
- Check the child's oropharynx: The child has had a tonsillectomy and is showing signs of possible bleeding, indicated by the small amount of bleeding in the posterior pharynx and bright red emesis (vomiting of blood). The nurse should check the oropharynx to assess the amount and source of the bleeding, as this could indicate a complication post-surgery.
- Obtaining a set of vital signs: After vomiting bright red emesis, it is crucial to assess the child's vital signs to monitor for signs of bleeding or shock. Changes in vital signs, especially increased heart rate or decreased blood pressure, could indicate significant blood loss.
Rationale for Incorrect Choices:
- Offer the child a red popsicle: Red-colored foods are generally avoided post-tonsillectomy as they can obscure or be mistaken for blood. More importantly, offering anything by mouth is contraindicated during active bleeding due to the risk of aspiration and potentially dislodging clots.
- Place the child in a supine position: The child should be positioned in a way that allows for the drainage of blood and secretions, ideally with the head elevated. Placing the child in a supine position could cause blood to pool in the throat, increasing the risk of aspiration.
- Encouraging the child to cough and deep breathe: Encouraging coughing and deep breathing immediately after tonsillectomy is not recommended, as it could dislodge a clot or exacerbate bleeding.
- Requesting a prescription for codeine: Although the child is experiencing some pain (rated 3/10), the primary concern at this point is bleeding, not pain. Pain management should be adjusted but the focus should be on addressing the bleeding first.
Correct Answer is ["A","B"]
Explanation
A. Oral rehydration solution: Oral rehydration solutions (ORS) are recommended to replace lost fluids and electrolytes during episodes of diarrhea. They help prevent dehydration, which is a common complication in infants with diarrhea.
B. Breast milk: Breast milk is the best option for a breastfed infant during an episode of diarrhea. It provides essential nutrients and hydration, as well as antibodies that can help protect against infections and improve recovery.
C. Chicken broth: Chicken broth is not recommended for infants under 6 months old due to its high sodium content and lack of essential nutrients for young infants. It could potentially cause electrolyte imbalances.
D. Clear soda: Clear soda should be avoided, as it contains high levels of sugar and can worsen dehydration. It does not provide the necessary electrolytes and fluids needed to rehydrate an infant.
E. Apple juice: Apple juice is not recommended for infants with diarrhea, as it can contribute to diarrhea due to its high sugar content, particularly fructose, which can draw water into the intestines and worsen dehydration.