A nurse is caring for a child who has epiglottitis due to an infection with Haemophilus influenzae type B. Which of the following actions should the nurse take? Select all that apply.
Inspect the epiglottis.
Obtain a throat culture.
Monitor oxygen saturation.
Begin droplet precautions.
Initiate IV access.
Correct Answer : C,D,E
A. Inspecting the epiglottis is contraindicated in suspected cases of epiglottitis as it may trigger laryngospasm and compromise the airway.
B. Obtaining a throat culture may be indicated to confirm the presence of Haemophilus influenzae type B but is not an immediate priority in the management of epiglottitis.
C. Monitoring oxygen saturation is crucial as respiratory distress and hypoxia are common complications of epiglottitis.
D. Beginning droplet precautions is important to prevent the spread of the infectious agent to others.
E. Initiating IV access is necessary for administering fluids and medications, as well as for potential airway management in severe cases of epiglottitis.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Maintaining extended eye contact may be uncomfortable or overwhelming for a child with autism spectrum disorder (ASD) and may not be an appropriate intervention.
B. Establishing a reward system can help reinforce positive behaviors and encourage desired outcomes in children with ASD.
C. Engaging in cooperative play may be challenging for a child with ASD due to difficulties with social interaction and communication.
D. Holding the child during assessments may cause distress or discomfort for a child with ASD and may not be necessary for the assessment process.
Correct Answer is D
Explanation
A. Providing a warm blanket can help alleviate discomfort associated with fever and chills, which are common symptoms of varicella.
B. Koplik spots are seen in measles, not varicella.
C. Aspirin administration is contraindicated in varicella due to the risk of Reye's syndrome. Acetaminophen or ibuprofen may be used for fever.
D. Varicella is spread through respiratory droplets, so standard precautions are typically sufficient. Airborne precautions are necessary to prevent transmission.
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