A nurse is caring for a child who received an initial dose of antibiotics 20 min ago. Which of the following findings is the priority to report to the provider?
Maculopapular rash
Headache
Wheezing
Increased pulse
The Correct Answer is C
Choice A reason:
A maculopapular rash may be an allergic reaction to the antibiotic. While this should be reported, wheezing is a more urgent concern.
Choice B reason:
A headache may be a side effect of the antibiotic, but it is not as urgent as wheezing.
Choice C reason:
Wheezing can indicate a potential serious allergic reaction or anaphylaxis to the antibiotic. This is the priority finding to report to the provider.
Choice D reason:
An increased pulse may be a side effect of the antibiotic, but it is not as urgent as wheezing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason:
Encouraging fruit juices is not the best approach for rehydration in a child with mild dehydration. Fruit juices can be high in sugar and may worsen diarrhea.
Choice B reason:
Giving oral rehydration solution in small, frequent amounts is the recommended treatment for mild dehydration due to infection. This helps replace lost fluids and electrolytes.
Choice C reason:
Promethazine is not indicated for the treatment of dehydration. It is an antihistamine and antiemetic, but it does not address the underlying issue of fluid loss.
Choice D reason:
Offering banana and rice can be part of a bland diet after rehydration, but it does not address the immediate need for replenishing lost fluids and electrolytes. The priority is to start with oral rehydration solution.
Correct Answer is D
Explanation
Choice A reason:
Taping the wire to the palm of the hand can be uncomfortable for the child and may interfere with blood flow.
Choice B reason:
Warming the skin prior to probe placement is not a standard practice for pulse oximetry monitoring.
Choice C reason:
Applying the sensor to the index fingernail is not a recommended site for pulse oximetry monitoring in children.
Choice D reason:
Repositioning the probe every 2 hours helps to prevent skin breakdown and ensures accurate readings over time. This is a standard practice in pulse oximetry monitoring.
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