A nurse is planning care for a preschool-age child who is in the acute phase of Kawasaki disease. Which of the following interventions should the nurse include in the plan of care?
Monitor the child's cardiac status.
Give scheduled doses of acetaminophen every 6 hr.
Provide stimulation with children of the same age in the play room.
Administer antibiotics via intermittent IV bolus for 24 hr.
The Correct Answer is A
A. Kawasaki disease involves inflammation of the blood vessels and can lead to serious cardiac complications, including coronary artery aneurysms. Monitoring cardiac status is essential to detect and manage these risks.
B. While managing fever is a part of treating Kawasaki disease, acetaminophen is typically used as needed rather than on a strict schedule unless fever is persistent.
C. During the acute phase of Kawasaki disease, children often feel very irritable and unwell; large group activities may be overwhelming and inappropriate.
D. Kawasaki disease is not caused by a bacterial infection, and antibiotics are not part of the treatment. Instead, treatment usually involves high-dose aspirin and intravenous immunoglobulin.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A: Methylphenidate should be taken preferably 30 to 45 minutes before meals to reduce the risk of stomach upset. Furthermore, food interferes with its absorption.
B: Administering methylphenidate at bedtime is incorrect because it is a stimulant and can interfere with sleep.
C: Avoiding foods containing tyramine is not relevant for methylphenidate; it is more commonly a concern with certain antidepressants such as MAO inhibitors.
D: There is no need to avoid excess sodium intake specifically related to methylphenidate usage; this advice does not pertain to the side effects or interactions of the medication.
Correct Answer is B
Explanation
A. Obtain a blood specimen for ABG analysis. Important, but not the first action.
B. In a client with burn injuries experiencing signs of airway compromise (drooling, hoarseness), the first action should be to ensure adequate oxygenation. Applying 100% humidified oxygen can help manage potential airway edema.
C. Obtain a baseline ECG. Necessary for monitoring but secondary to securing the airway.
D. Insert an 18-gauge IV catheter. Essential for fluid resuscitation and medication administration, but after ensuring adequate oxygenation.
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