A nurse is reviewing data for patients on an inpatient unit. Which patient will the nurse see first?

A 6-year-old who has asthma and an oxygen saturation of 94% on room air.

A 10-year-old who has sickle cell anaemia reporting severe chest pain.

A 47-year-old who has diabetes insipidus with a urine specific gravity of 1.010.

A 5-year-old who has respiratory syncytial virus (RSV) with a temperature of 102.2°F.

Answer and Explanation

The Correct Answer is B

Choice A reason: While an oxygen saturation of 94% is slightly low, it is not an immediate emergency for a child with asthma. This patient can be monitored but does not require the nurse's immediate attention.

Choice B reason: Severe chest pain in a patient with sickle cell anaemia can indicate a serious complication known as acute chest syndrome, which is a medical emergency. This condition requires immediate assessment and intervention to prevent life-threatening complications.

Choice C reason: A urine specific gravity of 1.010 indicates dilute urine, which is typical for a patient with diabetes insipidus. While this condition requires management, it is not an immediate emergency compared to severe chest pain in a sickle cell anaemia patient.

Choice D reason: A fever of 102.2°F in a child with respiratory syncytial virus (RSV) is concerning and requires attention, but it is not as immediately life-threatening as severe chest pain in a sickle cell anaemia patient. This patient can be seen after addressing the more urgent case.

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Correct Answer is A

Explanation

Choice A reason: Warming the stethoscope before use prevents heat loss through conduction. Conduction is the transfer of heat from the infant's body to a cooler surface or object that comes in direct contact with them. By warming the stethoscope, the nurse ensures that the infant does not lose heat to the cold surface of the stethoscope, thereby helping to maintain the infant's body temperature.

Choice B reason: Moving the infant away from a drafty vent helps prevent heat loss through convection, not conduction. Convection is the transfer of heat through air currents, and keeping the infant away from drafts helps minimize this type of heat loss.

Choice C reason: Drying the infant with a towel prevents heat loss through evaporation. When a wet infant is dried, it helps reduce the loss of heat that occurs as moisture evaporates from the skin.

Choice D reason: Closing the doors to the isolate helps prevent heat loss through radiation. Radiation is the transfer of heat from the infant's body to cooler surrounding surfaces. By closing the doors, the nurse helps maintain a warm environment, reducing heat loss.

A. Human Papillomavirus B. Pneumococcal C. Measles D. Rubella

Correct Answer is A

Explanation

Choice A reason: The Human Papillomavirus (HPV) vaccine is typically recommended for preteens at age 11 or 12 to protect against HPV infections that can lead to certain types of cancer later in life. This vaccine is given as a series of shots, and starting the series at 11 years old is ideal for maximizing its effectiveness before any potential exposure to the virus.

Choice B reason: The Pneumococcal vaccine is generally recommended for infants, young children, and older adults, particularly those with certain health conditions. It protects against pneumococcal disease, including infections in the lungs, blood, and brain. While it is crucial for vulnerable populations, it is not typically administered to healthy 11-year-old children.

Choice C reason: The Measles vaccine is part of the MMR (Measles, Mumps, Rubella) vaccine, which is usually administered in two doses—the first dose at 12-15 months of age and the second dose at 4-6 years of age. By the time a child reaches 11 years old, they would have already received both doses of the MMR vaccine, assuming they followed the standard vaccination schedule.

Choice D reason: The Rubella vaccine is also included in the MMR vaccine, which is given in two doses during early childhood. Since the second dose is typically administered by the age of 6, an 11-year-old child would not require another dose of the Rubella vaccine if they followed the standard vaccination schedule.

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