A nurse observes circumoral cyanosis in an infant who is choking. Which of the following actions should the nurse take?

Move the infant into an upright position and suction the airway with a bulb syringe.

Deliver back blows with the infant face down over the rescuer's arm.

Place the infant in a side-lying position and perform abdominal thrusts.

Perform a head tilt and a chin lift and then give two rescue breaths.

Answer and Explanation

The Correct Answer is B

Choice A reason:

Using a bulb syringe for suctioning is not the appropriate intervention for a choking infant. This may not effectively clear the airway obstruction.

Choice B reason:

Delivering back blows with the infant face down over the rescuer's arm is the recommended action for relieving a choking episode in an infant. This helps to dislodge the obstruction from the airway.

Choice C reason:

Placing the infant in a side-lying position and performing abdominal thrusts is the intervention for a conscious infant who is choking. This is not the appropriate action for an infant showing circumoral cyanosis.

Choice D reason:

Performing a head tilt and chin lift followed by giving rescue breaths is the procedure for providing rescue breaths in infant CPR. It is not the initial intervention for a choking infant.

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Correct Answer is C

Explanation

Choice A reason:

Connecting a bulb attachment to the syringe is not a standard method for administering a tube feeding and can potentially lead to complications.

Choice B reason:

Heating the formula to body temperature is not typically necessary and can be potentially dangerous if it leads to overheating.

Choice C reason:

Positioning the child with the head of the bed elevated at 15° helps to prevent aspiration during tube feeding.

Choice D reason:

Instilling the feeding based on pH alone is not a sufficient criterion for administration. Other factors, such as radiographic confirmation of tube placement, should also be considered.

A. Collect a stool specimen for occult blood. B. Conduct a tape test. C. Obtain a stool specimen for culture. D. Draw a blood culture.

Correct Answer is C

Explanation

Choice A reason:

Collecting a stool specimen for occult blood is not the most relevant test for suspected

Clostridium difficile infection. Stool culture or testing for C. difficile toxins is more appropriate.

Choice B reason:

Conducting a tape test is used to diagnose pinworms, not Clostridium difficile infection.

Choice C reason:

This statement is correct. Obtaining a stool specimen for culture, specifically for C. difficile, is the appropriate action for suspected infection.

Choice D reason:

Drawing a blood culture is not the primary diagnostic test for Clostridium difficile. Stool culture or testing for C. difficile toxins is more appropriate.

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A nurse observes circumoral cyanosis in an infant who is choking. Which of the following actions should the nurse take?

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