An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which of the following? (Select all that apply).

Administration of antibiotics

Cluster care to conserve energy

Limit fluids to prevent coughing

Round-the-clock administration of antitussive agents

Answer and Explanation

Correct Answer : A,B

Choice A reason: This response is correct because antibiotics are indicated for bacterial pneumonia caused by staphylococcus. Antibiotics help to fight the infection and prevent complications.

Choice B reason: This response is correct because cluster care means grouping nursing interventions together to minimize the disruption of the child's rest and sleep. Cluster care helps to conserve the child's energy and promote healing.

Choice C reason: This response is not correct because fluids are essential for hydration and thinning of secretions in pneumonia. Fluids help to prevent dehydration and facilitate expectoration of mucus.

Choice D reason: This response is not correct because antitussive agents are not recommended for pneumonia. Antitussive agents suppress the cough reflex, which is a natural mechanism to clear the airways of secretions. Antitussive agents may increase the risk of respiratory infection and atelectasis.

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Correct Answer is D

Explanation

Choice A reason: APT stands for Acute Pain Team, which is a multidisciplinary team that provides pain management for patients. It is not a tool to assess pain.

Choice B reason: Numeric is a pain scale that uses numbers from 0 to 10 to rate the intensity of pain. It is not suitable for a 4-year-old child who may not understand the concept of numbers or have difficulty expressing their pain level.

Choice C reason: FLACC stands for Face, Legs, Activity, Cry, and Consolability. It is a pain scale that uses behavioral cues to assess pain in infants and young children who are unable to verbalize their pain. It is more appropriate for children under 3 years of age.

Choice D reason: FACES is a pain scale that uses facial expressions to indicate the level of pain. It is suitable for a 4-year-old child who can point to the face that matches their pain. It is a simple and easy way to assess pain in children.

A. Respiratory tract infection B. Sore throat C. Complete airway obstruction D. Inspiratory stridor

Correct Answer is C

Explanation

Choice A reason: Respiratory tract infection is not a correct answer because it is not a complication of examining the child's throat. It is a possible cause of epiglottitis, which is an inflammation of the epiglottis, the flap that covers the entrance to the trachea.

Choice B reason: Sore throat is not a correct answer because it is not a complication of examining the child's throat. It is a symptom of epiglottitis, along with fever, difficulty swallowing, and drooling.

Choice C reason: Complete airway obstruction is the correct answer because it is a life-threatening complication of examining the child's throat. The tongue depressor can trigger a spasm of the epiglottis, which can block the airway and cause respiratory distress or arrest.

Choice D reason: Inspiratory stridor is not a correct answer because it is not a complication of examining the child's throat. It is a sign of upper airway obstruction, which can occur in epiglottitis, but it is not caused by the tongue depressor.

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An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which of the following? (Select all that apply).

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

While caring for a 4-year-old, the nurse uses which tool to assess pain?

Correct Answer is D

Explanation

The nurse is assessing a child with epiglottitis in the emergency department. The child has a sore throat and is drooling. Examining the child's throat using a tongue depressor might precipitate which of the following?

Correct Answer is C

Explanation

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