Exhibits
A nurse in an emergency department is caring for a 3-month-old infant. Which of the following actions should the nurse take?
Administer ceftriaxone.
Initiate serum glucose testing every 1 hr.
Administer pneumococcal conjugate vaccine.
Initiate neutropenic precautions.
The Correct Answer is A
A. Administer ceftriaxone. Correct. The CSF analysis shows elevated pressure, cloudy appearance, increased WBC count, elevated protein, and decreased glucose levels, which are indicative of bacterial meningitis. Ceftriaxone is a broad-spectrum antibiotic that is commonly used to treat bacterial meningitis, especially in infants and young children. Immediate administration of antibiotics is crucial to treat the infection and prevent complications.
Other Options:
B. Initiate serum glucose testing every 1 hr. Incorrect. Although the CSF glucose is low, this finding is associated with bacterial meningitis rather than a primary glucose metabolism issue in this context. Regular glucose monitoring every 1 hour is not warranted for managing meningitis. The priority is to address the underlying infection with antibiotics.
C. Administer pneumococcal conjugate vaccine. Incorrect. Vaccination is a preventive measure, not an immediate treatment for an ongoing infection. This infant likely already needs treatment for a current infection, and vaccination would be inappropriate at this stage.
D. Initiate neutropenic precautions.Incorrect. Neutropenic precautions are used for patients with significantly low neutrophil counts to prevent infection. The CSF results do not suggest neutropenia; instead, they suggest an active bacterial infection. The focus should be on treating the infection, not on precautions for low neutrophil count.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. "I will expect my child to need annual sweat chloride testing." Incorrect. Sweat chloride testing is primarily used for diagnosing cystic fibrosis, not for routine annual monitoring. Once a diagnosis is confirmed, ongoing management focuses on nutritional support, respiratory care, and monitoring for complications.
B. "I will have my child chew the pancrelipase medication before eating." Incorrect. Pancrelipase should not be chewed. It needs to be swallowed whole or sprinkled on acidic food to ensure proper absorption and to avoid irritation of the mouth and esophagus.
C. "I will ensure that my child consumes a high-calorie diet." Correct. Children with cystic fibrosis often require a high-calorie diet due to malabsorption issues and the increased energy expenditure related to their condition. Ensuring adequate caloric intake helps with growth and overall health.
D. "I will administer dornase alfa every 4 hours for wheezing." Incorrect. Dornase alfa (Pulmozyme) is usually administered once or twice daily to help thin mucus in the lungs. It is not typically used every 4 hours or specifically for wheezing.
Correct Answer is C
Explanation
A. Tea tree: Tea tree oil is known for its antimicrobial properties and is commonly used for skin issues such as acne or fungal infections. It is not typically recommended for relaxation purposes.
B. Eucalyptus: Eucalyptus oil is often used for its respiratory benefits, such as easing congestion and colds. It is stimulating rather than calming and is not commonly recommended for relaxation.
C. Lavender: Lavender oil is widely recognized for its calming and relaxing properties. It is often used to help reduce anxiety, promote relaxation, and improve sleep quality.
D. Jasmine: Jasmine oil is known for its uplifting and energizing properties rather than relaxing. While it has a pleasant scent and can have mood-enhancing effects, it is not specifically recommended for relaxation.
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