Exhibits

For each potential nursing intervention, click to specify if the intervention is indicated or not indicated for the child. There must be at least 1 selection in every row. There does not need to be a selection in every column.

Administer broad-spectrum antibiotics.

Implement isolation precautions.

Assist with a lumbar puncture.

Administer an antipyretic

Encourage ambulation

Provide external stimulation.

Initiate seizure precautions

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"B"},"F":{"answers":"B"},"G":{"answers":"A"}}

Administer broad-spectrum antibiotics: Prompt initiation of antibiotics is critical in suspected bacterial meningitis to prevent rapid progression and reduce neurological complications. Treatment should begin even before culture results return. Delay in treatment increases the risk of morbidity and mortality.
Implement isolation precautions: Droplet precautions should be initiated immediately due to the possibility of meningococcal meningitis, which is highly contagious. These precautions protect healthcare staff and other patients. Isolation continues until 24 hours after antibiotics are started.
Assist with a lumbar puncture: Lumbar puncture is a primary diagnostic tool to confirm meningitis and identify the pathogen in cerebrospinal fluid. It helps guide targeted antibiotic therapy. This should be done after initiating antibiotics if there's no contraindication.
Administer an antipyretic: Fever increases metabolic demand and can worsen neurologic symptoms like seizures or confusion. Antipyretics like acetaminophen help reduce fever and improve comfort. Controlling temperature also stabilizes cardiovascular and respiratory effort. This supports overall treatment goals.
Encourage ambulation: The child is lethargic, photophobic, and has altered mental status, making ambulation unsafe and unnecessary. Activity can increase intracranial pressure or fall risk. Rest is important during acute neurologic illness. Mobility is not a priority until the child stabilizes.
Provide external stimulation: Children with meningitis often experience neurologic hypersensitivity and irritability. External stimulation, such as bright lights or loud noises, can worsen symptoms. A calm, quiet environment is needed to reduce distress. Limiting stimulation aids in neurologic recovery.
Initiate seizure precautions: Meningitis increases the risk of seizures due to inflammation of the brain and elevated temperature. Altered mental status and photophobia further heighten this risk. Seizure precautions include padded side rails and having emergency medications ready. Safety preparation is essential.

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Correct Answer is C

Explanation

A. Rapid respirations: Tachypnea is a common response to lung infection and impaired gas exchange in pneumonia. However, it reflects respiratory distress rather than increasing the risk for aspiration directly.

B. Inspiratory wheezing: Wheezing suggests airway narrowing or inflammation, which occurs in pneumonia, but it does not contribute to aspiration risk. It primarily affects airflow, not swallowing or airway protection.

C. Neurological deficit: Neurological impairments can weaken the muscles involved in swallowing and reduce cough reflex, which are critical for protecting the airway. This increases the likelihood of food, fluids, or secretions entering the lungs, leading to aspiration pneumonia.

D. Elevated temperature: Fever is a systemic sign of infection and inflammation. Although it indicates illness severity, it does not influence the physical mechanisms that prevent aspiration or affect swallowing function.

A. "Ask her if she is ready to eat her sandwich for lunch." B. "Ask her if she would like to have her favorite sandwich for lunch." C. “Tell her she is having her favorite sandwich for lunch." D. "Tell her that she may have a sandwich or soup for lunch."

Correct Answer is B

Explanation

A. Ask her if she is ready to eat her sandwich for lunch: This question is closed-ended and might prompt resistance, as toddlers often respond negatively to direct commands or yes/no questions that limit their sense of control.

B. Ask her if she would like to have her favorite sandwich for lunch: Offering a choice with a positive option gives the toddler a sense of autonomy while guiding them toward a preferred food. This approach can reduce negativism by providing limited, acceptable choices.

C. Tell her she is having her favorite sandwich for lunch: This directive removes the toddler’s ability to choose, which may increase resistance or oppositional behavior during mealtime.

D. Tell her that she may have a sandwich or soup for lunch: While offering choices is good, this statement is more authoritative than inviting and may not engage the toddler’s cooperation as effectively as phrasing it as a question.

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Exhibits For each potential nursing intervention, click to specify if the intervention is indicated or not indicated for the child. There must be at least 1 selection in every row. There does not need to be a selection in every column.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a child who has bacterial pneumonia. Which of the following findings should the nurse identify as a potential risk for aspiration?

Correct Answer is C

Explanation

A nurse is providing teaching to the parents of a toddler who is exhibiting negativism during mealtimes. Which of the following statements by the nurse is appropriate?

Correct Answer is B

Explanation

A nurse is teaching the guardian of a child who is suspected of having cystic fibrosis and is scheduled for a sweat chloride test. Which of the following statements should the nurse include?

A nurse is reinforcing the provider's explanation about treatment options to the parents of a 1-month-old who has coarctation of the aorta. Which of the following statements should the nurse include?

Exhibits For each client finding, click to specify if the finding is consistent with meningitis or influenza. Each finding may support more than 1 disease process or none at all. There must be at least 1 selection in every column. There does not need to be a selection in every row.

A nurse is preparing to insert a peripheral intravenous (IV) catheter for a preschooler. Which of the following actions should the nurse take?

A nurse is providing teaching to a parent about sudden unexpected infant death (SUID). Which of the following statements should the nurse include?

A nurse is assessing a school-age child who is receiving cefazolin. For which of the following adverse effects should the nurse monitor?

A nurse is providing teaching to the parent of a school-age child who has diabetes mellitus about managing diabetes during illness. Which of the following statements by the parent indicates an understanding of the teaching?

Exhibits Which of the following complications should the nurse identify as being potential risks for this child? Select all that apply.

Exhibits

For each potential nursing intervention, click to specify if the intervention is indicated or not indicated for the child. There must be at least 1 selection in every row. There does not need to be a selection in every column.