The nurse is caring for a 2 month old child with a fever of 101.76. The child also appears toxic with poor color. Which of the following actions would the nurse expect to implement as a priority?
Replace fluids orally
Administer antibiotics as prescribed
Obtain a specimen for complete blood co
Obtain urinalysis
The Correct Answer is B
A. While fluid replacement is important, in a toxic-appearing child, oral fluids may not be safe or adequate due to potential dehydration and risk of worsening condition.
B. Administering antibiotics is the priority action because the child shows signs of potential serious infection, and timely antibiotic treatment is crucial in young infants who may quickly deteriorate.
C. Obtaining a specimen for a complete blood count is necessary for diagnosing infection but is not as urgent as administering antibiotics.
D. While obtaining a urinalysis may help identify a urinary tract infection, it is not the immediate priority compared to starting antibiotic therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Bagels with cream cheese and lox are not recommended as lox may carry a risk of contamination.
B. A vanilla milkshake made with pasteurized milk is safe for a neutropenic diet as pasteurization kills harmful bacteria.
C. Ham and cheese sandwiches may not be safe unless the ham is fully cooked, as deli meats can harbor bacteria.
D. Sushi is not appropriate for a neutropenic diet due to the risk of raw fish and potential bacteria.
Correct Answer is B
Explanation
A. Keeping a written document of the treatment plan is essential for ensuring continuity of care and effective communication with healthcare providers.
B. Parents should notify their provider immediately, rather than waiting for the next business day, if their child has a sore throat, as this could indicate a possible infection in an immunocompromised child.
C. Using acetaminophen is generally appropriate for managing pain or fever in children receiving chemotherapy, but it should be done with caution regarding dosage and timing.
D. Maintaining a written list of medical appointments helps keep track of the child’s care and is a good practice for managing their health.
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