The parents of a 7-year-old child bring her to the emergency department. They tell the nurse that she awoke with a tympanic temperature of 39.2 (102.2°), an extremely sore throat, drooling, and difficulty swallowing. Which of the following actions is the nurse's priority?

Obtain culture specimens.

Administer an antipyretic.

Prepare for intubation.

Insert an IV catheter.

Answer and Explanation

The Correct Answer is C

A. While obtaining culture specimens is important, the priority in this case is managing the child’s airway, as drooling and difficulty swallowing suggest potential airway obstruction.

B. Administering an antipyretic is not the priority; airway management is more urgent in this situation.

C. The priority is to prepare for intubation, as the child’s symptoms suggest possible epiglottitis, which can cause rapid airway obstruction. Securing the airway is critical.

D. Inserting an IV catheter is important for hydration and medication administration, but airway management is the immediate priority.

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Correct Answer is D

Explanation

A. Hypertension is not a common side effect of desmopressin.

B. Hyperkalemia is not typically associated with desmopressin.

C. Hypoglycemia is not a common side effect of desmopressin, as it is not used to manage blood glucose levels.

D. Desmopressin can cause water retention, leading to dilutional hyponatremia, which is a critical side effect to monitor for in clients receiving the medication.

A. Encourage drinking large amounts of favorite fluids. B. Administer an antiemetic 30 minutes to 1 hour before chemotherapy begins. C. Encourage child to take nothing by mouth (NPO) until nausea and vomiting subside. D. Administer an antiemetic as soon as the child has symptoms of nausea.

Correct Answer is B

Explanation

A. Encouraging large amounts of fluids may not be effective in preventing nausea and vomiting and can worsen dehydration if the child is unable to keep fluids down.

B. Administering an antiemetic 30 minutes to 1 hour before chemotherapy is the most effective strategy for preventing nausea and vomiting. This proactive approach helps to prevent the symptoms before they occur.

C. NPO until symptoms subside is not appropriate because it can lead to dehydration and malnutrition.

D. Administering an antiemetic after symptoms begin is reactive rather than proactive, and it is more effective to prevent symptoms from occurring.

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The parents of a 7-year-old child bring her to the emergency department. They tell the nurse that she awoke with a tympanic temperature of 39.2 (102.2°), an extremely sore throat, drooling, and difficulty swallowing. Which of the following actions is the nurse's priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is administering desmopressin (DDAVP) to a pediatric client with diabetes insipidus. The nurse should monitor for which of the following potential side effects of this medication?

Correct Answer is D

Explanation

Which is the most beneficial nursing action to prevent or minimize chemotherapy associated nausea and vomiting?

Correct Answer is B

Explanation

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