8-year-old male admitted with cystic fibrosis reports the following symptoms:
- Shortness of breath
- Wheezing throughout lung fields
- Productive cough with thick sputum
A nurse is creating a plan of care for a newly admitted child. Which of the following actions should the nurse include in the plan?
Initiate droplet isolation precautions
Keep the child on NPO status for 12 hr
Maintain the child on bed rest for 24 hr
Administer high-dose antibiotic therapy
The Correct Answer is D
Administer high-dose antibiotic therapy.
Rationale:
- A. Initiate droplet isolation precautions is incorrect because cystic fibrosis is not transmitted by droplets, but by autosomal recessive inheritance.
- B. Keep the child on NPO status for 12 hr is incorrect because there is no indication for withholding oral intake in this child. The child needs adequate hydration and nutrition to prevent dehydration and malnutrition due to increased metabolic demands and mucus production.
- C. Maintain the child on bed rest for 24 hr is incorrect because bed rest can worsen the child's respiratory status by decreasing lung expansion and increasing mucus retention. The child needs to be encouraged to ambulate and participate in activities as tolerated to promote airway clearance and prevent atelectasis and infection.
- D. Administer high-dose antibiotic therapy is correct because the child has signs of a pulmonary infection, such as wheezing, productive cough, and thick sputum. Antibiotics are indicated to treat the infection and prevent complications such as pneumonia and bronchiectasis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Hyperthyroidism is not a contraindication for niacin use. Niacin is used to lower LDL cholesterol levels and has no specific contraindications related to thyroid disorders.
Choice B rationale:
Asthma is not a contraindication for niacin use. Niacin does not interact with asthma medications or worsen asthma symptoms, so it is not contraindicated in individuals with asthma.
Choice C rationale:
High blood pressure is not a contraindication for niacin use. In fact, niacin can help lower blood pressure and improve overall cardiovascular health. It is often prescribed to individuals with high blood pressure and elevated cholesterol levels.
Choice D rationale:
Active liver disease is a contraindication for niacin use. Niacin can cause liver damage, and individuals with active liver disease should avoid niacin therapy to prevent further harm to the liver. Monitoring liver function tests is crucial in patients taking niacin to ensure their liver health.
Correct Answer is A
Explanation
Option A. Instruct the client to void, because this reduces the risk of bladder injury during the procedure. The other options are incorrect because they are not necessary or appropriate for a paracentesis.
Option B, position the client on their left side, is incorrect because the client should be positioned upright or semi-Fowler's to allow gravity to assist with fluid drainage.
Option C, insert an IV catheter, is incorrect because an IV catheter is not required for a paracentesis unless the client needs fluid replacement or medication administration.
Option D, prepare the client for moderate (conscious) sedation, is incorrect because a paracentesis is usually performed under local anesthesia and does not require sedation
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