A full-term, 24-hour-old infant in the nursery regurgitates and suddenly turns cyanotic. Which immediate intervention should the practical nurse (PN) implement?
Turn the infant onto the right side.
Give oxygen by positive pressure
Suction the oral and nasal passages.
Stimulate the infant to cry.
The Correct Answer is C
The correct answer is choice C. Suction the oral and nasal passages.
Choice A rationale:
Turning the infant onto the right side may not be the most appropriate intervention for cyanosis caused by regurgitation. Cyanosis signifies a lack of oxygen, and simply changing the infant's position might not address the underlying issue.
Choice B rationale:
Giving oxygen by positive pressure is not the immediate intervention needed for regurgitation-induced cyanosis. While administering oxygen is important, the first step should involve clearing the airway to ensure proper oxygenation.
Choice C rationale:
Suctioning the oral and nasal passages is crucial in this situation as the cyanosis is likely due to the infant's airway being obstructed by regurgitated material. Clearing the airway can restore normal breathing and oxygenation.
Choice D rationale:
Stimulating the infant to cry is not the appropriate action when cyanosis is present. Cyanosis indicates a serious problem with oxygenation, and crying may worsen the situation by further compromising the infant's breathing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The correct answer is Choice B. Refer to the dermatologist for prescribed long-term therapy. Choice A rationale:
Omitting specific foods like chocolate, carbonated drinks, and fried foods from the diet is a common misconception about acne management. While a healthy diet can contribute to overall skin health, there is no direct evidence to support the notion that avoiding these foods alone will effectively treat acne. Acne is a complex skin condition influenced by various factors, including hormonal imbalances and genetics.
Choice B rationale:
Referring the client to a dermatologist for prescribed long-term therapy is the most appropriate recommendation for managing acne. Dermatologists are medical professionals specialized in skin conditions and can provide personalized treatment plans based on the client's specific type and severity of acne. They may prescribe topical or oral medications, such as retinoids, antibiotics, or hormonal therapy, to effectively manage acne.
Choice C rationale:
Expressing blackheads and using an exfoliating scrub is not a recommended approach for managing acne. Manual extraction of blackheads can lead to skin irritation, infection, and scarring. Exfoliating scrubs can also cause damage to the skin, especially if used too frequently or if the acne is inflamed.
Choice D rationale:
Washing the hair and skin daily with mild soap and warm water is a general hygiene recommendation and may help to keep the skin clean, but it is not a specific and effective treatment for acne. Acne requires targeted therapies to address its underlying causes and manage its symptoms.
Correct Answer is D
Explanation
The correct answer is choice D: Provide fluid and electrolyte replacement. Choice A rationale:
Isolating all infectious diarrhea victims is not the highest priority in this situation. While it is essential to prevent the spread of cholera, immediate medical intervention to treat those affected takes precedence.
Choice B rationale:
Administering prophylactic antibiotics as prescribed is not the highest priority because it focuses on prevention rather than treatment. In the case of a cholera outbreak, it is more critical to address the immediate needs of those already diagnosed.
Choice C rationale:
Administering cholera vaccines may be part of a preventive strategy, but it is not the highest priority during an active cholera outbreak. Vaccination takes time to develop immunity, and the focus should be on treating those already affected.
Choice D rationale:
Providing fluid and electrolyte replacement is the highest priority in managing cholera. Cholera is characterized by severe diarrhea and dehydration, which can lead to life-threatening complications. Promptly restoring fluids and electrolytes helps prevent shock and organ failure.
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