A nurse in an emergency department is caring for a child who experienced a submersion injury.
Which of the following is the priority action for the nurse to take?
Assist with intubation
Obtain an ABG sample
Administer an IV bolus
Apply warming blankets
The Correct Answer is A
The correct answer is Choice A.
Choice A rationale: Assisting with intubation is the priority action. A submersion injury can cause respiratory distress or failure, and ensuring a clear airway is critical. Intubation is often necessary to maintain oxygenation and prevent complications like hypoxia or aspiration.
Choice B rationale: Obtaining an ABG sample is important to assess the child’s oxygenation and acid-base balance, but it is not the priority action. Ensuring the airway is clear and secured takes precedence over diagnostic tests.
Choice C rationale: Administering an IV bolus might be necessary for fluid resuscitation if the child is experiencing shock, but establishing and maintaining the airway is the first critical step in managing submersion injuries.
Choice D rationale: Applying warming blankets can be important to prevent hypothermia, especially if the child has been in cold water. However, addressing airway and breathing issues is the top priority before initiating warming measures.
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Related Questions
Correct Answer is C
Explanation
Choice A rationale
Jacket restraints are typically used to secure a child’s arms during procedures. They are not specifically designed for venipuncture in infants.
Choice Drationale
Elbow restraints are used to secure the child’s elbows, often during procedures involving the upper body. They are not typically used for venipuncture.
Choice Brationale
Mitten restraints are used to prevent the child from scratching or removing tubes. They are not typically used for venipuncture.
Choice Crationale
Mummy restraints are often used for infants during procedures like venipuncture. They allow the child to be wrapped securely while leaving one area exposed for the procedure.
Correct Answer is ["A","B"]
Explanation
Choice A rationale
Placing gates at the top and bottom of stairs is an important safety measure for infants. This can prevent falls, which are a common cause of injury in this age group.
Choice B rationale
Ensuring the crib mattress is in the lowest position is another important safety measure. As infants grow and begin to sit, stand, and climb, a high mattress position can increase the risk of falls.
Choice C rationale
Removing labels from containers that contain toxic substances is not recommended. It’s important to keep these substances out of reach of children, and the labels provide important information about the contents and potential hazards.
Choice D rationale
Keeping toilet lids in the upright position is not recommended. Infants can be curious and may try to explore or play with water in the toilet, which can lead to accidents or injuries.
Choice E rationale
Selecting a toy chest that has a heavy, hinged lid is not recommended. This could pose a risk of injury if the lid were to close unexpectedly, and small fingers could get caught.
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