A nurse in an emergency department is caring for a preschool-age child who has acute acetylsalicylic acid poisoning.
Which of the following should the nurse expect?
Hyperpyrexia.
Polyuria.
Neck vein distention.
Jaundice.
The Correct Answer is A
When a child ingests a toxic dose of acetylsalicylic acid, it can lead to salicylate toxicity, which can cause hyperpyrexia (high fever), among other symptoms such as vomiting, tinnitus, confusion, and dehydration. Hyperpyrexia is a serious complication that can lead to neurological damage and is a medical emergency that requires prompt intervention.
The nurse should monitor the child's temperature and administer antipyretic medications as necessary to reduce the fever.
Choice B is wrong because Polyuria, is not a common symptom of acute acetylsalicylic acid poisoning.
Salicylate toxicity can cause dehydration due to vomiting, which can lead to decreased urine output.
Choice C is wrong because Neck vein distention, is not typically associated with acetylsalicylic acid poisoning.
Neck vein distention is commonly seen in patients with heart failure, tension pneumothorax, or cardiac tamponade.
Choice D is wrong because Jaundice, is not a common symptom of acetylsalicylic acid poisoning. Jaundice is usually seen in liver diseases or hemolytic anemias.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Bruises in areas of the body not typically injured by accident or normal childhood activities can be a potential indicator of physical abuse.
Choice A is wrong because Weight in 45th percentile is not an answer because it falls within the normal range for weight.
Choice B is wrong because Abrasions on the knees are not an answer because they are a common injury in children and can occur during normal play.
Choice D is wrong because Front deciduous teeth missing is not an answer because it is normal for children to lose their deciduous teeth.
Correct Answer is A
Explanation
The first action the nurse should take is to assess the respiratory status of the infant.
After a head injury, it is important to ensure that the child’s airway is clear and that they are breathing adequately.
This is a crucial step in providing care for a patient with a head injury.
Choice B is wrong because inspecting for fluid leaking from the ears is not the first priority.
Choice C is wrong because examining the scalp for lacerations is not the first priority.
Choice D is wrong because checking pupil reactions is not the first priority.
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