A nurse is assessing a 6-month-old infant who has respiratory syncytial virus.
The nurse should immediately report which of the following findings to the provider?
Cough or difficulty in breathing.
Oxygen saturation < 90% or central cyanosis.
Severe respiratory distress (e.g grunting, very severe chest indrawing).
Signs of pneumonia with a general danger.
The Correct Answer is B
This is because oxygen saturation below 90% indicates that the infant is not getting enough oxygen and central cyanosis (bluish color of the skin due to lack of oxygen) is a sign of severe respiratory distress.
Both of these findings require immediate medical attention.
Choice A is wrong because cough or difficulty in breathing, while concerning, may not require immediate reporting to the provider as they are common symptoms of RSV infection.
Choice C is wrong because severe respiratory distress (e.g grunting, very severe chest indrawing), while concerning, may not require immediate reporting to the provider as they are common symptoms of RSV infection.
Choice D is wrong because signs of pneumonia with a general danger, while concerning, may not require immediate reporting to the provider as they are common symptoms of RSV infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","E"]
Explanation
This laboratory test can contribute to confirming a diagnosis of rheumatic fever.
Choice A is wrong because Blood urea nitrogen (BUN) is not used to diagnose rheumatic fever.
Choice D is wrong because Partial thromboplastin time (PTT) is not used to diagnose rheumatic fever.
Correct Answer is C
Explanation
During a seizure, it is important to clear the area around the person of anything hard or sharp to prevent injury.
Choice A is wrong because Minimize movement of the limbs, is not a recommended action during a seizure as it is important not to hold the person down or try to stop their movements.
Choice B is wrong because Insert a tongue blade between the teeth, is not a recommended action during a seizure as it is important not to put anything in the person’s mouth.
Choice D is wrong because Place the child in a prone position, is not a recommended action during a seizure as it is important to turn the person gently onto one side to help them breathe.
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