A nurse is assisting in the care of an 8-month-old infant.
Complete the diagram by dragging from the choices below to specify what condition the infant is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters where the nurse should collect data to monitor the infant's progress.
The Correct Answer is []
Potential Condition: Increased intracranial pressure
Actions to Take:
Measure head circumference: This action is important to monitor for signs of increasing intracranial pressure, as a bulging and tense fontanel suggests possible hydrocephalus or other intracranial pathology.
Plan to assist with administration of antibiotics: Antibiotics may be necessary if there is suspected meningitis or another infectious cause contributing to increased intracranial pressure.
Parameters to Monitor:
Behavioral changes: Monitor for irritability, difficulty to console, and other behavioral changes which can indicate neurological distress.
Pupillary response: Assess for changes in pupillary size and reactivity, as altered pupillary responses can indicate neurological involvement and increased intracranial pressure.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"dropdown-group-1":"D","dropdown-group-2":"A"}
Explanation
The nurse should plan to clarify the prescription for medication Ceftriaxone because of the child's finding medication allergy. Given the child's allergy to cephalosporins, which are related to ceftriaxone, clarifying the prescription ensures that an alternative antibiotic is chosen to treat the left lower lobe pneumonia effectively without risking an allergic reaction.
Correct Answer is C
Explanation
A. Mixing medication in a bottle of formula is not recommended as the infant may not finish the entire bottle, leading to incomplete dosage. It also changes the taste of the formula, which may cause feeding aversions.
B. Honey should not be given to infants under 1 year old due to the risk of botulism. It is not a suitable medium for mixing medication for young infants.
C. Placing the medication in an oral syringe allows for precise dosing and easy administration. It ensures that the infant receives the correct amount of medication.
D. Placing the medication in the back of the infant's throat using a dropper can cause gagging and aspiration. An oral syringe allows for better control and safer administration.
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