A nurse is assisting with collecting data from a 10-month-old in the emergency department.
Medical History: Guardians brought the infant to the emergency room after witnessing the infant’s arms and legs shaking.
The infant did not respond to the guardians’ voices during that time.
The episode lasted approximately 5 min and the infant was sleeping soundly afterwards.
On the way to the emergency department, the infant had another episode of shaking of the extremities and drooling. The infant was asleep when they arrived for evaluation.
The infant has no prior medical or surgical history.
Born full-term at 40 weeks to a birth mother who had regular prenatal visits.
Actions to Take: Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client’s progress.
Potential Condition
Parameters to Monitor 1
Parameters to Monitor 2
Vitamin
Blood pressure
The Correct Answer is A
The correct answer is A. Potential Condition.
The infant’s symptoms suggest a possible seizure disorder. Seizures can cause symptoms such as shaking of the extremities and unresponsiveness. The fact that the infant was sleeping soundly after the episode and had another episode of shaking and drooling on the way to the emergency department further supports this. The nurse should monitor the infant’s neurological status and vital signs, and administer anticonvulsant medication as ordered by the physician.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["3.125"]
Explanation
The child weighs 22 lb, which is approximately 10 kg (since 1 kg is approximately 2.2 lb).
The prescribed dose of acetaminophen is 10 mg/kg. Step 1 is: Calculate the total dose of acetaminophen for the child. This is done by multiplying the child’s weight in kg by the prescribed dose in mg/kg. 10 kg×10 mg/kg=100 mg The available acetaminophen liquid is 160 mg/5 mL. Step 2 is: Calculate the volume of acetaminophen liquid to administer. This is done by setting up a proportion with the total dose of acetaminophen and the concentration of the available liquid. x mL100 mg=5 mL160 mg Solving for x gives: x=160 mg mg×5 mL=3.125 mL Therefore, the nurse should administer approximately 3.125 mL of the acetaminophen liquid. .
Correct Answer is A
Explanation
Choice A rationale
Tinea Capitis, also known as scalp ringworm, is primarily transmitted through direct contact with infected personal items such as towels, combs, or hats.
Choice B rationale
Exposure to worm eggs through bare feet is not a mode of transmission for Tinea Capitis. This is more commonly associated with a different type of parasitic infection known as hookworm.
Choice C rationale
Sitting on worm eggs is not a mode of transmission for Tinea Capitis. This is a misconception and there is no scientific evidence to support this claim.
Choice D rationale
Airborne droplet transmission is not a mode of transmission for Tinea Capitis. Tinea Capitis is caused by a type of fungus, not a virus or bacteria, and it does not spread through the air via droplets.
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