A nurse is assisting with the care of a 2-year-old child.
For each potential provider's prescription, click to specify if the potential prescription is anticipated or contraindicated for the child.
Ceftriaxone 50 mg/kg/dose IV every 24 hr
Loperamide PO 1 mg twice daily
Check urine specific gravity every 4 hr.
Dextrose 5% sodium chloride IV infusion 60 mL/hr over 6 hr
Obtain arterial blood gases.
Oral rehydration solution 50 mL/kg over 4 hr
The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"B"},"F":{"answers":"A"}}
• Ceftriaxone 50 mg/kg/dose IV every 24 hr: The stool sample is positive for Escherichia coli, indicating a bacterial gastroenteritis that may require IV antibiotics due to dehydration and systemic involvement. Ceftriaxone provides broad-spectrum coverage appropriate for pediatric patients with moderate to severe infection. IV administration ensures adequate therapeutic levels while the child is unable to tolerate oral intake.
• Check urine specific gravity every 4 hr: The child shows signs of dehydration: weight loss, concentrated urine, sunken eyes, and poor skin turgor. Monitoring urine specific gravity frequently provides an objective measure of hydration status and kidney perfusion. It allows the nurse to evaluate response to fluid therapy.
• Loperamide PO 1 mg twice daily: Antidiarrheal medications like loperamide are contraindicated in pediatric infectious diarrhea, especially with E. coli. Loperamide slows intestinal motility, which can prolong infection and increase the risk of complications such as hemolytic uremic syndrome. In children, it can also cause central nervous system depression.
• Dextrose 5% sodium chloride IV infusion 60 mL/hr over 6 hr: IV fluid replacement is essential for a child with significant fluid loss from vomiting and diarrhea. Dextrose with sodium chloride provides both hydration and caloric support, correcting dehydration and electrolyte imbalances. Infusion rate is calculated to safely restore intravascular volume without causing fluid overload.
• Obtain arterial blood gases: Arterial blood gas analysis is not necessary in a child with mild to moderate dehydration and stable oxygenation. Vital signs and urine output provide adequate monitoring of perfusion and acid-base status in this context. ABGs are reserved for cases of severe dehydration with respiratory compromise or suspected metabolic derangements.
• Oral rehydration solution 50 mL/kg over 4 hr: Once the child is stable and able to tolerate oral intake, oral rehydration is recommended to maintain fluid and electrolyte balance. ORS replenishes lost sodium and water efficiently and reduces the risk of ongoing dehydration. It is evidence-based for mild to moderate dehydration in pediatric gastroenteritis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. "A client must withdraw consent for treatment in writing if he is competent to do so.": While written consent is generally required for initiating treatment, a competent client can revoke consent verbally or in writing. Requiring only written withdrawal is not accurate, as verbal refusal also upholds the client’s right to autonomy.
B. "A client who is an immediate danger to herself or others cannot refuse antipsychotic medications.": When a client poses an imminent risk of harm, healthcare providers may administer treatment, including antipsychotic medications, under emergency exceptions to consent laws. This ensures safety for the client and others while adhering to legal and ethical standards in mental health care.
C. "A client who is involuntarily committed loses the right to refuse treatment.": Involuntary commitment allows for hospitalization but does not automatically eliminate the client’s right to refuse treatment. Except in emergencies, treatment generally requires consent or a court order, preserving the client’s rights even during involuntary admission.
D. "A client who refuses to go to group therapy can be discharged for noncompliance.": Refusing group therapy alone is not sufficient cause for discharge, as mental health treatment plans are individualized and client rights to participate or decline interventions are protected. Discharge decisions must consider safety, treatment goals, and legal regulations rather than compliance alone.
Correct Answer is D
Explanation
A. "Wash your newborn's head under a stream of running water.": Running water directly over a newborn’s head can increase the risk of aspiration or chilling. It is safer to use a damp washcloth to gently cleanse the scalp and hair, controlling the amount of water applied and maintaining the infant’s body temperature.
B. "Bathe your newborn within 30 minutes after a feeding.": Bathing immediately after feeding can increase the risk of spitting up or vomiting due to abdominal distension. It is recommended to wait at least 1 hour after feeding to allow digestion and reduce discomfort during the bath.
C. "Start the bath by washing the newborn's diaper area first.": The bath should always progress from the cleanest areas to the dirtiest areas to prevent the spread of bacteria from the genital region to more sensitive areas like the eyes and face.
D. "The bath water should be 100 to 103 degrees Fahrenheit.": Maintaining the bath water between 100 and 103 degrees is essential to prevent both hypothermia and thermal burns, as a newborn's skin is much thinner and more delicate than an adult's. This temperature range mimics the infant’s internal body temperature, providing a soothing environment.
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