A nurse is caring for a 2-year-old child who has pneumonia and a temperature of 39.4° C (103° F). Which of the following actions should the nurse take?
Give 500 mg acetaminophen PO every 2 hr.
Administer a 300-mg aspirin suppository.
Place the child in an ice bath.
Lower the temperature of the room.
The Correct Answer is D
Choice A reason:
This is a high dose for a 2 year old child.
Choice B reason:
Aspirin is contraindicated for children with viral infections due to the risk of Reye's syndrome. It should not be administered.
Choice C reason:
Placing the child in an ice bath is an overly aggressive intervention and can lead to hypothermia. It is not recommended.
Choice D reason:
Lowering the temperature of the room is important in reducing external temperature to help cool the baby.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason:
Administering iron dextran subcutaneously into the vastus lateralis is not the recommended route for this medication. It is typically administered intramuscularly.
Choice B reason:
Correct. The preferred method for administering iron dextran is intramuscularly using the Z-track method. This technique helps prevent leakage of the medication into the subcutaneous tissue.
Choice C reason:
Administering iron dextran subcutaneously into the deltoid is not the preferred route for this medication. It is typically administered intramuscularly.
Choice D reason:
While a 20-gauge needle may be appropriate for intramuscular injections, the Z-track method is the preferred technique for administering iron dextran intramuscularly. The gauge of the needle may vary depending on the specific circumstances and patient characteristics.
Correct Answer is B
Explanation
Choice A reason:
A blood glucose level of 220 mg/dL is elevated and should be addressed, but it may not be an immediate priority compared to the presence of Kussmaul respirations.
Choice B reason.
Correct. Kussmaul respirations are a sign of diabetic ketoacidosis (DKA), a severe complication of diabetes. This requires immediate attention and intervention.
Choice C reason:
Vomiting is a concerning symptom, but it may not be as immediately life-threatening as Kussmaul respirations.
Choice D reason:
Frequent urination is a common symptom of diabetes, but it may not require immediate intervention unless it is accompanied by other severe symptoms.
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