A nurse is caring for a preschool-aged child who presents with manifestations of epiglottitis. Which of the following actions is the nurse's priority to perform?
Insert an intravenous catheter
Initiate droplet precautions
Provide blow-by humidified oxygen for the child
Place resuscitation equipment at child's bedside
The Correct Answer is D
D. Place resuscitation equipment at the child's bedside. This is because epiglottitis can lead to a life- threatening emergency requiring immediate intervention, and having resuscitation equipment readily available is essential for rapid response.
A. Establishing intravenous access may be necessary for administering fluids and medications but it is not the nurse's priority action when caring for a child with suspected epiglottitis.
B. Droplet precautions help reduce the risk of transmission of respiratory pathogens to others. However, the priority is to address the child's respiratory distress and potential airway compromise.
C. Providing blow-by humidified oxygen can be beneficial in managing the child's respiratory status. However, securing the airway takes precedence over other interventions, as indicated by the guidelines for managing epiglottitis.
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Related Questions
Correct Answer is D
Explanation
D. This is the correct action to take. A neurovascular check involves assessing the circulation, sensation, and movement in the affected limb. This check helps monitor for complications such as impaired circulation, nerve damage, or compartment syndrome, which can occur after the application of a plaster cast. Regular neurovascular checks are essential for early detection of any issues and appropriate intervention if necessary.
A. Using a hair dryer on a hot setting can cause burns to the skin under the cast. It can also cause the cast material to heat up and potentially cause discomfort or injury to the patient.
B. It's essential to follow the healthcare provider's instructions regarding weight-bearing restrictions, but completely discouraging ambulation can lead to complications such as muscle atrophy, decreased circulation, and increased risk of blood clots.
C. Keeping the client's leg in a dependent position means positioning it lower than the heart. This can increase swelling and exacerbate pain, potentially leading to complications such as compartment syndrome.
Correct Answer is D
Explanation
D. An oxygen saturation level of 85% is significantly below the normal range and indicates hypoxemia (low blood oxygen levels). This finding is concerning, especially in a child with cystic fibrosis, which can lead to respiratory complications such as airway obstruction, infection, or mucus plugging.
A. A blood glucose level of 140 mg/dL is within the normal range for children, so this finding would not typically require immediate reporting to the provider.
B. A serum sodium level of 156 mEq/L is significantly elevated and above the normal range. However, hypoxia is the priority.
C. A red blood cell (RBC) count of 3.2 million/µL falls within the normal range for children, so this finding would not typically require immediate reporting to the provider.
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