A nurse is educating a client on how to prevent the spread of RSV at home.
Which of the following instructions should the nurse include? (Select all that apply).
Isolate the child from other children or adults with respiratory infections.
Use contact precautions such as gown and gloves when caring for the child.
Encourage frequent hand hygiene.
Allow siblings to share toys and utensils with the infected child.
Avoid exposure to tobacco smoke.
Correct Answer : A,B,C,E
Choice A rationale:
Isolating the child from other children or adults with respiratory infections is crucial in preventing the spread of Respiratory Syncytial Virus (RSV).
RSV is highly contagious and spreads through respiratory droplets.
By isolating the infected child, the nurse helps prevent the transmission of the virus to others.
Choice B rationale:
Using contact precautions such as gown and gloves when caring for the child is essential to prevent the spread of RSV.
Direct contact with respiratory secretions can easily lead to transmission.
Wearing protective gear like gowns and gloves creates a barrier, reducing the risk of contamination and spread.
Choice C rationale:
Encouraging frequent hand hygiene is a fundamental preventive measure.
RSV can survive on surfaces for several hours, so regular handwashing with soap and water for at least 20 seconds can help eliminate the virus from hands, reducing the risk of infection.
Choice E rationale:
Avoiding exposure to tobacco smoke is important because smoke irritates the respiratory tract, making individuals more susceptible to respiratory infections like RSV.
Secondhand smoke can also worsen symptoms in infected individuals and increase the severity of the illness.
Choice D rationale:
Allowing siblings to share toys and utensils with the infected child is not recommended.
RSV spreads through respiratory droplets and direct contact with contaminated surfaces.
Sharing toys and utensils can facilitate the transmission of the virus to other children, increasing the risk of infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice B rationale:
Offering frequent small feedings of breast milk or formula to maintain nutrition is an appropriate response.
Infants with RSV may experience decreased appetite and difficulty feeding due to respiratory distress.
Providing small, frequent feedings ensures that the infant receives adequate nutrition and hydration despite reduced intake during each feeding session.
Choice A rationale:
Giving the baby aspirin if they develop a fever is not recommended.
Aspirin use in children with viral infections like RSV has been associated with Reye's syndrome, a severe and potentially fatal condition.
Acetaminophen or ibuprofen, if appropriate for the child's age, can be used to manage fever and discomfort.
Choice C rationale:
Keeping the baby in a flat position to promote comfort is not advisable.
Elevating the head of the crib or bassinet slightly can help improve breathing and reduce nasal congestion in infants with respiratory infections, promoting better comfort and easier breathing.
Choice D rationale:
Stopping all feedings if the baby seems to be having trouble breathing is not The correct approach.
Adequate nutrition is crucial for the infant's overall health and recovery.
Instead, the caregiver should seek medical advice if the baby experiences significant difficulty breathing or feeding.
Adjustments in feeding techniques or temporary alternative feeding methods may be recommended under medical supervision.
Correct Answer is ["A","C"]
Explanation
Choice A rationale: The child’s respiratory rate of 35 breaths per minute is slightly elevated but not uncommon for a 3-year-old with a respiratory infection like RSV. Given the child's oxygen saturation is 96%, which is within normal range, it is appropriate to continue monitoring the respiratory rate. Monitoring ensures any changes in the child’s condition can be promptly addressed without unnecessary interventions.
Choice B rationale: Administering supplemental oxygen is not necessary in this case because the child’s oxygen saturation is 96%, which is within the normal range (95-100%). Providing supplemental oxygen without clinical indication can cause potential harm and is not warranted when oxygen levels are adequate.
Choice C rationale: Reassessing the child’s oxygen saturation in one hour is a prudent action. This allows the nurse to ensure that the child’s oxygen levels remain stable and to detect any potential decline in respiratory function. It provides an ongoing assessment to ensure the child's condition does not worsen.
Choice D rationale: The pH value of 7.38 is within the normal range (7.35-7.45), indicating that the child is not experiencing acid-base imbalance. There is no immediate need to notify the healthcare provider about the pH value alone, as it does not suggest any critical condition requiring urgent intervention.
Choice E rationale: Preparing for immediate intubation due to elevated PaCO2 is not warranted. The child’s PaCO2 is 40, which is within the normal range for carbon dioxide levels (35-45 mmHg). Intubation is a severe intervention reserved for cases of respiratory failure, which is not indicated by the presented lab results.
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