A nurse is planning care for an 8-month-old infant who has bronchiolitis. Which of the following actions should the nurse include in the plan of care?
Use a bulb syringe to suction the nares.
Initiate IV antibiotic therapy.
Administer a meningococcal vaccine upon admission.
Place the infant in a room with negative-pressure airflow.
The Correct Answer is A
Choice A reason: Using a bulb syringe to suction the nares is appropriate for an infant with bronchiolitis to help clear mucus and maintain airway patency, as bronchiolitis often causes nasal congestion.
Choice B reason: Initiating IV antibiotic therapy is not typically indicated for bronchiolitis, which is usually caused by a virus, and antibiotics are ineffective against viral infections.
Choice C reason: Administering a meningococcal vaccine upon admission is not related to the immediate care needs of an infant with bronchiolitis and is not part of standard treatment for this condition.
Choice D reason: Placing the infant in a room with negative-pressure airflow is not necessary for bronchiolitis, as this measure is reserved for airborne infections like tuberculosis, not for bronchiolitis which is spread through droplets.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: A creatinine level of 1.4 mg/dL is higher than the normal range for a 4-year-old child and could indicate kidney impairment, which is a concern when administering gentamicin due to its potential nephrotoxic effects. The provider should be informed immediately to assess kidney function and adjust the medication if necessary.
Choice B reason: A BUN level of 5 mg/dL is within the normal range for children and does not typically warrant immediate concern. However, it should be monitored along with creatinine levels to assess kidney function.
Choice C reason: A creatinine level of 0.3 mg/dL is within the normal range for a 4-year-old child and does not indicate an immediate concern. It should be monitored for any changes, especially when on gentamicin.
Choice D reason: A WBC count of 15,000/mm³ is slightly elevated, which may be expected in a child with meningitis as it indicates an immune response to infection. However, it is not as critical as an abnormal creatinine level in the context of gentamicin therapy.
Correct Answer is B
Explanation
Choice A reason: Hemoglobin (Hgb) of 12 g/dL is within the normal range for school-age children and is not specifically indicative of nephrotic syndrome.
Choice B reason: A serum protein level of 4.2 g/dL is lower than the normal range, which is typically between 6 and 8 g/dL. This finding is consistent with nephrotic syndrome, as the condition is characterized by proteinuria and hypoalbuminemia, leading to low serum protein levels.
Choice C reason: A BUN (Blood Urea Nitrogen) level of 15 mg/dL is within the normal range for children and does not specifically indicate nephrotic syndrome. Nephrotic syndrome is characterized by protein loss, not necessarily changes in BUN levels.
Choice D reason: A serum sodium level of 144 mEq/L is within the normal range for children. While electrolyte imbalances can occur in nephrotic syndrome, this value does not specifically indicate the condition.
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