A nurse is taking vital signs on an infant diagnosed with bronchiolitis. Which of the following findings should the nurse immediately report to the provider?
Heart rate of 152 beats per minute
Temperature of 99.5°F (37.5°C)
Respiratory rate of 74 breaths per
Blood pressure of 90/60 mmHg
The Correct Answer is C
A. An elevated heart rate can be expected in infants with bronchiolitis due to increased work of breathing.
B. A slight elevation in temperature may be indicative of infection but is not an immediate concern.
C. A respiratory rate of 74 breaths per minute may indicate respiratory distress and warrants immediate attention.
D. A blood pressure of 90/60 mmHg is within the normal range for infants and not immediately concerning.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Respiratory system involvement is not typically associated with Kawasaki disease.
B. Gastrointestinal symptoms, such as abdominal pain, diarrhea, and vomiting, can occur but are secondary to cardiovascular manifestations.
C. Integumentary manifestations, like rash and erythema, are common in Kawasaki disease but are also secondary to cardiovascular involvement.
D. Kawasaki disease primarily affects the cardiovascular system, leading to inflammation of blood vessels, particularly coronary arteries, which can result in coronary artery aneurysms and other cardiac complications.
Correct Answer is D
Explanation
A. Clear liquids are often recommended before procedures requiring sedation, not necessarily after cardiac catheterization.
B. Keeping the child home for a week may not be necessary depending on the child's recovery.
C. Tub baths may be allowed unless contraindicated by specific post-catheterization instructions.
D. Acetaminophen can be given for discomfort following cardiac catheterization, as directed by the healthcare provider.
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