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Exhibits

For each potential provider prescription, click to specify if the prescription is expected or unexpected for the adolescent. There must be at least 1 selection in every row. There does not need to be a selection in every column.

A.

Insert a peripheral IV catheter.

B.

Place the adolescent on a cooling blanket.

C.

Administer IV acyclovir.

D.

Place on seizure precautions.

E.

Keep adolescent flat in bed for 24 hr post lumbar puncture.

F.

Administer IV cefotaxime.

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"A"},"F":{"answers":"A"}}

Rationale:

  • Insert a peripheral IV catheter: A peripheral IV catheter is essential for administering fluids and medications, which is critical for this adolescent, especially with the concern for bacterial meningitis.
  • Place the adolescent on a cooling blanket: The adolescent has a high fever (39°C), which needs to be managed promptly to prevent further complications. A cooling blanket helps reduce the fever and manage the patient’s temperature.
  • Administer IV acyclovir: Acyclovir is an antiviral medication typically used to treat viral infections such as herpes simplex virus or varicella-zoster virus, not bacterial meningitis. Given the CSF findings and suspected bacterial meningitis, acyclovir is not appropriate. Antibiotics like cefotaxime are indicated instead.
  • Place on seizure precautions: Given the adolescent's symptoms (e.g., headache, photophobia, lethargy), the risk of seizures is elevated, especially if meningitis is suspected. Seizure precautions are important to prevent injury during a potential seizure.
  • Keep adolescent flat in bed for 24 hr post lumbar puncture: After a lumbar puncture, keeping the adolescent flat in bed for 24 hours helps prevent post-lumbar puncture headaches and minimizes the risk of cerebrospinal fluid leaks or complications.
  • Administer IV cefotaxime: IV cefotaxime is an appropriate antibiotic for treating bacterial meningitis. Given the abnormal CSF results (low glucose, high protein, elevated WBC), the adolescent is at high risk for bacterial meningitis, and IV cefotaxime is expected to be part of the treatment plan.


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Related Questions

Correct Answer is C

Explanation

A. Short stature: Short stature is not a common adverse effect of budesonide when used as an inhaler. However, long-term use of inhaled corticosteroids in children may have a small effect on growth, but it is not a primary concern with budesonide.
B. Weight loss: Weight loss is not associated with the use of an inhaled corticosteroid like budesonide. Weight gain or fluid retention may be more common with systemic steroids, but this is less of a concern with inhaled forms.
C. Oral candidiasis: Oral candidiasis (thrush) is a known side effect of inhaled corticosteroids, including budesonide. This occurs due to the medication's impact on the oral mucosa, which can promote fungal growth. To reduce the risk, the child should rinse their mouth after using the inhaler.
D. Peptic ulcer: Peptic ulcers are more commonly associated with systemic corticosteroids, not with inhaled corticosteroids like budesonide. Although systemic absorption can occur, the risk for ulcers is significantly lower with inhaled forms compared to oral or injected steroids.

Correct Answer is D

Explanation

A. Lack of subcutaneous fat: Lack of subcutaneous fat may indicate neglect or malnutrition, but it is not a specific sign of sexual abuse.
B. Unexplained illness: Unexplained illness could be related to various conditions, including neglect or medical issues, but it is not a specific indicator of sexual abuse.
C. Poor personal hygiene: Poor personal hygiene can be a sign of neglect but does not directly point to sexual abuse. It could be due to lack of supervision, resources, or care rather than abuse.
D. Recurrent urinary tract infections: Recurrent urinary tract infections (UTIs) can be a red flag for sexual abuse, especially in young children. These infections may be caused by inappropriate sexual contact or injury to the genital area.

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