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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 []

Explanation

Rationale for Correct Choices:

  • Lead poisoning: The child's exposure to construction dust in a home built in the 1950s, coupled with symptoms like lethargy, irritability, weakness, and abdominal discomfort, suggests lead poisoning. Lead exposure in older homes with construction dust is a significant risk factor.
  • Reinforce education on lead exposure and prevention: Given the suspected lead exposure, educating the parents about how to reduce the child’s exposure to lead is crucial. This includes steps like avoiding dust, cleaning thoroughly, and taking preventive measures to protect the child.
  • Prepare to assist with chelation therapy: If lead poisoning is confirmed, chelation therapy is the mainstay treatment to help remove lead from the body. Chelation agents bind to lead in the body, facilitating its excretion.
  • Blood lead levels: Monitoring blood lead levels is essential for confirming lead poisoning and determining the severity of the exposure. Elevated blood lead levels would guide the need for chelation therapy.
  • Developmental milestones: Lead poisoning can adversely affect cognitive, motor, and developmental growth in children. Monitoring developmental milestones is critical to assess if lead exposure is impacting the child’s growth and development.

Rationale for Incorrect Choices:

  • Meningitis: Although the child has had exposure to meningitis, the clinical presentation does not align with typical meningitis, which often presents with more acute symptoms like fever, nuchal rigidity, and altered consciousness.
  • Guillain-Barré Syndrome: Guillain-Barré syndrome is unlikely as it typically presents with ascending paralysis. The child’s symptoms, such as irritability and weakness, are more consistent with lead poisoning, especially with the known risk factors of lead exposure.
  • Diabetes mellitus type 1: While the child shows increased thirst and urination, the overall presentation of irritability, abdominal discomfort, and weakness, along with the known risk of lead exposure, makes lead poisoning a more likely diagnosis.
  • Assist with lumbar puncture: A lumbar puncture is typically performed to diagnose meningitis or other central nervous system infections. The child’s symptoms do not suggest meningitis, and this action is not warranted at this time.
  • Glycosylated hemoglobin (HbA1c): Monitoring HbA1c is useful for diagnosing diabetes, but it is not appropriate for assessing lead poisoning. Blood glucose levels would be more relevant to diagnose diabetes type 1, but in this case, lead poisoning is the primary concern.
  • Assist with administration of intravenous immunoglobulin: Intravenous immunoglobulin (IVIG) is generally used to treat autoimmune disorders or infections, such as Guillain-Barré syndrome. It is not appropriate for lead poisoning, which requires chelation therapy.
  • Nuchal rigidity: There is no indication of neck stiffness or signs of meningitis. Nuchal rigidity would be relevant in the case of suspected meningitis, but this is not the primary diagnosis here. The child’s symptoms align more with lead poisoning.
  • Electromyography results: Electromyography is typically used to assess nerve function in conditions like Guillain-Barré syndrome, but it’s not necessary for diagnosing or managing lead poisoning.
  • Obtain a serum blood glucose: While obtaining a blood glucose is important to rule out diabetes type 1, the child’s symptoms, coupled with the lead exposure risk, are more aligned with lead poisoning.

Correct Answer is B

Explanation

A. A blood pressure of 95/58 mm Hg can be within an acceptable range for an infant and is not typically a cause for concern in a 2-month-old.

B. A respiratory rate of 18/min is abnormally low for a 2-month-old infant. Infants normally have a respiratory rate of about 30–60/min, and a low rate may indicate respiratory depression or other serious issues that should be reported promptly.

C. A temperature of 37.4° C (99.3°F) is within the expected range for an infant and does not indicate fever.

D. A heart rate of 160/min is within the normal range for a young infant, especially when awake or active.

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