The nurse is caring for a 10-month-old infant diagnosed with respiratory syncytial virus (RSV) bronchiolitis. Which interventions should be included in the child's care? (Select all that apply.).
Institute cluster care to encourage adequate rest.
Administer cough syrup.
Administer antibiotics.
Encourage infant to drink 8 ounces of formula every 4 hours.
Place on noninvasive oxygen monitoring.
Correct Answer : A,E
The correct answers are choices A and E: Institute cluster care to encourage adequate rest and Place on noninvasive oxygen monitoring.
Choice A rationale:
Institute cluster care to encourage adequate rest. This is a correct choice. Cluster care involves grouping nursing interventions together to minimize disruptions to the child's rest. Adequate rest is crucial for the healing process in infants with respiratory syncytial virus (RSV) bronchiolitis.
Choice B rationale:
Administer cough syrup. This choice is incorrect for RSV bronchiolitis. Cough syrup is not recommended for infants with bronchiolitis. RSV primarily affects the lower respiratory tract and can cause airway inflammation, making cough syrup potentially ineffective and unnecessary.
Choice C rationale:
Administer antibiotics. This choice is incorrect for RSV bronchiolitis. RSV is a viral infection, and antibiotics are ineffective against viruses. Antibiotics should only be used when there is a bacterial infection or a clear indication.
Choice D rationale:
Encourage infant to drink 8 ounces of formula every 4 hours. This choice is not the best approach for managing RSV bronchiolitis. Infants with RSV may experience decreased appetite due to respiratory distress. Smaller, more frequent feedings are often recommended to prevent overfeeding and aspiration.
Choice E rationale:
Place on noninvasive oxygen monitoring. This is a correct choice. RSV bronchiolitis can cause respiratory distress and compromise oxygenation. Noninvasive oxygen monitoring helps assess the child's oxygen levels and aids in determining the need for supplemental oxygen therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","D"]
Explanation
The correct answers are choices C. Novolin R, and D. NovoLog.
Choice A rationale:
Novolin N is an intermediate-acting insulin, not rapid or short acting. It has a slower onset and longer duration of action, making it unsuitable for rapid blood sugar control.
Choice B rationale:
Lantus is a long-acting insulin that provides basal insulin coverage and has a relatively steady effect over 24 hours. It is not rapid or short acting and is used to provide a baseline level of insulin, not for immediate blood sugar control.
Choice C rationale:
Novolin R, also known as regular insulin, is a short-acting insulin with an onset of about 30 minutes and a peak effect around 2 to 3 hours. It is often used to cover mealtime blood sugar elevations and is suitable for short-term blood sugar control.
Choice D rationale:
NovoLog is a rapid-acting insulin analog with an onset of about 15 minutes and a peak effect within 1 to 2 hours. It is designed to mimic the body's rapid insulin release after meals, making it effective for controlling postprandial blood sugar levels.
Correct Answer is A
Explanation
The correct answer is Choice A: Surgical removal of the affected section of bowel.
Choice A rationale:
Surgical removal of the affected section of bowel is the primary therapeutic management for most children with Hirschsprung's disease. Hirschsprung's disease is a congenital condition where there is a lack of nerve cells in a segment of the colon, leading to obstruction and dilation of the bowel. Surgical resection of the affected segment and reconnection of healthy bowel portions is the standard treatment to alleviate the obstruction and restore normal bowel function.
Choice B rationale:
Daily enemas might be used in some cases to manage symptoms temporarily, but they are not the primary therapeutic management for Hirschsprung's disease. Surgery is the mainstay of treatment.
Choice C rationale:
Permanent colostomy might be considered if the affected portion of bowel is extensive and cannot be safely reconnected after resection, but it's not the primary option for most children with Hirschsprung's disease.
Choice D rationale:
A low-fiber diet is not a therapeutic management for Hirschsprung's disease. Surgical intervention is necessary to address the underlying cause of obstruction, and diet modifications alone wouldn't resolve the condition.
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