The nurse is caring for a 2 month old child with a fever of 101.76. The child also appears toxic with poor color. Which of the following actions would the nurse expect to implement as a priority?
Replace fluids orally
Administer antibiotics as prescribed
Obtain a specimen for complete blood co
Obtain urinalysis
The Correct Answer is B
A. While fluid replacement is important, in a toxic-appearing child, oral fluids may not be safe or adequate due to potential dehydration and risk of worsening condition.
B. Administering antibiotics is the priority action because the child shows signs of potential serious infection, and timely antibiotic treatment is crucial in young infants who may quickly deteriorate.
C. Obtaining a specimen for a complete blood count is necessary for diagnosing infection but is not as urgent as administering antibiotics.
D. While obtaining a urinalysis may help identify a urinary tract infection, it is not the immediate priority compared to starting antibiotic therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["300"]
Explanation
To calculate the dose of ceftriaxone for the child, first convert the child's weight from pounds to kilograms, knowing that 1 kilogram equals 2.2 pounds. The child weighs 33 pounds, which is approximately 15 kilograms when divided by 2.2. The prescribed dose is 60 mg/kg/day, so for a 15 kg child, this would be 900 mg per day. Since the medication is to be administered in three divided doses, you would divide 900 mg by 3, resulting in 300 mg per dose.
Correct Answer is B
Explanation
A. Poor skin turgor typically indicates dehydration, not fluid overload.
B. Shortness of breath can be a sign of fluid overload, particularly in children with renal failure, as excess fluid can accumulate and lead to pulmonary edema.
C. Redness at the tube insertion site may indicate infection but does not specifically relate to fluid overload.
D. Fever is a sign of infection or inflammation and does not directly indicate fluid overload.
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