When caring for an infant with an upper respiratory tract infection and elevated temperature, which appropriate nursing intervention should the nurse implement?
Give tepid water baths to reduce fever.
Encourage food intake to maintain caloric needs.
Have child wear heavy clothing to prevent chilling.
Give small amounts of favorite fluids frequently to prevent dehydration.
The Correct Answer is D
Give small amounts of favorite fluids frequently to prevent dehydration.
Dehydration is a common complication of upper respiratory tract infections in infants, especially if they have a fever. Giving small amounts of fluids frequently can help maintain hydration and electrolyte balance.
Some additional information about the other choices are:
Choice A is wrong because tepid water baths are not recommended for fever reduction. They can cause shivering, which increases heat production and can raise the
temperature further. Instead, antipyretics such as acetaminophen or ibuprofen can be given as prescribed.
Choice B is wrong because food intake may be decreased due to poor appetite, difficulty breathing, or sore throat. Forcing food intake can cause vomiting or aspiration. Fluid intake is more important than caloric intake during an acute infection.
Choice C is wrong because heavy clothing can increase heat retention and discomfort. The infant should be dressed in light clothing and the room temperature should be comfortable.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Vernix caseosa is a cheese-like, whitish substance that fuses with the epidermis and serves as a protective coating for the newborn.
Some possible explanations for the other choices are:
- Choice B. Surfactant is a protein that lines the alveoli of the infant’s lungs and helps prevent them from collapsing.
- Choice C. Caput succedaneum is a swelling of the tissue over the presenting part of the fetal head caused by pressure during delivery.
- Choice D. Acrocyanosis is a bluish discoloration of the hands and feet due to reduced peripheral circulation.
Normal ranges for vernix caseosa are not applicable as it varies depending on the gestational age and skin maturity of the newborn. However, it is usually more abundant in preterm infants than in term or post-term infants.
Correct Answer is B
Explanation
If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place.
This is because the inflamed epiglottis can block the airway and cause respiratory distress or failure.
Choice A is wrong because inspiratory stridor is a sign of upper airway obstruction that is aggravated when a child with epiglottitis is supine.
It is not caused by examining the throat with a tongue depressor.
Choice C is wrong because sore throat and pain on swallowing are early signs of epiglottitis, not precipitated by examining the throat with a tongue depressor.
Choice D is wrong because respiratory tract infection is the cause of epiglottitis, not a symptom or condition that is precipitated by examining the throat with a tongue depressor.
Epiglottitis is caused by H. influenzae in the respiratory tract.
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