Nokea
An adolescent with pelvic inflammatory disease (PID) is admitted to the hospital after 14 days of taking levofloxacin 500 mg PO daily and metronidazole 500 mg IV piggy back (IVBP) twice daily (BID). She asks the nurse, 'Why do I have to be in the hospital? Why can't I get my treatment at home?' Which purpose should the nurse provide that supports an effective outcome?
- A. Detection of early symptoms of Jarisch-Herxheimer reaction.
- B. Collection of serial anaerobic cultures of vaginal discharge.
- C. Implementation of contact precautions to prevent spread of infection.
- D. Administration of a supervised parenteral antibiotic protocol.
Correct Answer: D
Rationale: Hospitalization ensures supervised IV antibiotics for severe PID unresponsive to outpatient therapy, preventing complications like tubo-ovarian abscess.
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History and Physical
Nurses Notes
The client is a 4-year-old male with a history of prematurity, short gut syndrome, and liver and bowel transplant. He has been hospitalized for the past 8 months, 6 of those were spent in the pediatric intensive care unit. He is currently in the pediatric unit for observation as his post transplant medications are stabilized for discharge.
Which action(s) is/are appropriate for the nurse caring for this child? Select all that apply.
- A. Avoid mentioning anything about the mother to the child.
- B. Develop a trusting relationship with the child.
- C. Notify the mother that social services will be notified if she does not visit regularly.
- D. Have the child sign a treatment contract stating he will participate in therapy.
- E. Ask the mother to bring a familiar object from home.
- F. Facilitate phone conversations between the child and his mother.
Correct Answer: B,E,F
Rationale: Building trust, providing familiar objects, and facilitating mother-child communication support the child's emotional well-being during hospitalization.
The nurse is caring for an infant admitted with dehydration, irritability, signs of extreme hunger, and a palpable olive-like mass in the upper right abdominal quadrant. When feeding the infant, the nurse should monitor for which development?
- A. Arched back.
- B. Coffee-ground emesis.
- C. Projectile vomiting.
- D. Frequent pauses.
Correct Answer: C
Rationale: Projectile vomiting is characteristic of pyloric stenosis, indicated by the olive-like mass, hunger, and dehydration.
A client who is in labor states, 'I think my water just broke!' The nurse notes that the umbilical cord is on the perineum. Which action should the nurse perform first?
- A. Notify the operating room team.
- B. Administer a fluid bolus of 500 mL.
- C. Administer oxygen via face mask.
- D. Place the client in Trendelenburg.
Correct Answer: D
Rationale: Trendelenburg positioning relieves umbilical cord compression, preventing fetal hypoxia in this emergency.
Following a vaginal delivery, the nurse places the neonate under the radiant warmer, provides naso-oropharyngeal suction, and dries the neonate's skin to elicit spontaneous respirations. The newborn heart rate is 100 beats/minute and remains apneic when the nurse flicks the soles of the feet. Which action should the nurse implement next?
- A. Give blow-by oxygen via cannula.
- B. Start IV infusion in a scalp vein.
- C. Assist neonatologist with intubation.
- D. Provide positive pressure ventilation.
Correct Answer: D
Rationale: Positive pressure ventilation is critical for an apneic newborn to establish breathing and ensure oxygenation, per neonatal resuscitation guidelines.
The nurse is caring for a child with a unilateral long-leg cast applied for the correction of club foot. Which action is most important for the nurse to perform?
- A. Palpate femoral pulses.
- B. Compare temperature of both legs.
- C. Monitor capillary refill of the toes.
- D. Examine for spontaneous movement.
Correct Answer: C
Rationale: Monitoring capillary refill ensures adequate circulation in the casted limb, detecting complications like compartment syndrome.