Nokea
Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which information?
- A. Do not use for more than 3 days.
- B. Keep drops to use again for nasal congestion.
- C. Administer drops after feedings and at bedtime.
- D. Give two drops every 5 minutes until nasal congestion subsides.
Correct Answer: A
Rationale: Using decongestant nose drops for no more than 3 days prevents rebound congestion. Drops should be discarded after illness to avoid contamination, administered before feedings for better effect, and given in two doses 5-10 minutes apart, not repeatedly every 5 minutes.
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An infants parents ask the nurse about preventing otitis media (OM). What information should be provided?
- A. Avoid tobacco smoke.
- B. Use nasal decongestants.
- C. Avoid children with OM.
- D. Bottle- or breastfeed in a supine position.
Correct Answer: A
Rationale: Avoiding tobacco smoke reduces the risk of otitis media and other childhood illnesses. Nasal decongestants don?t prevent OM, it?s not contagious unless other symptoms are present, and feeding in a semivertical position, not supine, helps prevent OM.
When caring for a child after a tonsillectomy, what intervention should the nurse do?
- A. Watch for continuous swallowing.
- B. Encourage gargling to reduce discomfort.
- C. Apply warm compresses to the throat.
- D. Position the child on the back for sleeping.
Correct Answer: A
Rationale: Continuous swallowing, especially during sleep, signals bleeding from the tonsillectomy site, requiring immediate attention. Gargling may irritate the site, ice compresses are preferred to reduce inflammation, and side or abdominal positioning aids drainage, not back sleeping.
Why are cool-mist vaporizers rather than steam vaporizers recommended in the home treatment of respiratory infections?
- A. They are safer.
- B. They are less expensive.
- C. Respiratory secretions are dried by steam vaporizers.
- D. A more comfortable environment is produced.
Correct Answer: A
Rationale: Cool-mist vaporizers are safer than steam vaporizers, reducing the risk of burns and microbial growth. Costs are comparable, steam vaporizers loosen rather than dry secretions, and both types enhance comfort, but safety is the primary reason for choosing cool-mist.
A 4-year-old girl is brought to the emergency department. She has a froglike croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should intervene in which manner?
- A. Make her lie down and rest quietly.
- B. Examine her oral pharynx and report to the physician.
- C. Auscultate her lungs and prepare for placement in a mist tent.
- D. Notify the physician immediately and be prepared to assist with a tracheostomy or intubation.
Correct Answer: D
Rationale: The symptoms suggest epiglottitis, a medical emergency requiring immediate physician notification and preparation for airway support like tracheostomy or intubation. Lying down worsens breathing, examining the throat risks obstruction, and mist tents are ineffective for epiglottitis.
An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires what type of isolation?
- A. Reverse isolation
- B. Airborne isolation
- C. Contact Precautions
- D. Standard Precautions
Correct Answer: C
Rationale: RSV requires Contact Precautions, including gloves and gowns, to prevent droplet transmission, in addition to Standard Precautions. Reverse isolation protects immunocompromised patients, airborne isolation is for diseases like measles, and Standard Precautions alone are insufficient.