A nurse is caring for a child who has a suspected diagnosis of bacterial meningitis. Which of the following actions is the nurse’s priority?
Obtain blood cultures.
Administer an intravenous antibiotic.
Prepare the child for a lumbar puncture.
Place the child in isolation.
The Correct Answer is B
Choice A rationale
Obtaining blood cultures is important for identifying the causative organism, but it should be done immediately before or concurrently with the administration of antibiotics.
Choice B rationale
Administering an intravenous antibiotic is the priority action for a child with suspected bacterial meningitis. Early administration of antibiotics is crucial to treat the infection and prevent complications such as brain swelling and seizures.
Choice C rationale
Preparing the child for a lumbar puncture is necessary for diagnosing meningitis, but it should not delay the administration of antibiotics.
Choice D rationale
Placing the child in isolation is important to prevent the spread of infection, but it is not the immediate priority over administering antibiotics.
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Correct Answer is B
Explanation
Choice A rationale
Mummy restraints, also known as swaddling, involve wrapping the infant’s body in a blanket to restrict movement. While this method can be used to calm and secure infants during certain procedures, it is not appropriate for postoperative care following cleft lip and palate repair. Mummy restraints do not prevent the infant from touching the surgical site and may cause discomfort.
Choice B rationale
Elbow restraints are the appropriate choice for an infant postoperative following cleft lip and palate repair. These restraints prevent the infant from bending their arms and touching or damaging the surgical site. Elbow restraints allow for some movement and circulation while ensuring the surgical area remains protected during the healing process. They are commonly used in pediatric postoperative care to prevent self-injury.
Choice C rationale
Jacket restraints involve securing the infant’s torso to prevent movement. While jacket restraints can be used in certain situations to ensure safety, they are not suitable for postoperative care following cleft lip and palate repair. Jacket restraints do not specifically prevent the infant from touching the surgical site and may cause unnecessary restriction and discomfort.
Choice D rationale
Wrist restraints involve securing the infant’s wrists to prevent movement. While wrist restraints can be used to prevent self-injury, they are not the best choice for postoperative care following cleft lip and palate repair. Wrist restraints may not effectively prevent the infant from reaching the surgical site and can cause discomfort and distress. .
Correct Answer is D
Explanation
Choice A rationale
Temper tantrums are not a type of learning disability. They are a normal part of toddler development and are a way for toddlers to express frustration and assert independence.
Choice B rationale
Leaving the room while a tantrum is happening is not recommended. It is important for parents to stay calm and present, providing a safe environment for the child. Ignoring the tantrum while staying nearby can help the child learn to self-regulate.
Choice C rationale
Psychological consults are not typically necessary for temper tantrums. Temper tantrums are a normal part of development and usually decrease as the child learns to communicate and manage emotions better.
Choice D rationale
Temper tantrums are indeed the toddler’s attempt to gain control of a situation. Toddlers often have tantrums when they are unable to express their needs or when they are frustrated by their lack of control over their environment. Understanding this can help parents respond appropriately and support their child’s emotional development.