A nurse on a pediatric unit is reviewing her client assignment following the shift report. Which of the following clients should the nurse plan to assess first?
An infant who has pertussis and is receiving oxygen via nasal cannula.
A school-age child who has diabetes mellitus and requires blood glucose monitoring.
An adolescent who was admitted to the unit in sickle cell crisis and is ready for discharge instructions.
A toddler who has both arms in casts and needs to be fed his breakfast.
The Correct Answer is A
Choice A reason: An infant who has pertussis and is receiving oxygen via nasal cannula:
Pertussis, also known as whooping cough, is a highly contagious respiratory disease that can be particularly severe in infants. The fact that the infant is receiving oxygen indicates respiratory distress, which is a critical condition requiring immediate attention. Infants with pertussis are at high risk for complications such as pneumonia, apnea, and respiratory failure. Therefore, this patient should be assessed first to ensure their airway and breathing are adequately supported.
Choice B reason: A school-age child who has diabetes mellitus and requires blood glucose monitoring:
While it is important to monitor blood glucose levels in children with diabetes mellitus to prevent hypo- or hyperglycemia, this condition is generally more stable and manageable compared to the acute respiratory distress seen in the infant with pertussis. Blood glucose monitoring can be scheduled and managed, making it a lower priority in this context.
Choice C reason: An adolescent who was admitted to the unit in sickle cell crisis and is ready for discharge instructions:
Sickle cell crisis can be extremely painful and requires careful management. However, if the adolescent is ready for discharge, it indicates that their condition has stabilized. Providing discharge instructions is important but can be deferred until more critical patients are assessed.
Choice D reason: A toddler who has both arms in casts and needs to be fed his breakfast:
While this toddler requires assistance with feeding due to their casts, this situation does not pose an immediate threat to their health. Feeding can be managed after ensuring that more critical patients, such as the infant with pertussis, are stable.
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Correct Answer is A
Explanation
Choice A reason: 0730:
Regular insulin, also known as short-acting insulin, typically begins to work within 30 minutes after administration. Therefore, ensuring the client receives breakfast at 0730, which is 15 minutes after the insulin dose, aligns with the onset of insulin action. This timing helps to prevent hypoglycemia by ensuring that glucose from the meal is available when the insulin starts to lower blood sugar levels.
Choice B reason: 0745:
Administering breakfast at 0745, which is 30 minutes after the insulin dose, might be slightly delayed. While it is still within the effective window, it is better to have the meal a bit earlier to ensure that glucose is available as soon as the insulin begins to act.
Choice C reason: 0815:
Providing breakfast at 0815, which is an hour after the insulin dose, is too late. By this time, the insulin would have already started to lower blood glucose levels significantly, increasing the risk of hypoglycemia. It is crucial to match the timing of food intake with the insulin action to maintain stable blood sugar levels.
Choice D reason: 0720:
Serving breakfast at 0720, which is only 5 minutes after the insulin dose, is too early. The insulin would not have started to act yet, and the blood glucose levels might rise too high before the insulin begins to lower them. It is important to wait at least 15-30 minutes after administering regular insulin before eating.
Correct Answer is ["B","D","E"]
Explanation
Choice A: Wash raw carrots before cooking
Reason: Washing raw vegetables, including carrots, before cooking is essential to remove dirt, bacteria, and pesticide residues. However, this option is not specific to preventing foodborne illnesses. Washing vegetables is a general hygiene practice, but it does not address the broader aspects of food safety, such as preventing cross-contamination or ensuring proper cooking temperatures. Therefore, while important, it is not the most critical instruction for preventing foodborne illnesses in this context.
Choice B: Separate raw foods from ready-to-eat foods
Reason: Separating raw foods from ready-to-eat foods is crucial to prevent cross-contamination. Raw foods, especially meats, poultry, and seafood, can harbor harmful bacteria that can transfer to ready-to-eat foods if not kept separate. This separation should be maintained during storage, preparation, and cooking. For example, raw meat should be stored on the bottom shelf of the refrigerator to prevent juices from dripping onto other foods. Using separate cutting boards and utensils for raw and ready-to-eat foods further minimizes the risk of cross-contamination.
Choice C: Wash utensils with warm water
Reason: While washing utensils with warm water is a good practice, it is not sufficient on its own to ensure food safety. Utensils that have come into contact with raw meat, poultry, or seafood should be washed with hot, soapy water and sanitized to kill any harmful bacteria. Simply using warm water may not effectively remove or kill bacteria, making this option less critical compared to others that directly address foodborne illness prevention.
Choice D: Practice good hand washing after handling raw eggs, meat, or poultry
Reason: Practicing good hand washing after handling raw eggs, meat, or poultry is one of the most effective ways to prevent foodborne illnesses. Hands can easily transfer bacteria from raw foods to other surfaces, utensils, and foods. Proper hand washing involves scrubbing hands with soap and water for at least 20 seconds, ensuring all parts of the hands are cleaned. This practice helps to eliminate harmful bacteria and reduce the risk of cross-contamination.
Choice E: Ensure all food is cooked to 165°F. Promptly refrigerate foods when finished eating
Reason:Cooking food to the proper internal temperature is essential to kill harmful bacteria that can cause foodborne illnesses. For most foods, an internal temperature of 165°F (73.9°C) is recommended to ensure safety. Using a food thermometer to check the temperature is the best way to ensure food is cooked thoroughly. Additionally, promptly refrigerating foods after eating helps to prevent bacterial growth. Bacteria can multiply rapidly at room temperature, so refrigerating leftovers within two hours (or one hour if the temperature is above 90°F) is crucial for food safety.
