The nurse is examining a 3-year-old boy with acute otitis media. He has a mild earache and a temperature of 38.5 degrees C. Which action would be most appropriate?
A) Obtain a culture of the middle ear fluid.
B) Advise the parents to watch for worsening of symptoms.
C) Administer antibiotics.
D) Administer antivirals.
B
Response:
In this case, the child should be continually observed. If the symptoms persist or become worse, antibiotics will be prescribed. This clinical practice guideline was developed by the American Academy of Pediatrics and American Academy of Family Physicians in order to avoid overusing antibiotics or obtaining a middle ear fluid culture with every occurrence of acute otitis media.
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A pregnant woman at 25 weeks of gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. Which response by the nurse is most accurate?
a. "That must have been a coincidence; babies can't respond like that." b. "The fetus is demonstrating the aural reflex." c. "Babies respond to sound starting at about 24 weeks of gestation." d. "Let me know if it happens again; we need to report that to your midwife."
An 8-year-old boy comes to the emergency department with abdominal pain. The nurse notes that when the child walks to the treatment room, he is walking on his toes. What might the nurse suspect is wrong with this child?
A) Incarcerated hernia B) Appendicitis C) Testicular torsion D) Wilms' tumor
A mother reports that her adolescent is always late. The mother states, "She was born late and has been late every day of her life." Which response should the nurse make to this mother?
1. "You need to establish specific time frames for your adolescent and be certain she adheres to them." 2. "You should not expect your adolescent to be an ‘on-time' individual unless you set specific alarms and then reinforce the value of being ‘on-time.'" 3. "You should not expect your adolescent to be on time. Teenagers are always late." 4. "You have a major problem. There must be a lot of screaming in your home."
A nurse in a community setting plans wellness outcomes with a 68-year-old female client who desires to participate in a half-marathon run. Which of the following outcomes should the nurse document?
A) The client will remain free of disease. B) The client will participate in daily aerobic activity class without falls. C) The client will increase activity until able to run 30 minutes. D) The client will participate in the half marathon that is scheduled in 6 months.