Difficulty: Medium
Average Score: 93%
Simulated
Passage / Scenario
Nurses notesVital Signs
Infant presents with difficulty in breathing. Lung sounds clear but with increased work of breathing noted. No cyanosis or retractions observed at this time. Infant appears alert but fatigued.
A nurse is assisting with the care of a 5 month-old infant who was just admitted to the pediatric unit. For each potential provider's prescription, specify if anticipated or contraindicated.
Correct answer
A,B,C,D,E,F
Rationale
Pulse oximetry, supine position, monitoring I&O, IV line, and chest x-ray are anticipated for respiratory distress. Small, frequent feedings are contraindicated due to fatigue and breathing difficulty.