P.A.S.S questions - help needed!

ShannonSRN · May 18, 2006

I'm working thru the P.A.S.S online review and I keep bumping my head against questions like this one, where I pick the wrong answer. I don't always agree with their rationales and I need to know if it is my thinking that is skewed here!!
The question is:
When planning care for a child suspected of having bacterial meningitis, the nurse's first priority should be to:
1. Offer cool, clear fluids
2. Administer the antipyretic, per MD's order
3. Administer the antibiotic, per MD's order
4. Check vital signs and perform neurological examination.
Which one would you pick and why?
I'll post my (wrong) answer and their right one with rationale in a little while.
Thanks
Elleann

I would choose #4. As they had drilled into us..Assess, assess, assess

AmyD_RN · May 18, 2006

that is the same one I would pick but I looked hard at #2 as well but my final answer (did I just hear Regis?) would be #4. number 1 and 2 are kinda the same so I would have eliminated those.

AmyD

Hebrews 13:5 · May 18, 2006

...I would choose number 4. Reason: Apart from assessing first because it's always the first thing to do, the information in the stem of the question shows that some kind of assessment has been done but it's incomplete. So, you need to validate that before implementing because think about it, what would be the outcome if you decide to offer fluids or give the prescribed meds? By validating your suspicions through VS and neuro assesment, you'll be able to implement better, I mean as far as knowing the right thing to do.... that's what i think, what's the answer? ...:)

AmyD_RN · May 18, 2006

now that I have had time to think about it , isn't Bact. meningitis treated with antibiotics even when just suspected? mmmm? maybe I change my answer,...................or am I reading into the question???

crb613, BSN, RN · May 19, 2006

The question is:

When planning care for a child suspected of having bacterial meningitis, the nurse's first priority should be to:

1. Offer cool, clear fluids

2. Administer the antipyretic, per MD's order

3. Administer the antibiotic, per MD's order

4. Check vital signs and perform neurological examination.

Which one would you pick and why?

I am going w/# 4.... Assess, Assess, Assess is what I was taught...I would want to know the VS,LOC among other things,...then isolation/antibiotics & antipyretic, hydration, I&O's.

pinoy_guy · May 19, 2006

when planning care for a child suspected of having bacterial meningitis, the nurse's first priority should be to:
1. offer cool, clear fluids
2. administer the antipyretic, per md's order
3. administer the antibiotic, per md's order
4. check vital signs and perform neurological examination.
which one would you pick and why?

i think it's 3.

you have to take care of the cause, not the symptom.

i'm going with this answer after going through 4,000 questions in the saunders comprehensive cd & 1,200 questions of the saunders q&a book.

btw, i took the nclex 3 days ago and most of the questions are not even similar to the questions in the review books.

i don't know if i passed.

so what's the right answer?

crb613, BSN, RN · May 19, 2006

now that I have had time to think about it , isn't Bact. meningitis treated with antibiotics even when just suspected? mmmm? maybe I change my answer,...................or am I reading into the question???

It is & isolation for 24 hrs I think but....I think you would need to assess 1st because of possible ICP & seizures????? I may be way off!

Hebrews 13:5 · May 19, 2006

...LOL...I now see why Elleann asked this question! I went over this question over and over again and have chosen my FINAL answer...serious......Although i may have other strong reasons why #4 is the right answer, i see that it doen't apply to this particular question considering the infectious nature... With safety at the back of my head, i think the priority nursing action would be to adminster the prescribed antibiotics and also take repiratory isolation precautions first (until it's ruled out) before doing any other thing. If the disease is not that infectious, I would go ahead and validate by assessment first before implementing...but with bac. meningitis, I would take my precautions initially...

By the way, thanx for bringing this up Elleann, I love to think! This type of Q brings out your critical thinking skills...Quite easy but also easy to miss..

debsuztx · May 19, 2006

I also choose #4. I have difficulty with tests in general and answering questions; but, the way I looked at this question was, "what is the worse thing that can happen to this child?" You know with bacterial meningitis the vital signs and neuro status could be affected. So, what's the MOST important (I think it says "nurse first priority") would the nurse do? Thanks for posting the question.

JourneyCC · May 19, 2006

#4. that's my story and I'm stickin' to it

Elleann · May 19, 2006

Thanks guys! I reacted the same way - assess, assess, assess! Especially as the question said 'PLANNING' care, not 'CARING FOR'. But, kudos to pinoy guy and Amy and Hebrews because according to P.A.S.S, the answer is ....

3. Administer the antibiotic, as per MD's order.

Rationale: The first priority of nursing care for a child with suspected bacterial meningitis is to treat the infection promptly and prevent its spread. High dose IV antibiotics are generally ordered. In addition, the child should be placed on respiratory isolation for at least 24 hours after the antibiotic is started, to protect the nurse and others from possible infection with meningits.

Live and learn! That's why we do these dang practice questions, right? There was another one that bothered me, if I can find it, I'll post it as well. Thanks for the input, all!

Elleann