Free BCEN Certified Emergency Nurse (CEN) Practice Question

The correct answer is to initiate azithromycin and admit for respiratory monitoring. The clinical presentation strongly suggests pertussis (whooping cough), especially given the incomplete vaccination status. In infants, pertussis can be severe and potentially life-threatening.

Azithromycin is the preferred antibiotic for pertussis treatment and prophylaxis. It's crucial to start treatment early to reduce symptom severity and duration. However, antibiotics alone are not sufficient for young infants with pertussis.

Admission for respiratory monitoring is necessary because infants with pertussis are at high risk for apnea, severe coughing spells, and respiratory failure. Close monitoring allows for prompt intervention if the infant's condition deteriorates.

While obtaining a nasopharyngeal PCR is important for diagnosis, treatment should not be delayed while waiting for results. Chest X-ray is not routinely needed and may be normal in early pertussis. Albuterol nebulization is not effective for the cough in pertussis as it's not caused by bronchospasm. Discharge with symptomatic treatment is inappropriate given the infant's age and risk for severe complications.