A nurse is planning care for a newly admitted schole-age child who has generalized seizure disorder. Which of the following interventions should the nurse
... [Show More] plan to include? - ANSWERSEnsure the oxygen source is functioning in the childs room
the nurse should recognize that maintaining the childs airway is important during a seizure. the nurse should ensure the oxygen source is functioning bc the child might require supplemental oxygen following a seizure
A nurse is providing dietary teaching to the guardian of a school-age child who has cystic fibrosis. Which of the following statements should the nurse make? - ANSWERS"You should offer your child high-protein meals and snacks throughout the day."
children who have cf require a higher percentage of the recommended dietary allowances of all nutrients to meet their energy requirements. children who have good nutritional intake have improved lung function and decrease risk of infection
A nurse is providing discharge teaching to the parents of a 6-month-old infant who is postoperative following hypospadias repair with a stent placement. Which of the following instructions should the nurse include in the teaching? - ANSWERS"Allow the stent to drain into your infants diaper."
this is to prevent kinking or twisting that can interfere with urine flow
A nurse is caring for a school-age child who has primary nephrotic syndrome and is taking prednisone. Following 1 week of treatment, which of the following manifestations indicates to the nurse that the medication is effective? - ANSWERSDecreased edema
a child who has nephrotic syndrome can experience edema d/t the increase glomerular permeability, which increases protein loss. prednisone decreases glomerular permeability, which causes fluid to shift from the extracellular spaces, resulting in decreased edema
A nurse is receiving change-of-shift report for four children. Which of the following children should the nurse assess first? - ANSWERSA toddler who has a concussion and an episode of forceful vomiting.
when using urgent vs. nonurgent approach to pt care, the nurse should assess this child first. an episode of forceful vomiting is an indication of increased ICP in a toddler who has a concussion
A nurse is providing discharge teaching to the guardians of a toddler who had lower leg cast applied 24 hr ago. The nurse should instruct the guardians to report which of the following finding to the provider? - ANSWERSRestricted ability to move the toes.
this is an indication of neurovascular compromise and requires immediate notification of the provider. permanent muscle and tissue damage can occur in just a few hours
A nurse in an emergency department is auscultating the lungs of an adolescent who is experiencing dyspnea. The nurse should identify the sound as which of the following? - ANSWERSWheezes
wheezes are high-pitched, musical or whistling-like sounds heard primarily on expiration as air passes through and vibrate narrowed airways
A nurse is caring for a preschooler who has congestive heart failure. The nurse observes wide QRS complexes and peaked T waves on the cardiac monitor. Which of the following prescriptions should the nurse clarify with the provider? - ANSWERSPotassium Chloride
the nurse should identify that a child who has a chf can develop e imbalances such as hyper hypokalemia. the nurse should identify that the child is exhibiting manifestations of hyperkalemia and contact the MD about the admin of this which can increase the severity of hyperkalemia
A nurse is planning an educational program for school-age children and their parents about bicycle safety. Which of the following information should the nurse plan to include? - ANSWERSThe child should be able to stand on the balls of their feet when sitting on the bike.
to decrease the risk of injury, parents should ensure that the bike is the correct size for the child. when seated on the bike, the child should be able to stand with the ball of each foot touching the ground and should be able to stand with each foot flat on the ground when straddling the bikes center
A nurse is monitoring the oxygen saturation level of an infant using pulse oximetry. The nurse should secure the sensor to which of the following areas on the infant? - ANSWERSGreat Toe
the nurse should secure the sensor to the great toe of the infant and then place a snug-fitting sock on the foot to hold the sensor in place. the nurse should also check the skin under the sensor site frequently for temp, color, and the presence of a pulse
A nurse is an emergency department is caring for a school-age child who has epiglottitis. Which of the following actions should the nurse take? - ANSWERSMonitor the childs oxygen saturation
b/c the child is experiencing acute resp distress and it is necessary to determine if the child is responding to tx
A nurse in an emergency department is caring for a school-age child who has sustained a minor superficial burn from fireworks on their forearm. Which of the following actions should the nurse take? - ANSWERSApply an antimicrobial ointment to the affected area.
to prevent infection
A nurse in a providers office is caring for a school-age child who has varicella. The parents asks the nurse when their child will no longer be contagious. Which of the following responses should the nurse make? - ANSWERS"When your childs lesions are crusted, usually 6 days after they appear."
the nurse should inform the parent that the child is contagious 1 day prior to lesion eruption and until the vesicles have crusted over, which usually takes about 6 days
A nurse is providing discharge teaching to the parent of a school-age child who has moderate persistant asthma. Which of the following instructions should the nurse include? - ANSWERS"Pulmonary function tests will be performed every 12 to 24 months to evaluate how your child is responding to therapy."
the nurse should include this to evaluate the presence of lung disease and how the child is responding to the current tx regimen. as children grow, sometimes their manifestations can improve or decline, and tx needs to change accordingly
A nurse is admitting an infant who has intussusception. Which of the following findings should the nurse expect? (Select all that apply.) - ANSWERS-Vomiting
-Lethargy
the nurse should expect an infant who has intussusception to exhibit vomiting d/t the obstruction that occurs when a segment of the bowel telescopes within another segment of the bowel
the nurse should expect lethargy d/t episode of severe pain during which the infant cries inconsolably, leading to exhaustion and decrease nutritional intake
A nurse is reviewing the laboratory results of a school-age child who is 1 week postoperative following an open fracture repair. Which of the following findings should the nurse identify as an indication of a potential complication? - ANSWERSErythrocyte sedimentation rate 18 mm/hr
this is above the expected range of up to 10 mm/hr and is an indication of osteomyelitis
A nurse is providing discharge teaching to the parents of a 3-month old infant following a cheiloplasty. Which of the following instructions should the nurse include? - ANSWERS"Apply a thin layer of antibiotic ointment on the your babys suture line daily for the next 3 days."
the nurse should instruct the parents to apply a thin layer of abx ointment on the infant's suture line daily for 3 days and then continue to apply petroleum jelly to the area for several weeks to promote healing
A nurse is discussion organ donation with the parents of a school-age child who has sustained brain death due to a bicycle crash. Which of the following actions should the nurse take first? - ANSWERSExplore the parents feelings and wishes regarding organ donation.
the first action should be assessment using the nursing process. the nurse should first explore the parents' feelings and wishes regarding the organ donation to assist in determining if organ donation is the right choice for the family
A nurse is caring for a 1-month-old infant who is breastfeeding and requires a heel stick. Which of the following actions should the nurse take to minimize the infants pain? - ANSWERSAllow the mother to breastfeed while the sample is being obtained. [Show Less]