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1330

Cardiac catheterization performed; ventricular septal defect closed with mesh

Admit to the pediatric floor for observation

Check pedal pulses every 4 hours

Nothing by mouth

Place the child on a continuous cardiopulmonary monitor

The nurse reviews the post-catheterization orders.

What two orders would the nurse question?

Point of care blood glucose

Check pedal pulses every 4 hours

Give lactated Ringers intravenously at 66 ml/hr while NPO

Vital signs every 4 hours

Nothing by mouth

Admit to the pediatric floor for observation

Check dressing every 15 minutes for 1 hour and then every hour for

Answer and Explanation

Correct Answer : B,C

B. Check pedal pulses every 4 hours: This order should be questioned because after a ventricular septal defect closure, it is essential to assess and monitor peripheral pulses frequently, especially in the immediate post-catheterization period. Checking pedal pulses every 4 hours may not provide adequate monitoring and could potentially lead to delayed detection of complications.

C. Give lactated Ringers intravenously at 66 ml/hr while NPO: This order should be questioned because it specifies a continuous intravenous infusion of lactated Ringer's solution, but the patient is listed as "Nothing by mouth" (E). In cases where a patient is NPO, it's important to clarify the rationale for the intravenous fluid rate and consider whether it's appropriate, especially after a cardiac catheterization procedure.

The other orders are appropriate or necessary for the post-catheterization care of a child with a closed ventricular septal defect:

A. Point of care blood glucose: Monitoring blood glucose levels is relevant in post-catheterization care.

D. Vital signs every 4 hours: Monitoring vital signs is standard post-catheterization care.

F. Admit to the pediatric floor for observation: This order is appropriate for post-catheterization observation.

G. Check dressing every 15 minutes for 1 hour and then every hour: Frequent dressing checks are important for assessing and preventing bleeding or other complications at the catheterization site.

H. Place the child on a continuous cardiopulmonary monitor: Continuous monitoring is important for early detection of any cardiopulmonary issues in the post-catheterization period.

In summary, monitoring peripheral pulses and the appropriateness of intravenous fluids in relation to NPO status should be questioned in this context.

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Correct Answer is C

Explanation

A. The mother being a single parent and living with her parents may have an impact on the family dynamics and support system but is not the most significant finding when it comes to addressing the baby's sleep issues.

B. The baby being irritable during feedings is important information and should be addressed, but it may not be the most significant finding when it comes to the baby's sleep patterns.

C. The diaper area shows severe skin breakdown.

Severe skin breakdown in the diaper area can be indicative of several issues, including frequent diaper changes, diaper rash, or potential underlying health concerns. This finding suggests that the infant may have discomfort or pain related to the diaper area, which could be contributing to the baby's nighttime awakenings and sleep disturbances.

D. The infant's formula being changed twice may be relevant, but it is not as significant as severe skin breakdown, which can indicate immediate discomfort for the baby.

A. Uses 1 word sentences. B. Speaks in simple sentences with four or more words. C. Recognizes most letters and numbers. D. Uses gestures with 1 to 2 word sentences.

Correct Answer is B

Explanation

A. Using 1-word sentences is more characteristic of a child's speech development at around 12-18 months, and by age 3, children are expected to use more words in their sentences.

B. Speaks in simple sentences with four or more words.

At the age of 3, children typically progress in their speech and language development. Speaking in simple sentences with four or more words is considered a normal developmental milestone at this age. It reflects the child's growing ability to form more complex and coherent sentences.

C. Recognizing most letters and numbers is not typically a developmental milestone for a 3-year-old. This skill often develops later, closer to the preschool and kindergarten years.

D. Using gestures with 1 to 2-word sentences may be seen in younger children, but by age 3, children should be progressing to longer and more complex sentences as part of their language development.

It's important to remember that there can be some individual variation in language development, but by the age of 3, children are generally expected to speak in simple sentences with more words and demonstrate growing language skills.

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Naxlex Comprehensive Predictor Exams

A mother brings her 3-month-old infant to the clinic because the baby does not sleep through the night. Which finding is most significant in planning care for this family?

Correct Answer is C

Explanation

The nurse is assessing the growth and development of a 3-year-old child. Which speech and language skills should the nurse identify as normal developmental milestones for this child?

Correct Answer is B

Explanation

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