A child with a brain tumor has a decreased respiratory hate and is less responsive to verbal commands than he was when the nurses assessed the client the previous hour. What should the nurse do next?

Raise the head of the bed

Notify the health care provider (HCP)

Obtain an oximeter reading

Implement seizure precautions

Answer and Explanation

The Correct Answer is B

A. Raising the head of the bed may help with respiratory effort but does not address the underlying issue of decreased responsiveness. Immediate assessment and intervention are necessary.

B. Notifying the healthcare provider is critical as the child’s decreased responsiveness and respiratory rate indicate a potential deterioration in condition that requires prompt medical evaluation.

C. While obtaining an oximeter reading can provide useful information about oxygenation, the priority is to notify the HCP about the change in the child's neurological status.

D. Implementing seizure precautions is important for a child with a brain tumor, but the immediate concern is the change in responsiveness, necessitating HCP notification first.

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Correct Answer is D

Explanation

A. Administering an IV bolus medication does not typically require gowning unless there is a risk of exposure to bodily fluids.

B. Talking to the client does not necessitate wearing a gown, as it does not pose a risk of exposure.

C. Administering an IM injection may require gloves but not necessarily a gown unless there is a risk of splashing.

D. Completing a dressing change involves potential exposure to bodily fluids, so wearing a gown is appropriate for infection control.

A. Encouraging frequent, thorough handwashing B. Having the child sleep in a single bed and room. C. Encouraging frequent close contact with visitors. D. Cheering up the environment with fresh flowers and plants. E. Protecting the central venous access device from non-sterile access

Correct Answer is ["C","D"]

Explanation

A. Frequent, thorough handwashing is essential to prevent infection, especially for immunocompromised children.

B. Having the child sleep in a separate bed and room may help minimize exposure to pathogens from family members.

C. Encouraging frequent close contact with visitors increases the risk of infections and should be avoided.

D. Fresh flowers and plants can harbor bacteria and should be avoided in the environment of an immunocompromised child.

E. Protecting the central venous access device is vital to prevent infections; this practice should be emphasized.

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A child with a brain tumor has a decreased respiratory hate and is less responsive to verbal commands than he was when the nurses assessed the client the previous hour. What should the nurse do next?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is HIV positive and is one day postoperative following an appendectomy. The nurse should wear a gown as personal protective equipment when taking which of the following actions?

Correct Answer is D

Explanation

The nurse is caring for a child with leukemia, a central venous access device, and chemotherapy-induced immunosuppression. Which of the following SHOULD NOT be included in the teaching plan for the child and parents about reducing the child's risk for infection? Select all that apply

Correct Answer is ["C","D"]

Explanation

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