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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Ibuprofen can be used for fever, but it is important to check if the child has varicella before administering due to potential Reye's syndrome.
B. The child should stay home until all lesions have crusted over to prevent spreading the virus, even if the fever is gone.
C. Once lesions have crusted, the child is no longer contagious, indicating understanding of the contagious period.
D. Using cool or tepid water is acceptable for soothing itching; however, it does not specifically address the need for proper care during the contagious phase.
Correct Answer is ["A","B","C","E"]
Explanation
A. Encouraging frequent fluid intake helps to dilute the urine and promotes urination, which can help flush out bacteria.
B. Frequent voiding is essential to reduce the risk of bacterial growth in the bladder and to alleviate symptoms.
C. Wiping from front to back is important in preventing the spread of bacteria from the rectal area to the urethra, thereby reducing the risk of UTIs.
D. Wearing nylon underwear may trap moisture and create an environment conducive to bacterial growth; cotton underwear is preferred.
E. Completing the course of antibiotics is crucial for fully eradicating the infection and preventing recurrence.
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