A nurse is assessing a preschool-age child who is in the immediate postoperative period following a tonsillectomy. Which of the following assessment findings is the priority?
The child's throat pain increases.
The child refuses clear liquids.
The child cries often.
The child swallows frequently.
The Correct Answer is D
Rationale:
A. The child's throat pain is expected post-tonsillectomy and can be managed using analgesics or an ice collar. However, this is not a priority finding compared to frequent swallowing which may indicate bleeding which is a life-threatening complication of tonsillectomy.
B. Refusing clear liquids may indicate discomfort but is not as urgent as a potential increase in throat pain.
C. Crying often may be a response to discomfort but does not necessarily indicate a complication requiring immediate intervention.
D. This assessment finding indicates that the child might have bleeding in the throat, which is a life-threatening complication of tonsillectomy. The nurse should
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Related Questions
Correct Answer is B
Explanation
A. Placing the child prone (face down) is not appropriate for a lumbar puncture.
B. Placing the child in a lateral position (lying on their side) with knees flexed is the correct position for a lumbar puncture as it allows for optimal access to the lumbar area.
C. Placing the child supine (on their back) is not ideal for a lumbar puncture as it does not provide the necessary access to the lumbar area.
D. Placing the child in semi-Fowler's position (lying on their back with the head of the bed elevated) is not typically used for lumbar puncture procedures.
Correct Answer is B
Explanation
Correct answer: B Rationale:
A) Impetigo is caused by bacteria, not viruses, so sealing soft toys in a plastic bag is unnecessary.
B) Applying bactericidal ointment to lesions helps kill the bacteria causing impetigo and promotes healing.
C) Soaking hairbrushes in boiling water is not typically necessary for the treatment of impetigo.
D) Acyclovir is an antiviral medication used to treat herpes simplex virus infections, not bacterial infections like impetigo.
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