A nurse is assisting in the care of a child.

Which of the following provider prescriptions is anticipated, nonessential, or contraindicated for the child?

For each potential provider’s prescription, click to specify if the potential prescription is anticipated, nonessential, or contraindicated for the child. There must be at least 1 selection in every row. There does not need to b e a selection in every column.

Home safety is a critical component of care for clients who have had a Cerebrovascular accident because they often experience weakness, impaired balance, visual deficits, and decreased coordination. These limitations increase the risk of falls and injuries in the home environment. The nurse’s role is to identify and correct hazards that could contribute to accidents while promoting independence and safety. Environmental modifications are key to reducing preventable harm.

Rationale:
A. Setting the water heater to 54.4°C (130°F) is unsafe because it increases the risk of thermal injury or burns, especially in clients with sensory or mobility impairments. The recommended safe setting is typically lower (around 49°C/120°F) to prevent scalding injuries. This does not promote safety.

B. Replacing burned-out light bulbs is an appropriate safety intervention because adequate lighting reduces the risk of falls and improves mobility in clients with neurological deficits. Good visibility is essential for clients recovering from stroke who may have impaired balance, coordination, or visual field deficits. This directly enhances environmental safety.

C. Running extension cords under throw rugs is unsafe because it creates a tripping hazard and increases the risk of falls. Additionally, covering cords can lead to overheating and potential fire hazards. This practice should be avoided in home safety planning.

D. Ensuring the client wears soft-soled slippers may improve comfort but does not provide optimal safety if the footwear lacks proper support or traction. In stroke clients, supportive, non-slip footwear is recommended to reduce fall risk. Soft slippers may actually increase instability if they do not fit securely.

This patient presents with an early pregnancy complication, presenting with abdominal pain, delayed menses, positive pregnancy test, and vaginal spotting. Ectopic pregnancy occurs when a fertilized ovum implants outside the uterine cavity, most commonly in the fallopian tube. It is a life-threatening condition if not identified early due to risk of tubal rupture and hemorrhage. Key clinical clues include unilateral lower abdominal pain, abnormal vaginal bleeding, and a positive hCG with pain localized to one side.

Rationale for correct choices:

• The client’s presentation is highly suggestive of ectopic pregnancy due to delayed menses, positive hCG, abdominal pain, and vaginal spotting. A significant risk factor is the history of pelvic inflammatory disease, which can cause tubal scarring and abnormal implantation. Ectopic pregnancies commonly present with unilateral lower abdominal pain and irregular bleeding in early gestation. Without timely intervention, rupture can lead to severe internal bleeding and shock.

• Right lower quadrant tenderness is a classic finding in ectopic pregnancy, particularly when implantation occurs in the right fallopian tube. This localized pain reflects tubal distention or early rupture at the implantation site. It is more specific than generalized abdominal discomfort and aligns with the client’s reported symptoms and assessment findings. Combined with positive pregnancy test and spotting, it strongly supports ectopic pregnancy.

Rationale for incorrect choices:

• Abruptio placentae involves premature separation of the placenta from the uterine wall and typically occurs in the second or third trimester, not at 6 weeks gestation. It presents with painful vaginal bleeding, uterine rigidity, and fetal distress. This client is in early pregnancy with no evidence of advanced gestation or uterine hypertonicity. Therefore, this condition is not consistent with the presentation.

• Pyelonephritis is a kidney infection characterized by fever, flank pain, costovertebral angle tenderness, and urinary symptoms such as dysuria or urgency. This client does not report fever, urinary symptoms, or flank pain. The abdominal pain is localized to the right lower quadrant and associated with vaginal spotting and pregnancy. These findings are not consistent with a urinary tract infection involving the kidneys.

• Placenta previa occurs in later pregnancy when the placenta partially or completely covers the cervical os, leading to painless, bright red vaginal bleeding. This client is only 6 weeks pregnant, making placenta previa physiologically impossible at this stage. Additionally, placenta previa does not present with abdominal pain or localized tenderness. Therefore, it is is not applicable.

• An acute asthma attack presents with respiratory symptoms such as wheezing, shortness of breath, and decreased oxygenation. While the client has mild inspiratory wheezes, there are no signs of respiratory distress or exacerbation. The primary concerns in this case are gynecologic, not respiratory. Therefore, asthma is not the primary condition explaining the overall clinical picture.

• Respiratory rate is not directly associated with ectopic pregnancy diagnosis in this client. While it is part of general vital sign assessment, the client’s respiratory status is stable and not the primary indicator of the condition. Mild wheezing related to asthma does not explain the abdominal and reproductive findings.

• A history of regular menstrual cycles is a baseline reproductive pattern and does not indicate a current complication. Although it supports the concept of a missed period, it is not a clinical finding that confirms ectopic pregnancy. It is nonspecific and does not explain the current pain or bleeding.

• Hyperactive bowel sounds are related to gastrointestinal activity and may be influenced by anxiety or nonspecific abdominal irritation. They are not characteristic of ectopic pregnancy and do not localize the pathology to the reproductive system. This finding does not help differentiate ectopic pregnancy from other conditions.

• Temperature is typically normal in ectopic pregnancy unless there is rupture and secondary infection or inflammation. The client does not demonstrate fever or systemic infection signs. Therefore, temperature is not a useful indicator for identifying ectopic pregnancy in this case.