A nurse is assisting in the discharge planning of an infant who has a spica cast. Which of the following equipment needs should the nurse identify for discharge?

Urinary catheter

Wound vac

Car seat

Feeding pump

Answer and Explanation

The Correct Answer is C

A. Urinary catheter: A urinary catheter is not routinely required for infants with a spica cast. Unless there are specific urinary retention issues or surgical complications, normal voiding is expected, and a catheter would introduce unnecessary risk for infection.

B. Wound vac: A wound vac is used for complex wound management involving significant drainage or delayed healing. Infants with a spica cast typically do not have open wounds that necessitate negative pressure wound therapy, making this equipment unnecessary for discharge.

C. Car seat: A special car seat or car bed is necessary for safe transportation of an infant in a spica cast, as standard car seats cannot accommodate the wide leg positioning. Proper fitting ensures both safety and compliance with transportation regulations during discharge.

D. Feeding pump: A feeding pump is typically used for clients requiring continuous enteral feeding. Unless the infant has a separate feeding disorder or gastrointestinal complication, feeding by mouth is expected, and a feeding pump would not be standard discharge equipment.

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Correct Answer is C

Explanation

A. "I do not need to sign a consent form before this procedure.": A signed informed consent form is required before an intravenous pyelogram (IVP) because it involves the injection of contrast dye, which carries risks such as allergic reactions and kidney injury.

B. "I should limit my fluid intake for 2 days after the procedure.": Clients are encouraged to increase fluid intake after an IVP to help flush the contrast dye from their system and reduce the risk of kidney complications, not limit fluids.

C. "I will feel a warming sensation after the injection of the dye.": This statement shows understanding. It is common to feel a warm, flushing sensation or a metallic taste in the mouth shortly after the contrast dye is injected during an IVP. These effects are usually brief and harmless.

D. "I can have a meal up to 2 hours before the procedure.": Clients are typically instructed to be NPO (nothing by mouth) for a certain period, often after midnight, before the procedure to reduce the risk of aspiration and to ensure clear imaging. Eating close to the procedure time is not recommended.

A. Clay-colored stools B. Confusion C. Spider angiomas D. Jaundice

Correct Answer is B

Explanation

A. Clay-colored stools: Clay-colored stools indicate a lack of bile flow due to liver dysfunction, which is expected in cirrhosis. While concerning, it is not the most urgent finding compared to signs indicating acute neurological compromise.

B. Confusion: Confusion suggests hepatic encephalopathy, a serious complication of cirrhosis resulting from the buildup of toxins like ammonia in the bloodstream. It indicates potential cerebral impairment and requires immediate provider notification and intervention to prevent progression to coma.

C. Spider angiomas: Spider angiomas are small, dilated blood vessels visible on the skin, commonly seen in cirrhosis due to hormonal changes and altered vascular dynamics. They are a chronic sign of liver disease and do not represent an immediate threat.

D. Jaundice: Jaundice results from elevated bilirubin levels due to impaired liver function. While jaundice signals worsening liver disease, it develops gradually and is less immediately life-threatening than the onset of neurological symptoms like confusion.

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A nurse is assisting in the discharge planning of an infant who has a spica cast. Which of the following equipment needs should the nurse identify for discharge?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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