A nurse is assisting with planning care for a school-age child on the pediatric unit.
div id="exhibits">ExhibitsComplete the following sentence by using the lists of options.
The nurse should recommend to
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"C"}
Rationale for Correct Choices:
- Check the child's oropharynx: The child has had a tonsillectomy and is showing signs of possible bleeding, indicated by the small amount of bleeding in the posterior pharynx and bright red emesis (vomiting of blood). The nurse should check the oropharynx to assess the amount and source of the bleeding, as this could indicate a complication post-surgery.
- Obtaining a set of vital signs: After vomiting bright red emesis, it is crucial to assess the child's vital signs to monitor for signs of bleeding or shock. Changes in vital signs, especially increased heart rate or decreased blood pressure, could indicate significant blood loss.
Rationale for Incorrect Choices:
- Offer the child a red popsicle: Red-colored foods are generally avoided post-tonsillectomy as they can obscure or be mistaken for blood. More importantly, offering anything by mouth is contraindicated during active bleeding due to the risk of aspiration and potentially dislodging clots.
- Place the child in a supine position: The child should be positioned in a way that allows for the drainage of blood and secretions, ideally with the head elevated. Placing the child in a supine position could cause blood to pool in the throat, increasing the risk of aspiration.
- Encouraging the child to cough and deep breathe: Encouraging coughing and deep breathing immediately after tonsillectomy is not recommended, as it could dislodge a clot or exacerbate bleeding.
- Requesting a prescription for codeine: Although the child is experiencing some pain (rated 3/10), the primary concern at this point is bleeding, not pain. Pain management should be adjusted but the focus should be on addressing the bleeding first.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","D"]
Explanation
A. Encourage the child to take responsibility for his actions: While ADHD affects attention and impulse control, it's crucial to teach children accountability for their behavior. This helps them develop self-awareness, learn from mistakes, and foster a sense of control over their actions
B. Maintain a consistent routine at home: Children with ADHD benefit from a structured and predictable environment. A consistent routine helps them feel secure, reduces anxiety, and supports better management of their symptoms, including focus and behavior.
C. Provide frequent breaks during homework: Frequent breaks during homework or tasks help children with ADHD stay focused and prevent frustration. This is an effective strategy to improve concentration and task completion.
D. Administer stimulant medication in the morning: Stimulant medications for ADHD, such as methylphenidate or amphetamines, are usually administered in the morning to help manage symptoms throughout the day. This helps avoid any interference with sleep at night.
E. Limit the child's involvement in physical activities: Physical activity can actually be beneficial for children with ADHD, as it helps them release excess energy and improve focus. Exercise can be a helpful outlet for managing symptoms.
Correct Answer is C
Explanation
A. Teeth: It is typical for infants to start getting their first teeth between 6 and 10 months. The infant in this scenario already has two lower central incisors, which is normal and does not need to be reported.
B. Weight: The infant's weight of 7.26 kg (16 lb) is within the expected range for a 6-month-old. Infants typically double their birth weight by 5 to 6 months of age, and this infant has almost reached that milestone, so the weight is not a concern.
C. Speech: By 6 months, most infants begin to make cooing sounds and may start attempting to imitate speech. That the infant makes cooing sounds but does not attempt to imitate speech is slightly concerning, as by 6 months, some infants are beginning to imitate speech sounds.
D. Temperature: The infant's temperature of 37.1°C (98.8°F) is within the normal range for an infant and does not indicate any issue. There is no need to report this finding to the provider.
