A nurse is assisting with the care of a school-age child who is terminally ill. Which of the following interventions should the nurse perform?
Encourage the family to involve siblings when caring for the child.
Reinforce with the family that they should avoid discussing death with the child.
Collect vital signs every 2 hr as the child's condition deteriorates.
Perform passive range of motion to the child's extremities every 4 hr.
The Correct Answer is A
A. Encouraging the family to involve siblings in the care of the terminally ill child is important for fostering family support, allowing siblings to understand the situation, and promoting emotional bonding.
B. Avoiding discussions about death is not recommended. It is important to communicate with the child about death in an age-appropriate manner to help them understand and cope with the situation.
C. While monitoring vital signs is important, it is not the most therapeutic intervention in the final stages of terminal illness. Comfort care, including pain management and emotional support, takes priority.
D. Passive range of motion is not essential for a child in the final stages of terminal illness unless necessary for specific comfort or mobility needs. Care should focus on comfort measures rather than routine interventions.
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Correct Answer is B
Explanation
A. Applying calamine lotion is helpful for symptom relief but does not remove the poison ivy oil from the skin.
B. Flushing the affected area with cold, running water immediately after exposure helps to remove the poison ivy oil (urushiol) from the skin, which is crucial in preventing or reducing the severity of the rash.
C. While an oatmeal bath can help soothe itching, it is not the priority action in the acute stage of exposure.
D. Administering an oral corticosteroid may be necessary if the rash is severe, but flushing the area with water should be the first step in preventing further reaction.
Correct Answer is A
Explanation
A. Rice milk is a good alternative for someone with lactose intolerance as it is lactose-free and does not cause digestive discomfort.
B. Flavored yogurt may still contain lactose, and the added sugar can make it less ideal for someone with lactose intolerance. Plain yogurt, however, may be easier to digest for some individuals because it contains live cultures that help break down lactose.
C. Gradually increasing lactose-containing products is not recommended for someone with lactose intolerance. The goal is typically to avoid or limit lactose to prevent symptoms.
D. Calcium-fortified orange juice is a good source of calcium for individuals with lactose intolerance and does not need to be limited unless the individual has other dietary restrictions.
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