A nurse is caring for a 4-year-old child who is postoperative following abdominal surgery. Which of the following statements should the nurse make to encourage the child to take deep breaths?
"This will not be painful, just a little uncomfortable."
"Let's play a game of blowing cotton balls across your table."
"Do you want to take deep breaths for me now?"
"You can't go to the playroom until you finish doing your deep breathing."
The Correct Answer is B
A. "This will not be painful, just a little uncomfortable." While this statement might provide some reassurance, it does not actively engage the child or make the task of taking deep breaths more enjoyable.
B. "Let's play a game of blowing cotton balls across your table." This is the best choice as it makes deep breathing fun and engaging for the child, encouraging them to participate without feeling like it’s a chore.
C. "Do you want to take deep breaths for me now?" This approach is too passive and doesn't engage the child actively or make the activity interesting.
D. "You can't go to the playroom until you finish doing your deep breathing." This approach can create negative reinforcement and might make the child associate deep breathing with punishment or coercion, which is not desirable.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Attempt to obtain a throat culture: This is contraindicated because manipulating the throat could exacerbate airway obstruction, leading to a potential respiratory emergency.
B. Use a tongue depressor to observe the back of the throat: This can provoke a spasm or cause complete airway obstruction in a child with epiglottitis and should be avoided.
C. Apply humidified oxygen via a mask: This helps to keep the airways moist and can provide some relief and improve oxygenation while minimizing the risk of airway manipulation.
D. Initiate airborne precautions: Epiglottitis primarily requires droplet precautions, not airborne. Airborne precautions are used for diseases like tuberculosis, which are spread through smaller droplets that remain suspended in the air.
Correct Answer is B
Explanation
A. Perform range-of-motion (ROM) exercises to the infant's hips. ROM exercises are not the priority for an infant with spina bifida and could potentially cause harm if not done properly, particularly if the lesion is in a sensitive area.
B. Place the infant in a prone position. This is the correct action as it helps prevent pressure on the spina bifida lesion and minimizes the risk of injury or infection to the exposed spinal cord or meninges.
C. Feed the infant through an NG tube. An NG tube is not typically necessary for feeding infants with spina bifida unless there are other complicating factors that affect feeding.
D. Cover the infant's lesion with a dry cloth. The lesion should be covered with a sterile, moist, and non-adhesive dressing to prevent infection and keep the area moist. A dry cloth could cause the lesion to dry out and increase the risk of infection or damage.
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