A nurse is caring for a 6-year-old child who is receiving radiation therapy. The child is crying because their hair is falling out. Which of the following actions should the nurse take?
Provide the child with electronics to watch movies.
Tell the child there's no need to cry because this is expected.
Provide the child with a doll that does not have any hair.
Tell the child not to worry about their hair loss because their hair will grow back.
The Correct Answer is C
Rationale:
A. Provide the child with electronics to watch movies: While distraction can be helpful in managing anxiety or discomfort, it does not directly address the child’s feelings about hair loss. Emotional support specific to the child’s concern is more appropriate in this situation.
B. Tell the child there's no need to cry because this is expected: Minimizing the child’s feelings invalidates their emotional experience and can increase distress. Acknowledging and supporting the child’s emotions is essential for coping during hair loss caused by radiation therapy.
C. Provide the child with a doll that does not have any hair: Giving a doll without hair helps the child normalize hair loss and provides a concrete way to express and cope with feelings. This action demonstrates understanding, empathy, and age-appropriate support for the child’s emotional needs.
D. Tell the child not to worry about their hair loss because their hair will grow back: While it is true that hair often regrows after treatment, reassurance alone does not address the child’s immediate emotional reaction. Supporting the child’s feelings and providing relatable coping strategies is more effective.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. Strabismus: Strabismus, or misalignment of the eyes, is not a known adverse effect of timolol. Timolol primarily affects intraocular pressure and systemic cardiovascular parameters rather than eye muscle alignment.
B. Bradycardia: Timolol is a nonselective beta-adrenergic blocker that can be absorbed systemically even when administered as eye drops. One potential systemic adverse effect is bradycardia, as the medication can reduce heart rate and cardiac output, particularly in clients with preexisting heart conditions.
C. Conjunctivitis: While eye irritation or mild stinging can occur with timolol, conjunctivitis is not a typical adverse effect. Instructing clients to monitor for more common ocular side effects, such as burning or discomfort, is appropriate.
D. Hyperglycemia: Timolol does not typically cause hyperglycemia. Beta-blockers can sometimes mask hypoglycemia symptoms in diabetic clients but are not associated with raising blood glucose levels directly.
Correct Answer is ["A","B","D","E","G"]
Explanation
Rationale for correct choices
• The statement "Why don't you just leave me? I am of no use" reflects hopelessness, a high‑risk indicator for self‑harm in older adults. Expressions of worthlessness or being a burden require immediate follow‑up because they signal severe depression or suicidal ideation. The priority is ensuring safety and initiating urgent mental health evaluation.
• The report of cognitive decline accompanied by worsening memory, disordered thought process, and impaired self‑care indicates a significant functional deterioration. These symptoms can reflect rapidly progressing depression, delirium, or early dementia. Any acute decline in cognition or functional ability in an older adult warrants prompt assessment to identify reversible causes.
• Loss of appetite with an 8‑lb weight loss in one month suggests clinically significant unintentional weight loss. Combined with decreased interest in eating, this is a red flag for major depressive disorder, frailty progression, or underlying illness. Sudden nutritional decline increases morbidity risk and requires timely intervention.
• Poor eye contact, monotone speech, and flat facial expression are key affective indicators of depression. These signs, when combined with statements of worthlessness, suggest severe depressive symptoms that require urgent assessment and intervention to prevent further decline.
Rationale for incorrect choices
• Sleeping 7 hours per night with 1–2 awakenings to urinate can be normal for older adults. This finding does not indicate acute risk and is not a priority compared with weight loss, cognitive decline, or suicidal statements. It can be evaluated during routine assessment rather than requiring urgent follow‑up.
• Heart rate 68/min is within normal limits for an older adult and does not signal instability or deterioration. It does not require immediate intervention and can be monitored routinely while priority concerns related to mood, cognition, and safety are addressed.
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