A nurse is caring for a child in the postoperative period following a tonsillectomy. Which of the following actions should the nurse take?
Position the child supine.
Administer analgesics on a schedule.
Encourage the child to blow their nose gently.
Offer orange juice.
The Correct Answer is B
Choice A reason: Positioning a child supine after a tonsillectomy is not recommended due to the risk of respiratory complications. Elevating the head of the bed is preferred to prevent aspiration and facilitate breathing.
Choice B reason: Administering analgesics on a schedule is crucial for effective pain management. It helps maintain consistent pain relief, which is important for encouraging fluid intake and preventing dehydration.
Choice C reason: Encouraging a child to blow their nose gently after a tonsillectomy is not advised because it can increase the risk of bleeding. Instead, gentle mouth breathing and avoiding nose blowing are recommended.
Choice D reason: Offering orange juice after a tonsillectomy is not ideal as acidic beverages can irritate the throat. It's better to provide non-acidic fluids like water or apple juice to keep the child hydrated.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: A blood creatinine level of 1.3 mg/dL is elevated for a school-age child and indicates impaired kidney function, which is a concern in acute glomerulonephritis.
Choice B reason: A urine output of 550 mL in 24 hours is within the normal range for a school-age child and does not need to be reported unless there is a significant change.
Choice C reason: A blood pressure of 100/74 mm Hg is within the normal range for a school-age child and does not indicate an immediate concern.
Choice D reason: A BUN level of 8 mg/dL is within the normal range for a school-age child and does not need to be reported unless there is a significant change.
Correct Answer is ["B","C"]
Explanation
Choice A reason: Increased urinary output is not typically associated with heart failure. In fact, reduced urinary output may be expected due to decreased kidney perfusion.
Choice B reason: Nasal flaring is a sign of respiratory distress and can be expected in infants with heart failure as they struggle to maintain oxygenation.
Choice C reason: Peripheral edema is a common finding in heart failure due to fluid retention and poor circulation.
Choice D reason: Bradycardia is not a typical sign of heart failure in infants; tachycardia is more common. However, bradycardia can occur in advanced stages due to poor cardiac output.
Choice E reason: Cool extremities are indicative of poor perfusion, which is a consequence of decreased cardiac output in heart failure.
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