A nurse is caring for a child who is 2 hr postoperative following a tonsillectomy. Which of the following fluid items should the nurse offer the child at this time?
Cranberry juice
Crushed ice
Vanilla milkshake
Orange juice
The Correct Answer is B
A. Cranberry juice
Explanation: Acidic and citrus juices, including cranberry and orange juice, should be avoided in the immediate postoperative period as they can be irritating to the surgical site and may increase the risk of bleeding.
B. Crushed ice
Explanation:
After a tonsillectomy, it's important to provide cold and clear fluids to soothe the throat and prevent bleeding. Crushed ice is a suitable option as it helps keep the throat cool and provides hydration without irritating the surgical site. Cold liquids can help minimize swelling and provide comfort.
C. Vanilla milkshake
Explanation: While milkshakes may be appealing, dairy products can coat the throat and may not be recommended immediately after surgery. Additionally, it's crucial to avoid using straws, as sucking can increase the risk of bleeding.
D. Orange juice
Explanation: As mentioned earlier, citrus juices like orange juice can be irritating to the surgical site and are not recommended in the early postoperative period after a tonsillectomy. It's essential to choose clear and non-acidic fluids to support healing and prevent complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Shows preferences towards foods
Explanation: Showing preferences towards foods, such as liking some tastes more than others, is a normal developmental behavior in infants. It is not typically a cause for concern.
B. Babbles one-syllable sounds
Explanation:
By the age of 7 months, most infants should be engaging in babbling with repetitive consonant-vowel combinations. If an infant is only producing one-syllable sounds at this age, it might be a potential sign of delayed language development. Further evaluation by a healthcare provider, such as a pediatrician or a speech-language pathologist, may be warranted to assess the child's language and communication skills.
C. Uses a unidextrous grasp
Explanation: A unidextrous grasp, where the infant uses one hand to grasp objects, is a typical developmental milestone at this age. Infants typically begin to show a dominant hand preference later in their development.
D. Has a fear of strangers
Explanation: Fear of strangers, often referred to as "stranger anxiety," is a normal developmental stage that typically emerges around 6 to 9 months of age. It is a sign of social and cognitive development and is not generally a cause for concern.
Correct Answer is B
Explanation
A. "I am unable to discuss this, but I can contact my supervisor to speak with you."
Explanation: While it is appropriate to involve a supervisor in difficult situations, the nurse should first clarify the legal obligation to report suspected child abuse. This response may leave the impression that the nurse is avoiding the question.
B. "As a nurse, I am required by law to report suspected child abuse."
Explanation:
Nurses are mandated reporters, meaning they are legally obligated to report suspected child abuse. It is important to communicate this legal obligation to the parents when they inquire about the reason for the report. This response is honest, direct, and reinforces the nurse's ethical and legal responsibility to prioritize the well-being and safety of the child.
C. "I reported the incident to my supervisor who decided to contact the authorities."
Explanation: This response may create confusion about the reporting process. It is important to convey that reporting is a legal obligation for the nurse, and it is not solely at the discretion of the supervisor.
D. "The provider will be coming to explain the situation."
Explanation: While involving other healthcare professionals, such as a provider, may be part of the process, it is crucial to emphasize the nurse's legal responsibility to report suspected child abuse. This response does not clearly communicate the legal obligation that the nurse has in reporting such incidents.
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