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A nurse is caring for a school-age child who has a new prescription for continuous pulse oximetry monitoring. Which of the following actions should the nurse take?

Warm the skin prior to probe placement.

Reposition the probe every 2 hr.

Tape the wire to the palm of the hand.

Apply the sensor to the index fingernail.

Answer and Explanation

The Correct Answer is B

Answer: B. Reposition the probe every 2 hours.

Rationale:

A. Warm the skin prior to probe placement: While cold fingers can lead to inaccurate readings, warming the skin is not an essential step and is not routinely recommended in clinical practice.
B. Reposition the probe every 2 hours: This is correct. Continuous pressure from the probe in one spot can cause skin breakdown and pressure injuries. Repositioning the probe every 2 hours helps to prevent this and ensure accurate readings.
C. Tape the wire to the palm of the hand: This is incorrect. The pulse oximeter probe should be placed on a vascular site, such as a fingertip or earlobe. Taping the wire to the palm would not provide accurate readings.
D. Apply the sensor to the index fingernail: This is incorrect. The fingernail does not have sufficient blood flow for accurate pulse oximetry readings. The probe should be placed on the fleshy pad of the fingertip.

Therefore, the most important action for the nurse to take is to reposition the probe every 2 hours to prevent skin breakdown and ensure accurate readings.

Additional Points:

The nurse should also choose a clean and dry site for probe placement.
The probe should be snug but not too tight.
The nurse should monitor the child for signs of skin breakdown, such as redness, swelling, or pain.
If the child is restless or active, the nurse may need to secure the probe with additional tape or a special wrap.

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Correct Answer is C

Explanation

Choice A rationale:
Perfectionistic behavior is not typically considered a behavioral finding indicative of sexual abuse in a school-age child. Perfectionism may be related to personality traits, family dynamics, or individual tendencies, but it is not a specific behavioral marker for sexual abuse.
Choice B rationale:
Manipulative behavior is not a specific indicator of sexual abuse in a school-age child. Children can display manipulative behavior for various reasons, including seeking attention or attempting to control situations. While behavioral changes can occur in response to trauma, manipulative behavior alone does not necessarily point to sexual abuse.
Choice C rationale:
Withdrawn behavior is a possible indication of sexual abuse in a school-age child. Sexual abuse can cause emotional and psychological distress in children, leading them to withdraw from social interactions. They might become isolated, exhibit changes in their usual behavior, and show decreased interest in activities they previously enjoyed.
Choice D rationale:
Destructive behavior is not a prominent behavioral finding associated specifically with sexual abuse in a school-age child. Destructive behaviors can arise from a range of factors, including emotional difficulties, behavioral disorders, or reactions to stressors. While trauma like sexual abuse can influence behavior, it's not a defining characteristic of sexual abuse in isolation.

A. Popcorn. B. Hot dog. C. Dried apricots. D. Plain yogurt.

Correct Answer is D

Explanation

Choice A rationale:
Popcorn can be problematic for a child with Crohn's disease. Crohn's disease is characterized by inflammation in the gastrointestinal tract, and certain high-fiber foods like popcorn can exacerbate symptoms, causing discomfort and potential irritation of the intestinal lining.
Choice B rationale:
Hot dogs are typically high in fat and can be difficult to digest, which can trigger symptoms in a child with Crohn's disease. Additionally, processed meats like hot dogs might contain additives that could worsen inflammation in the digestive tract.
Choice C rationale:
Dried apricots are also not the best choice for a child with Crohn's disease. Dried fruits are concentrated sources of fiber and can be tough on the digestive system, potentially leading to abdominal pain and diarrhea in individuals with inflamed intestines.
Choice D rationale:
Plain yogurt is a suitable food choice for a child with Crohn's disease. It is a good source of protein and calcium and contains probiotics that can promote gut health. Probiotics may help regulate the digestive system and alleviate some symptoms associated with Crohn's disease. However, individual tolerances may vary, so it's important to monitor the child's response to yogurt.

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A nurse is caring for a school-age child who has a new prescription for continuous pulse oximetry monitoring. Which of the following actions should the nurse take?

Answer: B. Reposition the probe every 2 hours.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in a family practice clinic is collecting data from a school-age child. Which of the following behavioral findings should the nurse identify as a possible indication of sexual abuse?

Correct Answer is C

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Correct Answer is D

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