A nurse is caring for a school-age child who has appendicitis. For which of the following findings should the nurse monitor as a manifestation of a perforated appendix and report to the provider?

Elevated temperature

Lethargy

Decreased abdominal girth

Bradycardia

Answer and Explanation

The Correct Answer is A

A nurse caring for a school-age child who has appendicitis should monitor for several manifestations of a perforated appendix and report to the provider. According to my sources, one of the major complications of appendicitis is the perforation of the appendix, which can lead to peritonitis, abscess formation, or portal pylephlebitis. Perforation generally occurs 24 hours after the onset of pain. Symptoms include a fever of 37.7⁰C or greater, a toxic appearance, and continued abdominal pain or tenderness.

B- Lethargy is not mentioned as a manifestation of a perforated appendix.

C- Decreased abdominal girth is not mentioned as a manifestation of a perforated appendix.

D- Bradycardia, which refers to a slower than normal heart rate, is also not mentioned as a manifestation of a perforated appendix.

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Correct Answer is D

Explanation

Swelling of the lips

The nurse should reinforce with the client that the epinephrine auto-injector can help treat swelling of the lips. Epinephrine is a medication commonly used to treat severe allergic reactions, also known as anaphylaxis. Swelling of the lips is one of the hallmark manifestations of an allergic reaction.

Epinephrine acts quickly to reverse the allergic response by constricting blood vessels, relaxing smooth muscles, and reducing swelling and inflammation.

Nausea in (option A) is incorrect: Nausea can have various causes, and epinephrine is not specifically indicated for treating this symptom.

Hyperglycemia in (option B) is incorrect: Epinephrine can potentially increase blood glucose levels, so it is not used to treat hyperglycemia.

Hand tremors in (option C) is incorrect: Epinephrine can cause tremors as a side effect, so it is not used to treat hand tremors.

A. "I should not feed my baby anything for 2 hours prior to an immunization." B. "My baby will receive three doses of the meningococcal immunization before kindergarten." C. “My baby will receive the rotavirus immunization orally." D. "I should expect my baby to have a high fever for 24 hours after an immunization.”

Correct Answer is C

Explanation

"My baby will receive the rotavirus immunization orally." - This statement is correct. The rotavirus vaccine is administered orally, typically as drops or as an oral suspension. It is important for the guardian to follow the specific instructions provided by the healthcare provider for the administration of the rotavirus vaccine.

"I should not feed my baby anything for 2 hours prior to an immunization." - This statement is incorrect. It is not necessary to withhold feeding prior to immunizations. In fact, it is generally recommended to feed the baby before the immunization to help provide comfort during the procedure.

"My baby will receive three doses of the meningococcal immunization before kindergarten." - This statement is incorrect. The number of doses and the schedule for each immunization may vary. The guardian should consult with the healthcare provider or refer to the immunization schedule for specific recommendations regarding meningococcal immunization.

"I should expect my baby to have a high fever for 24 hours after an immunization." - This statement is not entirely accurate. While it is common for infants to experience mild side effects such as a low-grade fever after immunizations, a high fever is less common. The guardian should be aware of the potential side effects and contact the healthcare provider if they have concerns about their baby's reaction to the immunization.

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A nurse is caring for a school-age child who has appendicitis. For which of the following findings should the nurse monitor as a manifestation of a perforated appendix and report to the provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching with a client who has a new prescription for epinephrine auto-injector PRN. The nurse should reinforce with the client that the medication can help treat which of the following manifestations?

Correct Answer is D

Explanation

A nurse is reinforcing teaching with the guardian of a 2-month-old infant about immunizations. Which of the following statements by a guardian indicates an understanding of the teaching?

Correct Answer is C

Explanation

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