A nurse is caring for an infant following surgical repair of omphalocele. What is the nurse's priority?
Administer pain medication as ordered
Assess the surgical site for signs of infection
Educate the parents about proper wound care
Provide age-appropriate toys for play
The Correct Answer is B
A. Administering pain medication is important, but assessing the surgical site for signs of infection takes priority to prevent complications.
B. Assessing the surgical site for signs of infection is crucial in preventing complications and ensuring proper healing post-surgery.
C. Educating the parents about proper wound care is essential but may not be the priority compared to assessing for signs of infection.
D. Providing age-appropriate toys for play is important for the infant's comfort and development but is not the priority compared to assessing for signs of infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Broth may be too heavy for the stomach and could exacerbate symptoms in a child with acute gastroenteritis.
B. Water alone may not adequately replace lost electrolytes, which are crucial in cases of gastroenteritis.
C. Diluted apple juice may not provide the necessary electrolyte replacement needed for fluid resuscitation in acute gastroenteritis.
D. Oral rehydration solution is specifically formulated to replace lost fluids and electrolytes and is the recommended fluid for children with acute gastroenteritis.
Correct Answer is C
Explanation
A. While burping the baby more frequently might help with gas, projectile vomiting after feeding could indicate a more serious issue that requires immediate attention.
B. Giving an oral rehydration solution is not appropriate for a 2-month-old infant experiencing projectile vomiting after feeding; medical evaluation is needed.
C. Projectile vomiting in a young infant could indicate a serious problem such as pyloric stenosis, which requires immediate medical evaluation.
D. Switching formula may not address the underlying cause of projectile vomiting and could delay appropriate treatment; medical evaluation is needed.
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