A nurse is preparing a 9-year-old child for an IV catheter insertion. Which of the following actions should the nurse take first?

Allow the child to see and touch IV tubing and supplies.

Explain to the child's parents what role they will have during the procedure.

Describe the procedure using visual aids.

Ask the child what he knows about the procedure.

Answer and Explanation

The Correct Answer is D

A. Allow the child to see and touch IV tubing and supplies.

Allowing the child to see and touch the IV tubing and supplies can help familiarize them with the equipment and reduce anxiety. However, there may be a more appropriate action to take first.

B. Explain to the child's parents what role they will have during the procedure.

While it's important to involve the child's parents and inform them of their role during the procedure, the priority should be to prepare the child for the insertion itself.

C. Describe the procedure using visual aids.

Using visual aids can be helpful in explaining the procedure to the child and providing a clear understanding of what will happen. However, there may be a more appropriate action to take first.

D. Ask the child what he knows about the procedure.

This is the correct answer. Asking the child what they already know about the procedure allows the nurse to assess their understanding and address any misconceptions or concerns they may have. It also helps the nurse tailor their explanation to the child's level of understanding and provide information that is relevant and meaningful to them.

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Correct Answer is D

Explanation

A. Place the infant in prone position.

This option is incorrect. Placing the infant in the prone position (lying on the stomach) could put pressure on the spinal lesion, potentially causing discomfort or complications. It's important to minimize pressure on the affected area in infants with spina bifida.

B. Cover the infant's lesion with a dry cloth.

This option is incorrect. While keeping the lesion clean and dry is important for preventing infection, simply covering it with a dry cloth may not provide adequate protection. Proper wound care techniques, such as using sterile dressings and cleaning the area with prescribed solutions, are typically necessary to prevent infection and promote healing.

C. Feed the infant through an NG tube.

This option is incorrect. While infants with severe forms of spina bifida may have difficulty feeding due to associated complications, such as difficulty swallowing or weak sucking reflexes, feeding through a nasogastric (NG) tube is not a standard intervention for spina bifida itself. Feeding methods would depend on the specific needs and abilities of the infant, and may involve breastfeeding, bottle-feeding, or other methods under the guidance of healthcare professionals.

D. Diapering over a low defect will keep the infant free from infection.

This option is correct. Diapering over a low defect (the opening in the spine caused by spina bifida) helps to keep the area clean and reduce the risk of infection. By properly covering the defect with a diaper, exposure to urine and feces, which can increase the risk of infection, is minimized. Additionally, regular diaper changes and proper hygiene practices are essential for preventing complications in infants with spina bifida.

A. Upright B. Supine C. Prone D. Side-lying

Correct Answer is A

Explanation

A. Upright: This position allows for better expansion of the lungs and improved ventilation-perfusion matching, as gravity helps the diaphragm move downward and expand the lungs. It is often beneficial for patients with respiratory distress or failure.

B. Supine: While lying flat on the back (supine position) may be comfortable for some patients, it can restrict lung expansion, especially in individuals with compromised respiratory function. This position may not be ideal for maximal lung expansion in this scenario.

C. Prone: The prone position involves lying flat on the abdomen. In some cases, especially in adults with acute respiratory distress syndrome (ARDS), prone positioning has been shown to improve oxygenation by optimizing lung mechanics. However, it may not be practical or comfortable for all patients and is not typically used as a first-line intervention in school-age children with pneumonia.

D. Side-lying: While side-lying positions can sometimes improve lung expansion on the dependent side, it may not be as effective as the upright position in maximizing lung expansion, especially in cases of respiratory failure.

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A nurse is preparing a 9-year-old child for an IV catheter insertion. Which of the following actions should the nurse take first?

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Naxlex Comprehensive Predictor Exams

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