A nurse is preparing to assist with applying a cast to a preschooler's arm. Which of the following actions should the nurse take?
Place a heated fan at the bedside to facilitate drying.
Support the casted arm with a firm grasp.
Tell the child, "This will make your arm feel better."
Wrap the arm of the child's doll or toy prior to the procedure.
The Correct Answer is D
A. Place a heated fan at the bedside to facilitate drying: Using a heated fan can increase the risk of burns to the child's skin underneath the cast. The drying process for a cast should occur naturally, and artificial heat sources should not be used.
B. Support the casted arm with a firm grasp: While it's important to support the child's arm during the casting procedure, doing so with a firm grasp may not be necessary or appropriate. The nurse should follow the orthopedic surgeon's instructions regarding the positioning and support of the arm during casting.
C. Tell the child, "This will make your arm feel better": This statement may not accurately reflect the purpose of the cast, as casting is typically done to immobilize and protect the injured limb during the healing process. It's important to provide developmentally appropriate explanations to children about medical procedures, but this particular statement may not be helpful or accurate in this context.
D. Wrap the arm of the child's doll or toy prior to the procedure: This action helps familiarize the child with the procedure and can serve as a form of therapeutic play. By involving the child's toy or doll, the nurse can help reduce anxiety and fear associated with the casting procedure. It also provides an opportunity for the child to understand what will happen to their own arm, promoting a sense of familiarity and control over the situation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Bleeding: Haloperidol, an antipsychotic medication, is not typically associated with bleeding as an adverse effect. Bleeding is more commonly associated with medications such as anticoagulants or antiplatelet agents.
B. Pancreatitis: While rare, pancreatitis is not a common adverse effect of haloperidol. This condition is more commonly associated with other factors such as gallstones, alcohol consumption, or certain medications.
C. Dysrhythmias: Haloperidol can prolong the QT interval on an electrocardiogram (ECG), which may lead to dysrhythmias, including torsades de pointes. Therefore, it is essential to monitor clients receiving haloperidol for signs and symptoms of dysrhythmias, such as palpitations, syncope, or sudden cardiac arrest.
D. Cataracts: While long-term use of antipsychotic medications like haloperidol may increase the risk of developing cataracts, this adverse effect is not typically observed in clients receiving haloperidol on a PRN basis for agitation.
Correct Answer is D
Explanation
A. Use a 1.8 mm (0.5 in) needle:
Rationale: Needle length is typically not measured in millimeters for intramuscular injections. The length of the needle for intramuscular injections in preschoolers is usually longer, ranging from 16 to 25 mm (5/8 to 1 inch), depending on factors such as the child's size and the thickness of adipose tissue at the injection site.
B. Use a 20-gauge needle:
Rationale: While the gauge of the needle is important for controlling the flow rate of the medication, the size of the gauge alone does not determine the appropriateness of the needle for administering a vaccine into the deltoid muscle of a preschooler. The gauge of the needle commonly used for intramuscular injections in children is typically between 22 and 25 gauge.
C. Insert the needle at a 15-degree angle:
Rationale: When administering an intramuscular injection into the deltoid muscle, the needle should be inserted at a 90-degree angle (perpendicular to the skin) for children and adults. Using a 15-degree angle would result in a subcutaneous injection rather than reaching the muscle tissue.
D. Insert the needle just below the acromion process:
This is the correct action. When administering a vaccine into the deltoid muscle of a preschooler, the nurse should insert the needle just below the acromion process. This landmark helps ensure accurate placement of the needle into the deltoid muscle, which is the recommended site for intramuscular injections in preschool-age children.
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