A nurse is providing instructions to the parent of a 10-year-old child who has recently been diagnosed with type 1 diabetes mellitus (DM). The parent expresses a fear of needles and is unable to perform the procedure of administering subcutaneous insulin injections to the child.
What action should the nurse take?
Evaluate the parent’s ability to care for the child.
Determine if the child can administer the insulin.
Encourage the parent to handle the needles.
Inquire if there is another person who can assist with the injections.
The Correct Answer is B
Choice A rationale
While it’s important to evaluate the parent’s ability to care for the child, this does not directly address the parent’s fear of needles. The parent’s fear of needles is a specific issue that needs to be addressed in order to ensure the child receives the necessary insulin injections.
Choice B rationale
Determining if the child can administer the insulin is a potential solution to the parent’s fear of needles. Some children as young as 10 years old may be able to administer their own insulin injections with proper training and supervision. This would allow the child to manage their diabetes independently and alleviate the parent’s fear of needles.
Choice C rationale
Encouraging the parent to handle the needles may not be effective if the parent has a significant fear of needles. It’s important to respect the parent’s fear and find alternative solutions, such as having the child administer the insulin or finding another person who can assist with the injections.
Choice D rationale
Inquiring if there is another person who can assist with the injections is a potential solution to the parent’s fear of needles. If there is another person available who is comfortable administering the insulin injections, this could alleviate the parent’s fear and ensure the child receives the necessary care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
If the child is sleeping now and is difficult to wake, this could be a sign of worsening respiratory status. Children with respiratory distress often have difficulty sleeping due to discomfort and difficulty breathing. If the child is now sleeping and difficult to wake, this could indicate a decrease in oxygen levels, leading to lethargy and decreased responsiveness. This would require immediate attention.
Choice B rationale
The vital signs provided indicate a potentially serious situation. A heart rate of 130 beats/minute is high for a 3-year-old child, indicating that the heart is working harder to pump blood. A respiratory rate of 15 breaths/minute is on the lower end of normal for a 3-year-old, which could indicate that the child is not getting enough oxygen. An oxygen saturation of 66% on a 5L face mask is dangerously low, indicating severe hypoxia. A temperature of 102.8° F(39.3° C) axillary indicates a fever, which could be a sign of infection. A blood pressure of 92/48 mm Hg is within normal range for a 3-year-old.
Choice C rationale
If the child is active and playing with toys, this could indicate that his respiratory status is not worsening. Children who are experiencing respiratory distress often have difficulty engaging in normal activities due to discomfort and shortness of breath. If the child is able to play normally, this could indicate that he is getting enough oxygen and his condition is stable.
Choice D rationale
If the child’s breathing has returned to normal, this could indicate that his respiratory status is improving. However, it’s important to continue monitoring the child closely, as respiratory conditions can change rapidly, especially in young children.
Correct Answer is C
Explanation
Choice A rationale
Administering oxygen via a facemask is an intervention that can be used if the baby shows signs of distress or if the decelerations do not improve with other interventions. However, it is not the first action that should be taken.
Choice B rationale
Turning off the oxytocin infusion could be an appropriate action if the mother is receiving oxytocin and the baby is showing signs of distress. However, it is not the first action that should be taken.
Choice C rationale
Changing the client’s position is the correct first action for variable decelerations. This can relieve potential cord compression and improve fetal oxygenation.
Choice D rationale
Assessing cervical dilation is an important part of monitoring labor progress, but it is not the first action that should be taken in response to variable decelerations.
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