An 8-year-old patient with status asthmaticus insists on sitting straight up in bed. Which action should the nurse take?
Allow the patient to stay in the position the child has chosen.
Explain to the patient why semi-Fowler's is a more therapeutic position.
Demonstrate a variety of positions to the patient.
Remove the pillows from the patient's bed.
The Correct Answer is B
Choice A rationale:
Allowing the patient to stay in the chosen position might not be the best approach, as the child's preference might not align with therapeutic considerations for managing status asthmaticus.
Choice B rationale:
Semi-Fowler's position, with the head of the bed elevated, promotes improved lung expansion and easier breathing for patients with respiratory distress. Explaining the rationale behind this position to the child helps them understand its therapeutic benefits, encouraging compliance.
Choice C rationale:
Demonstrating various positions could confuse the child and delay appropriate intervention. A clear explanation of the preferred position is more effective in this critical situation.
Choice D rationale:
Removing pillows might be counterproductive, as elevating the head of the bed is beneficial for respiratory distress. This choice contradicts the therapeutic goal.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Minimize crying.
Choice A rationale:
Encouraging attachment might be important for the child's emotional well-being, but in the immediate postoperative period after cleft lip repair, minimizing crying takes priority. Crying can place stress on the suture line and disrupt the healing process.
Choice B rationale:
Minimizing crying is crucial to prevent tension on the suture line and ensure proper healing of the cleft lip repair. Excessive crying can lead to increased pressure on the surgical site and potential complications. Elbow restraints are applied to prevent the child from touching the surgical site, so minimizing crying helps to maintain the effectiveness of these restraints.
Choice C rationale:
Restricting oral intake is not a priority in this case. While it's important to ensure the child doesn't consume anything that might harm the surgical site, it's not the highest priority action compared to preventing tension on the suture line.
Choice D rationale:
Initiating range of motion is not the priority postoperative intervention for a cleft lip repair. The primary concern at this stage is to prevent disruption of the surgical site and ensure proper healing, making minimizing crying a higher priority.
Correct Answer is A
Explanation
Choice A rationale:
After undergoing cleft palate repair, it's appropriate to inform the mother that her child may want to be close to her most of the time. The child might feel more secure in the presence of their caregiver during the recovery period.
Choice B rationale:
Having the child sleep in the same bed is not typically recommended due to safety concerns, especially after surgery.
Choice C rationale:
Increased independence is not a common immediate response after hospitalization, especially for a young child recovering from surgery.
Choice D rationale:
While attention during hospitalization is important, it wouldn't necessarily translate to the need for stricter limits. Post-hospitalization care should focus on the child's comfort and recovery rather than punitive measures.
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