During the first few days after surgery for cleft lip, which intervention should the nurse implement?
Apply Neosporin to avoid Infection.
Apply elbow immobilizers when not being held.
Suction secretions away from the suture line.
Feed Increased amounts of formula to prevent weight loss.
The Correct Answer is C
Suctioning secretions away from the suture line helps maintain the surgical site's cleanliness and promotes healing. It helps prevent accumulation of mucus or oral secretions that can interfere with the healing process and increase the risk of infection. The nurse should use a gentle suctioning technique to avoid disrupting the surgical site.
Applying Neosporin to the surgical site is not typically recommended unless specifically prescribed by the healthcare provider. It is important to follow the provider's instructions regarding wound care.
Applying elbow immobilizers when not being held is not necessary for cleft lip surgery. Elbow immobilizers are usually used in other surgical procedures or for other reasons, such as preventing contractures.
Feeding increased amounts of formula to prevent weight loss is not an appropriate intervention for the first few days after cleft lip surgery. The surgical site may be sensitive, and the child may experience difficulty with feeding initially. The nurse should provide guidance and support for feeding techniques appropriate for the child, which may include using specialized bottles or positioning techniques.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Hemoglobin A1C is a blood test that provides an average blood glucose level over the past 2-3 months. Regular monitoring of A1C levels helps to assess the effectiveness of lifestyle modifications and treatment plans and guides adjustments in management if necessary.
Daily exercise is another essential aspect of managing pre-diabetes. Regular physical activity helps improve insulin sensitivity, promotes weight management, and reduces the risk of developing type 2 diabetes. The nurse should educate patients on the importance of incorporating physical activity into their daily routine and provide recommendations on suitable exercise types and durations.
While other options may be relevant for patients with diabetes, they are not specifically tailored to pre-diabetes, which is a condition where blood glucose levels are higher than normal but not yet meeting the criteria for diabetes.
Hypoglycemia and injection site infection are more relevant concerns for individuals with diabetes who require insulin or other medications to manage their blood sugar levels. Increasing carbohydrate intake and administering insulin are not appropriate recommendations for pre-diabetes management, as they can contribute to elevated blood glucose levels.
Correct Answer is C
Explanation
School-age children typically have a growing awareness of their bodies and an understanding of potential harm or pain. They may fear procedures or treatments that involve physical discomfort, such as injections, blood draws, or invasive procedures. The fear of experiencing pain or bodily injury can cause anxiety and distress in school-age children.
It is important for the nurse to acknowledge and address the child's fear of pain or bodily injury by providing age-appropriate explanations, offering reassurance, and implementing strategies to minimize discomfort. This may involve using distraction techniques, providing emotional support, and ensuring proper pain management during procedures.
While loss of privacy and control, separation anxiety, and stranger anxiety can also be stressors for school-age children, the fear of pain or bodily injury is often a significant concern that may require specific attention and interventions from the nurse.
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