Exhibits
Review H and P and nurse's note.
Which are the first four actions that the practical nurse (PN) should do?
Take the child's pulse
Place a cervical collar on the client
Call child protective services
Start a peripheral IV line
Look for any open wounds
Determine if the child's airway is clear
The Correct Answer is A, F, E
A. Take the child's pulse
Assessing the pulse is crucial to determine if the child has a heartbeat and to evaluate the effectiveness of CPR. This helps to determine the current cardiovascular status of the child and the urgency of further resuscitation efforts.
F. Determine if the child's airway is clear
Ensuring a clear airway is a priority in any emergency situation. A blocked airway can prevent effective ventilation and oxygenation, which is critical for a child who has experienced a near-drowning incident.
D. Start a peripheral IV line
Starting a peripheral IV line is important for administering fluids and medications that may be necessary for resuscitation and stabilization. It allows for rapid access to the child's circulatory system for necessary interventions.
E. Look for any open wounds
Checking for open wounds is necessary to identify any immediate sources of bleeding or potential infections that need to be addressed. It is part of a thorough initial assessment to ensure comprehensive care for the child.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D"]
Explanation
A. Gloves
Gloves are essential when entering the room because MRSA (Methicillin-resistant Staphylococcus aureus) is a pathogen that can be transmitted through direct contact with contaminated surfaces or secretions. Gloves protect both the client and the PN from the spread of the infection and should be worn when touching the patient or surfaces/items in the room.
B. N95 Mask
An N95 mask is not required for MRSA infections unless there are concerns about airborne transmission, which is not typical for MRSA. MRSA transmission is primarily through direct or indirect contact rather than airborne routes, so an N95 mask is not necessary in this scenario.
C. Gown
A gown is required when there is a risk of contamination from the environment or the patient, especially with MRSA infections. It helps to protect the PN’s clothing and skin from coming into contact with any infectious materials from the surgical site.
D. Surgical Mask
A surgical mask is appropriate for MRSA to protect against droplets and to prevent the spread of infection. It is particularly useful if there is a risk of droplets from the patient or if the PN is performing procedures that might generate droplets.
E. Goggles
Goggles are not required for MRSA unless there is a specific risk of splash or spray that could potentially expose the PN’s eyes to infectious materials. In the context of a surgical site infection, goggles are not a standard part of the PPE unless additional procedures are being performed that involve splashes
Correct Answer is ["B","D","E","F"]
Explanation
A. A warning about potential charges for child neglect
This is not appropriate in a pre-discharge education context. The focus should be on providing support and education to prevent future incidents and to help the parents understand the importance of supervision and safety.
B. Information about pool safety
Providing information about pool safety is essential to prevent future drowning incidents. Parents should be educated on supervision, barriers, and emergency response measures like CPR. This helps ensure the child's safety and reduces the risk of similar accidents.
C. Instructions on how to access long-term home care
Long-term home care instructions are unnecessary unless the child has specific ongoing medical needs resulting from the submersion. Since the child is showing only minor signs of impact, this education is not relevant.
D. When to follow up with the child's pediatrician
Clear instructions on when to follow up with the pediatrician ensure ongoing monitoring for any delayed effects of the submersion injury. This follow-up helps address any emerging health concerns and reassures the parents about their child's recovery.
E. Assessment of the parent's coping skills
Assessing the parents' coping skills is important to understand their emotional and psychological state post-incident. This can help identify any need for further support or counseling, ensuring the family is equipped to handle the situation.
F. Contact information for community resources
Providing contact information for community resources offers additional support to the parents, such as access to counseling, parenting classes, or safety courses. This reinforces the safety education provided and ensures the parents have resources to turn to if needed
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