Exhibits
The parents are at the bedside and state that each parent thought the other parent was watching the child. They are not sure how long he was in the pool or how he might have fallen in. The temperature of the pool was cool as the temperature outside was about 64 °F (17.8 °C).
Placed a cervical collar with the assistance of the physician. The child's pulse is 121 beats/minute, the airway is patent, and there are no signs of any bleeding.
Review H and P, nurse's note, laboratory results, orders, and imaging studies. What complications should the nurse monitor for in the next 6 to 8 hours? Select all that apply.
Cerebral edema
Acute asphyxia
Hypertension
Respiratory distress
Hyperthermia
Subdural hemorrhage
Correct Answer : A,B,D,F
A) Cerebral edema: Brain injury or trauma can lead to swelling and increased intracranial pressure.
B) Correct- Near- drowning causes acute asphyxia because it prevents the person from breathing in oxygen and exhaling carbon dioxide. Asphyxia is a condition where the body is deprived of oxygen, which can lead to loss of consciousness, brain injury, or death.
C) Incorrect- Hypertension is not a common complication following near-drowning. The focus should be on potential brain injuries and respiratory distress.
D) Correct- Near-drowning can lead to aspiration of water or other substances, which can result in respiratory distress.
E) Incorrect- hyperthermia is not likely to occur in this case because the child was exposed to cold water.
F) Correct- Head trauma can lead to bleeding within the brain, such as a subdural hemorrhage.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A) Incorrect- While repeating information can be helpful, it might not address the specific needs of a client with unilateral hearing loss. Simply repeating information may not improve comprehension if the client's hearing loss is in one ear.
B) Correct- Providing education for a client with unilateral hearing loss requires consideration of their specific communication needs. Writing information on a whiteboard allows the client to visually process the information, which can be particularly helpful for those with hearing loss in one ear. This method ensures that the client can access the information accurately and effectively.
C) Incorrect- Speaking loudly into the affected ear is not a recommended approach. It can be uncomfortable for the client and may not necessarily improve communication if the hearing loss is unilateral.
D) Incorrect- While speaking directly facing the client is a good practice in general, it may not fully address the communication challenges of someone with unilateral hearing loss. Providing visual information through writing is a more effective way to ensure the client receives the information accurately.
Correct Answer is ["A","C","D","E"]
Explanation
Certain medications can contribute to constipation as a side effect. Reviewing the client's medication list will help identify any potential medications that may be causing or exacerbating constipation.
Understanding the client's current approach to managing constipation, such as dietary changes, laxative use, or other remedies, will provide insight into their self-care practices and effectiveness of current interventions.
Diet plays a crucial role in bowel regularity. Assessing the client's dietary habits, including fiber intake and hydration, can help identify potential factors contributing to constipation.
Physical activity and exercise promote bowel regularity by stimulating intestinal motility. Evaluating the client's level of physical activity and exercise routine can provide information on their overall mobility and potential impact on bowel function.
The next scheduled visit with the healthcare provider may be important for the overall management of the client's health but may not be directly related to formulating a plan of care specifically for constipation.
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