A nurse is providing discharge instructions to a parent and his school-age child who has juvenile idiopathic arthritis. Which of the following
instructions should the nurse include?
Encourage the child to take a 45 min nap daily
Administer prednisone on an alternate day schedule
Apply cool compresses for 20 min every hour
Allow the child to stay at home on days when her joints are painful
The Correct Answer is B
Choice A reason: Encouraging the child to take a 45 min nap daily is not a helpful instruction, as it may interfere with the child's normal sleep pattern and school schedule. The child may benefit from regular rest periods throughout the day, but not necessarily a long nap. ⁵
Choice B reason: Administering prednisone on an alternate day schedule is a helpful instruction, as it is a common way of prescribing corticosteroids for children with juvenile idiopathic arthritis. Corticosteroids are used to reduce inflammation and control symptoms, but they have many side effects, such as growth suppression, weight gain, and osteoporosis. Giving the medication every other day may reduce some of these side effects and improve compliance. ⁶
Choice C reason: Applying cool compresses for 20 min every hour is not a helpful instruction, as it may cause skin damage and discomfort. Cool compresses may be useful for acute inflammation, but not for chronic arthritis. Warm compresses or baths may be more soothing and beneficial for the child's joints. ⁷
Choice D reason: Allowing the child to stay at home on days when her joints are painful is not a helpful instruction, as it may lead to social isolation, academic difficulties, and reduced physical activity. The child should be encouraged to attend school and participate in activities as much as possible, with appropriate accommodations and modifications if needed. The child may also benefit from physical therapy, occupational therapy, and pain management strategies. ⁸
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: This is not a correct instruction for the nurse to include in the teaching. Emphasizing the quantity, rather than the quality, of food consumed may lead to overeating, obesity, or malnutrition. The nurse should encourage the mother to offer a variety of healthy foods in appropriate portions and avoid forcing or bribing the child to eat.
Choice B reason: This is not a correct instruction for the nurse to include in the teaching. Expecting that food consumption might not decrease significantly may cause the mother to ignore the signs of poor nutrition or growth in the child. The nurse should advise the mother to monitor the child's weight, height, and development regularly and consult the provider if there are any concerns.
Choice C reason: This is a correct instruction for the nurse to include in the teaching. Adding fruit juice to the child's diet can increase the vitamin intake, especially vitamin C, which is important for immune function and wound healing. The nurse should recommend the mother to choose 100% fruit juice and limit the amount to 4 to 6 oz per day.
Choice D reason: This is not a correct instruction for the nurse to include in the teaching. Having the child remain at the table after meals to increase food intake may create a negative association with eating and cause more resistance or frustration. The nurse should suggest the mother to make mealtime a pleasant and relaxed experience and respect the child's appetite and preferences.
Correct Answer is D
Explanation
Choice A reason: This is not a correct statement by the child. The child should take their regular insulin as prescribed, even when they are sick. Insulin helps the body use glucose for energy and prevents high blood sugar levels, which can cause complications. The child may need to adjust their insulin dose or frequency depending on their blood glucose levels, food intake, and activity level.
Choice B reason: This is not a correct statement by the child. The child should not store unopened bottles of insulin in the freezer. Freezing can damage the insulin and make it ineffective. The child should store unopened bottles of insulin in the refrigerator, away from direct light and heat. The child should store opened bottles of insulin at room temperature and discard them after 28 days.
Choice C reason: This is not a correct statement by the child. The child's morning blood glucose should be between 70 and 110 mg/dL, according to the American Diabetes Association. A blood glucose level between 90 and 130 mg/dL may indicate that the child has hyperglycemia, or high blood sugar, which can cause symptoms such as thirst, hunger, fatigue, and frequent urination.
Choice D reason: This is a correct statement by the child. The child should eat a snack half an hour before playing soccer or engaging in any physical activity. Physical activity lowers blood glucose levels, and a snack can help prevent hypoglycemia, or low blood sugar, which can cause symptoms such as shakiness, sweating, dizziness, and confusion.
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