1030: The child has an audible murmur. Lung sounds are clear and equal. Pedal pulses present and marked. The parents state that the child has no known allergies. His last meal was approximately 3 hours ago. The child's parents are extremely concerned about the cardiac catheterization.
Vital signs:
Heart rate 108 beats/minute
Blood pressure 92/56 mm Hg
Respiratory rate 22 breaths/minute
Ovvoen saturation 96%
What can the nurse do to help the parents to decrease their anxiety? Select all that apply
Provide the parents with ideas about how to make their child feel better after the p
ell the parents that the procedure is 100% effective and safe
Limit visitation as long as the parents are anxious
Find a comfortable area that the parents can wait that is close to the procedure an
Do not give any specifics on the amount of time the procedure will take
Correct Answer : A,D,E
To help the parents decrease their anxiety, the nurse can:
A. Provide the parents with ideas about how to make their child feel better after the procedure. This can help reassure the parents that they can support their child during the recovery process.
D. Find a comfortable area that the parents can wait that is close to the procedure area. Being close to the procedure area allows the parents to stay informed and feel more connected to their child during the procedure.
E. Do not give any specifics on the amount of time the procedure will take. Providing a specific time may increase anxiety, so it's often better to provide a general idea of the timeframe.
Option B is not appropriate because stating that the procedure is 100% effective and safe may not be accurate and could lead to false expectations.
Option C is not appropriate because limiting visitation based on the parents' anxiety is not typically recommended. Supportive presence is generally encouraged for both the child and parents.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Correct answer: D
A.This can be a good distraction technique, but it might not directly facilitate the lung sound assessment.
B.This activity might help engage the child but could make it difficult for the nurse to listen to breath sounds accurately.
C.Holding a toy might keep the child occupied but does not directly relate to the assessment process and might not ensure cooperation as effectively as using a stethoscope on a stuffed animal.
D.Allowing the child to use the stethoscope on a stuffed animal can help reduce fear and anxiety by making the procedure more familiar and less intimidating. It engages the child in a playful and interactive manner, helping to build trust and cooperation.
Correct Answer is ["A","D","E"]
Explanation
The correct answers are A, D, E.
Before the cardiac catheterization for a 3-year-old with a history of ventricular septal defect, the nurse's focused assessment should include the following:
A. Determine when the child last ate: Knowing when the child last ate is important because the procedure may require fasting, and the nurse needs to ensure that the child has adhered to the fasting guidelines.
D. Locate and mark the pedal pulses: Locating and marking the pedal pulses is essential to establish a baseline for assessing peripheral circulation, especially given the history of ventricular septal defect.
E. Obtain a history of allergic reactions: Obtaining a history of allergic reactions is important to ensure that there are no allergies or sensitivities that could impact the procedure or the use of any contrast materials during the cardiac catheterization.
The other options are not necessary components of the focused assessment in preparation for the cardiac catheterization:
B. Measure the child's height and weight: Measuring height and weight may be done at some point but is not a priority in the immediate pre-procedural assessment.
C. Perform a mini-mental exam on the child: A mini-mental exam may not be applicable or necessary in the pre-catheterization assessment of a 3-year-old.
F. Document lying, sitting, and standing blood pressures: Blood pressure variations in different positions are typically not relevant for this type of procedure, and it may not be practical or necessary for a 3-year-old.
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