What is an important nursing consideration when suctioning a young child who has had heart surgery?
Expect symptoms of respiratory distress when suctioning.
Administer supplemental oxygen before and after suctioning.
Perform suctioning at least every hour.
Suction for no longer than 30 seconds at a time.
The Correct Answer is B
The correct answer is choice B. Administer supplemental oxygen before and after suctioning.
Choice A rationale:
Expect symptoms of respiratory distress when suctioning. While respiratory distress can occur during and after suctioning, it is not the main nursing consideration. The primary goal is to minimize any potential complications and ensure the child's safety during the procedure, which can be achieved by following appropriate guidelines.
Choice B rationale:
Administer supplemental oxygen before and after suctioning. Correct Answer. Administering supplemental oxygen before and after suctioning is crucial to maintain adequate oxygenation during and after the procedure. Suctioning can temporarily decrease oxygen levels and cause desaturation, especially in a child who has undergone heart surgery. Providing supplemental oxygen helps prevent hypoxia and supports respiratory function.
Choice C rationale:
Perform suctioning at least every hour. Frequent suctioning at least every hour is not a standard nursing practice, especially for a child who has had heart surgery. Suctioning should only be performed as needed based on the child's clinical condition, and excessive suctioning can irritate the airway and lead to complications.
Choice D rationale:
Suction for no longer than 30 seconds at a time. While limiting the duration of suctioning is important to prevent hypoxia and trauma to the airway, the specific duration of 30 seconds is not a universal rule. Suctioning should be performed for the shortest effective duration to minimize the risk of complications, but the optimal time can vary based on the child's condition and the type of suctioning being used.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D"]
Explanation
The correct answers are choices A, C, and D: Tachycardia, Hyperthermia, and Vomiting.
Choice A rationale:
Tachycardia. Tachycardia, an abnormally fast heart rate, is a classic manifestation of thyroid storm. In this life-threatening condition, there is an excessive release of thyroid hormones, leading to increased metabolic rate and subsequent cardiovascular effects such as tachycardia.
Choice B rationale:
Constipation. This choice is incorrect for thyroid storm. Hyperthyroidism typically leads to increased bowel motility and can cause diarrhea rather than constipation.
Choice C rationale:
Hyperthermia. This is a correct choice. Thyroid storm is associated with severe hyperthermia due to the increased metabolic rate caused by excessive thyroid hormones. The body's temperature regulation is disrupted, leading to dangerously high body temperatures.
Choice D rationale:
Vomiting. This is a correct choice. Gastrointestinal symptoms, including vomiting and nausea, can occur in thyroid storm due to the heightened metabolic state. Thyroid storm affects various systems, including the gastrointestinal system, leading to symptoms like vomiting.
Choice E rationale:
Hypotension. This choice is incorrect for thyroid storm. Thyroid storm is more likely to cause hypertension rather than hypotension due to the increased cardiac output and sympathetic stimulation.
Correct Answer is C
Explanation
The correct answer is choice C. After taking antibiotics for 24 hours.
Choice A rationale:
Returning to school if no complications develop is not a sufficient guideline for allowing a child with streptococcal pharyngitis to return to school. Streptococcal pharyngitis (strep throat) is highly contagious, and children should be treated with antibiotics to prevent the spread of the infection.
Choice B rationale:
Waiting until the sore throat is better is not a specific enough criterion for returning to school. While the resolution of symptoms is an important factor, it's crucial to ensure that the child has also been on antibiotics for an appropriate duration to reduce the risk of spreading the infection to others.
Choice C rationale:
The recommended guideline is to return to school after taking antibiotics for 24 hours. This timeframe helps ensure that the child's contagiousness is significantly reduced, minimizing the risk of transmitting the infection to classmates and school staff.
Choice D rationale:
Waiting for three days after taking antibiotics is not as precise as waiting for 24 hours. With proper antibiotic treatment, the child's contagiousness decreases rapidly, and waiting for three days might be unnecessary and could potentially result in more missed school days than needed.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.