Which action should the nurse take when providing postoperative nursing care to a child after insertion of ventriculoperitone (VP) shunt?
Check the urine for glucose and protein
Administer narcotics for pain control
Test cerebrospinal (CSP) fluid leakage for protein
Monitor for increased temperature
The Correct Answer is D
A. Checking urine for glucose and protein is not directly related to the care of a child with a VP shunt. The focus is on monitoring the child for signs of complications related to the shunt.
B. Administering narcotics for pain control may be indicated if the child is in pain, but it is not the primary action and should be determined based on the child's pain assessment.
C. Testing cerebrospinal (CSF) fluid leakage for protein is not typically a nursing responsibility in the immediate postoperative period. Leakage of CSF should be reported to the healthcare provider, and diagnostic tests would be conducted by medical staff as needed.
D. Monitor for increased temperature.
Monitoring for an increased temperature is essential because postoperative fever could be an early sign of infection or complications related to the VP shunt. Infection and shunt malfunction are potential risks in the postoperative period.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Demonstrating independent dressing is usually not expected at 18 months. Toddlers are still developing fine motor skills and may need assistance with dressing.
B. Using a vocabulary of 300 words is advanced for an 18-month-old. At this age, most children have a more limited vocabulary, typically around 50 words or so.
C. Jump with both feet.
At 18 months of age, children are usually developing their motor skills, including gross motor skills like walking, running, and jumping. Jumping with both feet is an age-appropriate milestone for a toddler of this age.
D. Walking upstairs with one hand held is typically not expected at 18 months. This is a skill that develops later as toddlers gain more confidence in their mobility and coordination.
Correct Answer is ["A","C","D"]
Explanation
A.Anemia can be a common finding in nephrotic syndrome, often due to the loss of proteins like transferrin that are involved in red blood cell production, along with potential blood loss during episodes of proteinuria. The reduction in red blood cell production or anemia in nephrotic syndrome can also be exacerbated by decreased erythropoietin production.
B.Hypolipidemia is not a characteristic of nephrotic syndrome. In fact, nephrotic syndrome is associated with hyperlipidemia.
C.Hyperlipidemia is a classic feature of nephrotic syndrome. It results from an increase in the synthesis of lipoproteins by the liver as a compensatory mechanism to the loss of proteins (particularly albumin) in the urine.
D.Hypoproteinemia, specifically hypoalbuminemia, is a hallmark of nephrotic syndrome. The loss of protein (especially albumin) through the urine due to damaged glomeruli leads to decreased levels of proteins in the blood. This contributes to the characteristic edema seen in nephrotic syndrome.
E.Hypoglycemiais not typically associated with nephrotic syndrome. Instead, children with nephrotic syndrome generally do not experience significant changes in glucose metabolism. In fact, if anything, glucose levels may be slightly elevated in some cases due to stress or steroid treatment.
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