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 A
Explanation
Correct Answer is C
Explanation
A. "Palliative care focuses on the care of the client." - This statement is accurate. Palliative care is centered around providing comprehensive care that addresses the physical, emotional, social, and spiritual needs of the patient.
B. "Palliative care is an inter-professional approach to the delivery of care." - This statement is also accurate. Palliative care typically involves a team of healthcare professionals, including physicians, nurses, social workers, chaplains, and other specialists, who work collaboratively to provide holistic care.
C. "Palliative care is the same as hospice care." - This statement is incorrect. Palliative care and hospice care share similarities in that they both focus on improving the quality of life for patients with serious illnesses, but they are not the same. The key difference is that palliative care can be provided at any stage of a serious illness, even alongside curative treatments, while hospice care is typically provided when a patient has a terminal illness with a prognosis of six months or less to live.
D. "Palliative care includes symptom management in the cent" - This statement is accurate. Symptom management and relief of distressing symptoms are essential components of palliative care, with the goal of improving the patient's quality of life.
So, the statement in option C is incorrect, and the registered nurse should correct it by explaining the distinction between palliative care and hospice care to the client's family.
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