Which client on an acute care pediatric unit requires the nurse’s immediate attention?

An 18-month-old client who had a cleft palate repair and is crying in pain.

A 12-year-old client who had an appendectomy and refuses to ambulate.

An 8-year-old client who had a tonsillectomy and is swallowing frequently.

A 15-year-old client who has an IV infusion and reports pain at the insertion site.

Answer and Explanation

The Correct Answer is C

Choice A rationale
While pain management is important following a cleft palate repair, it does not typically require immediate attention. Pain can be managed with appropriate analgesics and does not typically present an immediate risk to the patient’s health.
Choice B rationale
A patient refusing to ambulate following an appendectomy does not typically require immediate attention. Encouraging mobility is important for recovery, but refusal to ambulate does not present an immediate risk to the patient’s health.
Choice C rationale
Frequent swallowing following a tonsillectomy could indicate post-operative bleeding, which requires immediate attention. Post-tonsillectomy hemorrhage can be a life-threatening condition that requires immediate intervention.
Choice D rationale
While pain at the site of an IV infusion should be addressed, it does not typically require immediate attention unless there are signs of infection or infiltration. It does not present an immediate risk to the patient’s health.

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Free Nursing Study Resources

Correct Answer is ["A","C","E"]

Explanation

Choice A rationale
Cold compresses can help relieve joint pain associated with juvenile idiopathic arthritis. Cold therapy can reduce inflammation and numb the affected area, providing temporary relief.
Choice B rationale
This is incorrect. Ibuprofen should not be taken on an empty stomach because it can cause stomach upset or even lead to ulcers or bleeding. It is generally recommended to take ibuprofen with food or milk.
Choice C rationale
Performing range of motion exercises can help maintain joint flexibility and muscle strength in children with juvenile idiopathic arthritis. Regular exercise can also improve overall physical function and well-being.
Choice D rationale
While homeschooling may be a consideration for some families, it is not a general recommendation for all children with juvenile idiopathic arthritis. Many children with this condition can attend regular school with some accommodations as needed.
Choice E rationale
This is correct. Providing extra time for completion of activities of daily living (ADLs) can help children with juvenile idiopathic arthritis manage their symptoms and maintain their independence. It is important to allow children to perform tasks at their own pace to avoid causing unnecessary pain or fatigue.

A. “Follow the directions on the aspirin bottle for her age and weight.”. B. “She should be given acetaminophen, not aspirin.”. C. “Just be sure you administer the medication with food.”. D. “Give her no more than three baby aspirin every 4 hours.”.

Correct Answer is B

Explanation

Choice A rationale
It’s not advisable to follow the directions on the aspirin bottle for her age and weight. Aspirin is not recommended for use in children due to the risk of Reye’s syndrome, a rare but serious condition that can affect the liver and brain.
Choice B rationale
This is the correct response. Acetaminophen is a safer alternative to aspirin for managing fever in children.
Choice C rationale
While it’s generally a good idea to administer medication with food to prevent stomach upset, this advice does not address the specific risks associated with giving aspirin to a toddler.
Choice D rationale
Giving a toddler three baby aspirin every 4 hours is not recommended due to the risk of Reye’s syndrome.

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Which client on an acute care pediatric unit requires the nurse’s immediate attention?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a school-age child who has juvenile idiopathic arthritis. Which of the following home care actions should the nurse recommend? (Select all that apply)

Correct Answer is ["A","C","E"]

Explanation

A nurse at a pediatric hotline receives a call from a mother who plans to administer aspirin to a toddler for a fever and wants to know the dosage. Which of the following statements by the nurse is an appropriate response?

Correct Answer is B

Explanation

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