Which nursing intervention will assist a toddler-age client in end-stage renal failure the most?
Explain the body changes that will take place.
Maintain the child's normal routines.
Allow the child to talk about the illness.
Encourage friends to visit.
The Correct Answer is B
Choice A reason: Explaining body changes to a toddler may not be effective due to their limited understanding at this developmental stage.
Choice B reason: Maintaining normal routines provides a sense of security and normalcy, which is crucial for a toddler's emotional well-being, especially during a serious illness.
Choice C reason: Allowing the child to talk about the illness can be therapeutic, but toddlers may not have the verbal skills to express complex emotions or understand their condition.
Choice D reason: While encouraging friends to visit can provide social support, it is not as fundamental as maintaining daily routines that offer stability in the child's life. Maintaining normal routines is the most comforting and beneficial intervention for a toddler in this situation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","D","E"]
Explanation
Choice A reason: Administering oxygen helps increase the oxygen saturation during a 'tet' spell.
Choice B reason: The Trendelenburg position is not recommended for 'tet' spells as it does not help alleviate the hypercyanotic episode.
Choice C reason: While important for overall assessment, drawing blood for serum hemoglobin is not an immediate intervention during a 'tet' spell.
Choice D reason: Placing the infant in a knee-chest position increases systemic vascular resistance, which can help improve oxygenation.
Choice E reason: Administering morphine is appropriate as it helps to relax the infant, reducing the work of breathing and improving oxygenation.
Correct Answer is D
Explanation
Choice A reason: A high-pitched cry can be a sign of distress in an infant, but it is not a specific indicator of increased intracranial pressure. It could be due to a variety of reasons, including discomfort, hunger, or other forms of distress.
Choice B reason: Decreased lower extremity movement could be a sign of a neurological issue, but it is not a direct indicator of increased intracranial pressure. It would require further evaluation to determine the cause.
Choice C reason: Excessive wet diapers are not typically associated with increased intracranial pressure. This symptom could be related to other conditions such as diabetes insipidus or excessive fluid intake.
Choice D reason: This is the correct choice. A bulging fontanel when crying is a classic sign of increased intracranial pressure in an infant. The fontanel, or soft spot on the baby's head, can bulge when there is increased pressure within the skull. This should be promptly evaluated by a healthcare professional.
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