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1330

Cardiac catheterization performed; ventricular septal defect closed with mesh

Admit to the pediatric floor for observation

Check pedal pulses every 4 hours

Nothing by mouth

Place the child on a continuous cardiopulmonary monitor

The nurse reviews the post-catheterization orders.

What two orders would the nurse question?

Point of care blood glucose

Check pedal pulses every 4 hours

Give lactated Ringers intravenously at 66 ml/hr while NPO

Vital signs every 4 hours

Nothing by mouth

Admit to the pediatric floor for observation

Check dressing every 15 minutes for 1 hour and then every hour for

Answer and Explanation

Correct Answer : B,C

B. Check pedal pulses every 4 hours: This order should be questioned because after a ventricular septal defect closure, it is essential to assess and monitor peripheral pulses frequently, especially in the immediate post-catheterization period. Checking pedal pulses every 4 hours may not provide adequate monitoring and could potentially lead to delayed detection of complications.

C. Give lactated Ringers intravenously at 66 ml/hr while NPO: This order should be questioned because it specifies a continuous intravenous infusion of lactated Ringer's solution, but the patient is listed as "Nothing by mouth" (E). In cases where a patient is NPO, it's important to clarify the rationale for the intravenous fluid rate and consider whether it's appropriate, especially after a cardiac catheterization procedure.

The other orders are appropriate or necessary for the post-catheterization care of a child with a closed ventricular septal defect:

A. Point of care blood glucose: Monitoring blood glucose levels is relevant in post-catheterization care.

D. Vital signs every 4 hours: Monitoring vital signs is standard post-catheterization care.

F. Admit to the pediatric floor for observation: This order is appropriate for post-catheterization observation.

G. Check dressing every 15 minutes for 1 hour and then every hour: Frequent dressing checks are important for assessing and preventing bleeding or other complications at the catheterization site.

H. Place the child on a continuous cardiopulmonary monitor: Continuous monitoring is important for early detection of any cardiopulmonary issues in the post-catheterization period.

In summary, monitoring peripheral pulses and the appropriateness of intravenous fluids in relation to NPO status should be questioned in this context.

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Correct Answer is B

Explanation

A. Regular syringe feedings alone do not necessarily promote rapid weight gain, and their appropriateness depends on the underlying cause of FTT and the healthcare provider's recommendations.

B. Breast milk provides adequate calories for the child.

Breast milk is an excellent source of nutrition for infants, providing essential nutrients and calories needed for healthy growth and development. It is generally well-tolerated and suitable for most infants. Encouraging breastfeeding, especially if the infant is not exclusively breastfed, can be a valuable approach in managing FTT.

C. Fruit juice, particularly in excess, may not be recommended for infants with FTT as it can be high in sugars and low in essential nutrients. It is not a primary intervention for FTT.

D. High-calorie formula can be considered for infants with FTT, but it should be prescribed and monitored by a healthcare provider. Simply using high-calorie formula without proper guidance is not an appropriate intervention.

Breast milk is a valuable and appropriate source of nutrition for infants with FTT, and the nurse should support and encourage its use while monitoring the infant's growth and progress closely.

A. Fever 101.0° F (38.3° C) B. Difficulty swallowing secretions. C. Barking cough, worse at night. D. Cries often when nursing.

Correct Answer is B

Explanation

When advising a new mother in caring for a child with croup, the symptom that should be a priority concern to the telephone triage nurse is B.

Explanation:

A. A fever of 101.0°F (38.3°C) is a common symptom in many childhood illnesses, including croup, but it is not the primary concern when difficulty swallowing secretions is present.

B Difficulty swallowing secretions.

Croup is characterized by a barking cough and may also be associated with stridor (noisy breathing), hoarseness, and difficulty swallowing secretions. While all the symptoms mentioned can be concerning, difficulty swallowing secretions is a priority concern because it can potentially lead to respiratory distress if not managed appropriately. Thick secretions can cause airway obstruction, and prompt assessment and intervention are needed to ensure the child's airway remains clear and that the child is able to breathe effectively.

C. A barking cough, worse at night, is a classic symptom of croup and should be addressed, but difficulty swallowing secretions can have a more direct impact on the child's airway.

D. Crying often when nursing may be related to the discomfort caused by croup, but it is not as immediately concerning as difficulty swallowing secretions.

While the barking cough, hoarseness, and other croup symptoms should also be addressed, the priority is ensuring that the child is able to manage secretions effectively without respiratory distress. The telephone triage nurse should provide guidance to the mother on how to help the child manage these secretions and when to seek medical attention if the situation worsens.

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Naxlex Comprehensive Predictor Exams

The nurse is providing nutrition education to the parents of an infant with failure to thrive (FTT). Which statement made by the parent should the nurse recognize as an appropriate understanding of interventions?

Correct Answer is B

Explanation

When advising a new mother in caring for a child with croup, which symptom should be a priority concern to the telephone triage nurse?

Correct Answer is B

Explanation

The nurse is assessing the lung sounds of a preschooler. Which action should the nurse Implement to ensure the child's cooperation?

Exhibits Two days later, the nurse completes an assessment of the client. Which assessment findings indicate that the client has stabilized? Select all that apply.

A 3-year-old boy in a daycare facility scratches his head frequently, and the nurse confirms the presence of head lice. The nurse washes the child's hair with permethrin shampoo and calls his parents. Which instruction should the nurse provide to the parents about treatment for head lice?

The parents of a 14-month-old child who is hospitalized due to febrile seizures tell the nurse that they fear their child will have lifelong seizures. Which information should the nurse convey to these parents?