A 10-year-old boy who had an appendectomy had expressed worry that following the procedure he would have lots of pain. Two days after the procedure the child is claiming he is having no pain. Which nursing intervention should the nurse prioritize when assessing this child?

Observe him for physical signs which might indicate pain.

Ask him to show you his pain level using the color pain scale.

Explain to his caregiver that his pain level shows he is getting better quickly.

Tell him to let you know if he begins to feel pain.

Answer and Explanation

The Correct Answer is A

Choice A reason: Observing for physical signs like grimacing or guarding ensures accurate pain assessment, as a 10-year-old may underreport pain. This aligns with pediatric pain assessment protocols, making it the prioritized intervention to verify the child’s claim of no pain post-appendectomy accurately.

Choice B reason: A color pain scale relies on the child’s verbal report, which may be unreliable if he’s minimizing pain. Observing physical signs is more objective, making this secondary and incorrect compared to the nurse’s priority of assessing for hidden pain in the post-surgical child.

Choice C reason: Explaining to the caregiver assumes no pain without objective assessment, risking missed discomfort. Observing physical signs confirms the child’s status, making this premature and incorrect compared to the nurse’s role in thoroughly assessing pain in the 10-year-old post-appendectomy.

Choice D reason: Asking the child to report pain later depends on his willingness, which may be inconsistent. Observing physical signs provides immediate data, making this passive and incorrect compared to the nurse’s priority of actively assessing for pain in the child post-appendectomy procedure.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

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

Explanation

Choice A reason: Discussing care options involves clinical judgment, which is the nurse’s responsibility, not delegable to family. Providing comfort tasks like swabs or pads is appropriate, making this incorrect, as it involves professional decision-making unsuitable for family delegation in the adolescent’s care.

Choice B reason: Keeping medical equipment like a blood pressure cuff involves monitoring, a nursing task, not delegable to family. Comfort tasks like providing swabs or pillows are suitable, making this incorrect, as it requires clinical skills beyond family’s role in the terminally ill adolescent’s care.

Choice C reason: Supplying mouth swabs for lip moistening is a simple comfort task family can perform, promoting involvement and patient comfort. This aligns with pediatric palliative care delegation, making it a correct intervention to delegate to family for the terminally ill adolescent’s care.

Choice D reason: Providing disposable pads for hygiene is a non-clinical task family can manage, supporting dignity and comfort. This aligns with family involvement in palliative care, making it a correct intervention to delegate for the terminally ill adolescent’s care in the hospital setting.

Choice E reason: Supplying pillows for repositioning is a comfort-focused task family can handle, enhancing the adolescent’s well-being. This aligns with pediatric palliative care principles, making it a correct intervention to delegate to family members for the terminally ill adolescent’s hospital care.

A. Encourage the client to wear his or her own clothes, talk to friends on the phone, and interact with other clients who have similar illnesses. B. Make all treatment and care decisions; the preteen is too young to have any responsibility for his or her own care. C. Encourage the client to keep his or her limitations foremost in mind when trying a new skill or task at which his or her peers have begun to excel. D. Create a clear list of behavioral rules to give the client when he or she arrives.

Correct Answer is A

Explanation

Choice A reason: Wearing personal clothes, connecting with friends, and interacting with peers with similar illnesses fosters normalcy and emotional well-being in a 12-year-old. This aligns with pediatric psychosocial care for chronic illness, making it the correct action to help the preteen thrive during hospitalization.

Choice B reason: Making all decisions excludes the 12-year-old from care involvement, undermining autonomy and coping. Encouraging personal expression and peer connection supports thriving, making this disempowering and incorrect compared to fostering independence and emotional health in a chronically ill preteen in the hospital.

Choice C reason: Focusing on limitations discourages confidence and resilience, hindering a 12-year-old’s adaptation to chronic illness. Promoting normalcy through clothes and social interaction is more supportive, making this negative and incorrect for helping the preteen thrive during their hospital stay with a chronic condition.

Choice D reason: Strict behavioral rules may provide structure but do not address emotional and social needs like personal expression and peer support. Encouraging normalcy fosters thriving, making this less impactful and incorrect compared to actions promoting psychosocial well-being in a hospitalized 12-year-old with chronic illness.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A 10-year-old boy who had an appendectomy had expressed worry that following the procedure he would have lots of pain. Two days after the procedure the child is claiming he is having no pain. Which nursing intervention should the nurse prioritize when assessing this child?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is attempting to include family in the care of a hospitalized, terminally ill adolescent. Which interventions can be appropriately delegated to family members? (Select all that apply)

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

Explanation

The nurse is working with a 12-year-old who is hospitalized with a chronic illness. Which action by the nurse might help the chronically ill preteen thrive while hospitalized?

Correct Answer is A

Explanation

The nurse has an order to administer a rectal suppository to a 3-month-old child. In addition to lubricating the suppository, which intervention will help assure appropriate administration of the medication?

The nurse is doing discharge teaching for a child who has had a tonsillectomy. The nurse tells the client and family that the child should have plenty of fluids. In addition, the nurse would explain to the child’s caregiver that the child may:

The parent of an adolescent has called to talk to the pediatric nurse over concern that her daughter is not getting proper nutrition now that she has started following a vegetarian diet. Which response should the nurse prioritize for this parent?

A 10-year-old boy who had an appendectomy had expressed worry that following the procedure he would have lots of pain. Two days after the procedure the child is claiming he is having no pain. Which nursing intervention should the nurse prioritize when assessing this child?

In discussing the causes of iron-deficiency anemia in children with a group of nurses, the following statements are made. Which of these statements is a misconception related to iron-deficiency anemia?

The caregiver of an infant keeps removing the pulse oximetry sensor claiming it is too tight and hurting the baby. Which response should the nurse prioritize in addressing this situation?

The nurse is assisting with a physical exam on a child who has been admitted with a diagnosis of possible child abuse (child maltreatment). Which finding might alert the nurse to this possibility that the child may have been abused?