A 13-year-old with severe scoliosis is admitted for insertion of Harrington rods. In preparing the patient for postoperative care, the nurse should provide which information?

"You will be placed in halo traction.".

"The nurses will use a log-roll technique when you are turned.".

"You can have nothing by mouth for 72 hours.".

"You will not be allowed to have visitors for 48 hours.".

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Placing the patient in halo traction is not applicable for a scoliosis correction surgery with Harrington rods. Halo traction is typically used for cervical spine injuries or deformities, not for scoliosis correction.

Choice B rationale:

The correct answer. After Harrington rod insertion, maintaining proper alignment is crucial to prevent complications. Using a log-roll technique when turning the patient helps maintain spinal alignment and prevent stress on the surgical site.

Choice C rationale:

Keeping the patient nothing by mouth for 72 hours is not typically necessary after scoliosis surgery. Clear fluids and a light diet are usually initiated shortly after surgery.

Choice D rationale:

Restricting visitors for 48 hours is not a standard practice after scoliosis surgery unless there are specific infection control concerns, which are not mentioned in the scenario.

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Correct Answer is C

Explanation

Urine output 76 mL/24 hours.

Choice A rationale:

BUN (Blood Urea Nitrogen) of 14 mg/dL falls within the normal range (7-20 mg/dL) and is not an immediate concern.

Choice B rationale:

Serum Creatinine of 0.4 mg/dL is also within the normal range (0.2-0.5 mg/dL) and does not warrant immediate action.

Choice C rationale:

Urine output of 76 mL/24 hours is significantly decreased from the expected normal range (1-2 mL/kg/hour), indicating potential kidney dysfunction or dehydration. This requires immediate action to assess the child's hydration status and kidney function.

Choice D rationale:

Hb (Hemoglobin) of 12 g/dL is within the normal range for a 5-year-old child (11.5-15.5 g/dL) and does not necessitate urgent intervention.

A. Ask the client about personal food preferences. B. Determine what the client knows about this illness. C. Obtain a urine specimen. D. Administer pain relief medication.

Correct Answer is D

Explanation

Choice A rationale:

While addressing the client's food preferences is important for their overall care, pain management takes priority during a vaso-occlusive sickle cell crisis to alleviate suffering and prevent complications.

Choice B rationale:

Assessing the client's knowledge about the illness is significant for education, but pain relief should precede this assessment to promptly address their distress.

Choice C rationale:

Obtaining a urine specimen is a relevant diagnostic step, but pain management should be initiated before further assessments or interventions.

Choice D rationale:

Administering pain relief medication is the immediate nursing priority. Sickle cell crises are excruciating, and timely pain management helps alleviate suffering and improve the client's well-being.

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A 13-year-old with severe scoliosis is admitted for insertion of Harrington rods. In preparing the patient for postoperative care, the nurse should provide which information?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which finding in a 5-year-old child diagnosed with hemolytic uremic syndrome would require the nurse to take immediate action?

Correct Answer is C

Explanation

A child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which prescription by the health care provider should the nurse implement first?

Correct Answer is D

Explanation

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