A 9-year-old admitted to the unit with severe abdominal pain and fever is diagnosed with appendicitis and is placed on the surgery schedule for an appendectomy. The child reports to the nurse of experiencing sudden relief in abdominal pain. Which action should the nurse take first?
Document the client's relief of pain.
Inquire about the client's last meal.
Give prescribed intravenous antibiotics.
Contact the healthcare provider.
The Correct Answer is D
A. Documenting the client's relief of pain is important for the medical record but is not the first priority in this situation. The immediate concern is to determine the cause of the sudden pain relief and ensure the child's well-being.
B. Inquiring about the client's last meal is important for pre-operative considerations, but it is not the first action to take when sudden relief of abdominal pain is reported.
C. Giving prescribed intravenous antibiotics may be part of the treatment plan, but it should not be the first action when the child experiences sudden relief of abdominal pain. Contacting the healthcare provider to assess the situation is more urgent.
D Contact the healthcare provider.
In the case of a child diagnosed with appendicitis, sudden relief in abdominal pain can be concerning. This might indicate that the appendix has ruptured, leading to the spread of infection into the abdominal cavity, which can be a critical situation. It's essential for the healthcare provider to be informed immediately so they can assess the child's condition, order any necessary interventions, and potentially expedite the surgical procedure if required.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Evaluating the infant for failure to thrive (FTT) is not the most appropriate initial intervention in this case. FTT is a long-term growth issue, and the immediate concern is the infant's current symptoms and cardiac status.
B. Auscultate heart and lungs while the infant is held.
Tetralogy of Fallot (TOF) is a congenital heart defect that includes four specific cardiac abnormalities, and it often requires surgical correction in infancy. When an infant with a history of TOF surgery presents with symptoms such as rapid breathing, feeding difficulties, and fatigue, it may raise concerns about potential cardiac issues or complications.
The most appropriate initial intervention is to auscultate the infant's heart and lungs while the infant is held to assess for any abnormal heart sounds or signs of respiratory distress. Auscultation can provide important information about the infant's cardiac and respiratory status. This assessment will help determine if there are any immediate concerns related to the infant's cardiac condition.
C. Stimulating the infant to cry to produce cyanosis is not a recommended or appropriate intervention. Cyanosis is a sign of inadequate oxygenation and should not be induced in a child.
D. Obtaining a 12-lead electrocardiogram may be indicated if there are significant concerns about the infant's cardiac status, but auscultation should be performed first to assess the immediate condition. An electrocardiogram is a diagnostic tool and would be ordered as a follow-up assessment if needed.
Correct Answer is ["A","D","F"]
Explanation
A - Maintaining a consistent home schedule is an essential strategy for managing ADHD, as routines and structure can help the child stay organized and focused.
B - Understanding that nonstimulant medications can also be beneficial in the treatment of ADHD is correct, as nonstimulant medications are an alternative or additional treatment option for some individuals with ADHD. It's important to have a comprehensive understanding of available treatment options.
C - The statement "Know that medication is the best approach to treatment" is not accurate. Medication can be an effective component of ADHD treatment, but it is not necessarily the best approach for every child. Treatment plans should be individualized and may include a combination of strategies, such as behavioral interventions, psychoeducation, and medication.
D - Creating an organization chart for tasks is a helpful approach for children with ADHD to manage their responsibilities and activities effectively.
E - Anticipating being automatically entered into a specialized education plan is not necessarily accurate. While some children with ADHD may benefit from an Individualized Education Plan (IEP) or a 504 Plan in the educational setting, these plans are typically established based on specific assessments and the child's needs.
F - Designating an established area for study is important for creating a distraction-free environment, which can support the child's ability to focus on their schoolwork.
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