A child presents to the emergency department with a complaint of a headache. The child's discharge diagnosis is a chronic progressive headache. Which of the following would be included in the discharge instructions?
A prescription for antibiotics to treat a sinus infection
A referral to a counselor for a psychiatric evaluation
A prescription for a preventative medication for migraines
An appointment for a CT scan of the brain
The Correct Answer is C
A. Antibiotics are only indicated if a bacterial infection is diagnosed, such as sinusitis. Chronic progressive headaches are usually not caused by bacterial infections, so empiric antibiotic therapy is not appropriate.
B. Referral to a counselor or psychiatric evaluation may be considered if psychosocial factors contribute to headache, but it is not a primary treatment for chronic progressive headaches unless indicated by assessment.
C. Chronic progressive headaches, especially migraines, are often managed with preventive pharmacologic therapy to reduce the frequency and severity of episodes. Discharge instructions would include prescription medications, education on proper use, potential side effects, and lifestyle modifications to prevent triggers. This intervention directly addresses the child’s ongoing headache management.
D. Imaging such as a CT scan is typically reserved for cases with red flag symptoms (sudden onset, neurological deficits, vomiting, altered consciousness) or unclear etiology. It is not routinely included in discharge instructions for known chronic progressive headaches without concerning features.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Myelomeningocele is a type of spina bifida in which a portion of the spinal cord and meninges protrude through a defect in the vertebral column. The exposed sac is fragile and at high risk for infection and trauma. Covering it with a sterile, saline-moistened dressing maintains moisture, prevents desiccation, and reduces the risk of infection. This is the highest priority nursing intervention prior to surgical repair.
B. While thermoregulation is important in newborns, preventing cold stress is secondary to protecting the integrity of the myelomeningocele sac. The sac’s protection and prevention of infection take priority over temperature control.
C. Leaving the sac exposed and dry increases the risk of rupture and infection, which can lead to severe complications including meningitis or neurological damage. This approach is unsafe and contrary to standard preoperative care guidelines.
D. Positioning an infant with myelomeningocele requires caution to avoid pressure on the sac. Typically, the infant is placed prone or on the side with careful padding to prevent sac trauma. Frequent repositioning without proper support could injure the sac. Therefore, routine side-to-side turning is not recommended until after surgical repair and stabilization.
Correct Answer is D
Explanation
A. Osteomyelitis is a bone infection, not a malignancy. Referral to oncology is unnecessary unless there is an unrelated suspected malignancy. This does not align with standard osteomyelitis discharge planning.
B. Proper nutrition for a child with osteomyelitis should be well-balanced with adequate protein to support tissue repair and immune function. A high-fat, low-protein diet would be counterproductive and is not recommended.
C. Children recovering from osteomyelitis should avoid strenuous activity until cleared by the healthcare provider. Premature return to physical activity can risk re-injury, delayed healing, or exacerbation of infection.
D. Osteomyelitis often requires prolonged intravenous antibiotic therapy, sometimes lasting several weeks. A home healthcare referral allows for safe administration of IV antibiotics, monitoring for complications, and ongoing patient/family education, which is an essential component of discharge planning.
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