A home health nurse is developing a care plan for a child with hemiplegic cerebral palsy. What is the priority goal for the nurse to include in the care plan?
Improve the patient’s communication skills.
Foster self-care activities.
Provide respite services for the parents.
Enhance the patient’s mobility skills.
The Correct Answer is D
Choice A rationale
While improving the patient’s communication skills is an important goal in the care of a child with hemiplegic cerebral palsy, it is not the priority goal. The priority should be based on the child’s most immediate needs and the potential for harm if those needs are not met.
Choice B rationale
Fostering self-care activities is another important goal in the care of a child with hemiplegic cerebral palsy. However, it is not the priority goal. The priority should be based on the child’s most immediate needs and the potential for harm if those needs are not met.
Choice C rationale
Providing respite services for the parents is an important aspect of care, but it is not the priority goal for the child’s care plan. The priority should be based on the child’s most immediate needs and the potential for harm if those needs are not met.
Choice D rationale
Enhancing the patient’s mobility skills is the priority goal for a child with hemiplegic cerebral palsy. Hemiplegic cerebral palsy affects one side of the body, impacting the child’s mobility.
Therefore, interventions should focus on improving mobility to enhance the child’s independence and quality of life.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","D"]
Explanation
Choice A rationale
In ARDS, impaired carbon dioxide elimination due to shunting can occur. Shunting refers to the diversion of blood from areas of the lung that are ventilated to areas that are not, leading to impaired gas exchange.
Choice B rationale
Decreased pulmonary arterial pressure due to ventilation-perfusion (V/Q) mismatch is not a typical finding in ARDS3.
Choice C rationale
Hypoxemia due to dead space is not a typical finding in ARDS. Dead space refers to areas of the lung that are ventilated but not perfused.
Choice D rationale
Decreased pulmonary compliance due to stiffness is a typical finding in ARDS. The lungs become stiff and less compliant due to the accumulation of fluid and inflammatory cells in the alveoli and interstitial space.
Correct Answer is D
Explanation
Choice A rationale
Phenytoin is an antiepileptic medication used to control seizures. It’s important for the patient to understand that they should not switch brands of this medication without consulting their healthcare provider. Different brands of phenytoin can have different effects, and switching could potentially lead to changes in seizure control.
Choice B rationale
Regular dental appointments are important for patients taking phenytoin. This medication can cause gum overgrowth (gingival hyperplasia), so good oral hygiene and regular dental check- ups are essential.
Choice C rationale
It’s crucial for patients to notify their doctor before taking any other medications. Phenytoin can interact with many other drugs, altering their effectiveness or increasing side effects.
Therefore, the patient’s statement indicates an understanding of the need for caution when considering additional medications.
Choice D rationale
Phenytoin is a long-term medication for controlling seizures. It’s not something that patients can stop taking once they feel better. Abruptly stopping the medication can lead to withdrawal
seizures. Therefore, the patient’s statement, “I’ll be glad when I can stop taking this medicine,” indicates a need for further teaching about the importance of continuing the medication as prescribed.
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