A home health nurse is developing a plan of care for a child diagnosed with hemiplegic cerebral palsy. Which of the following goals is the priority for the nurse to include in the plan of care?

Foster self-care activities.

Provide respite services for the parents.

Modify the environment.

Improve the client's communication skills.

Answer and Explanation

The Correct Answer is A

A.   Encouraging self-care activities helps promote independence and improve the quality of life for a child with hemiplegic cerebral palsy. It focuses on maximizing the child's potential for autonomy.
B.   Respite care is important for caregiver support, but fostering self-care activities for the child is a higher priority for long-term development.
C.   Modifying the environment is useful for safety and mobility but does not address the child’s ability to perform self-care, which is a key aspect of daily functioning.
D.   While communication skills are important, fostering self-care activities takes precedence in
supporting the child’s independence.

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Correct Answer is C

Explanation

A. While hydration is important to help with blood flow, pain management takes precedence during an SCD crisis.
B. Oxygen may be necessary in certain cases but is not the priority in the acute pain crisis, where pain control is the primary concern.
C. Pain management is the priority in sickle cell disease (SCD) crisis, as it helps alleviate the intense pain associated with vaso-occlusive events.
D. Antipyretics are not the priority unless the child has a fever. Pain relief is more urgent during a crisis.

A. Initiate isolation protocols. B. Administer IV antibiotics. C. Prepare for a lumbar puncture. D. Obtain blood cultures.

Correct Answer is A

Explanation

A. Bacterial meningitis is highly contagious, and isolation precautions are necessary to prevent the spread of the infection to others. This should be the nurse's first action to protect both the child and others.
B. While antibiotics are crucial in treating bacterial meningitis, initiating isolation protocols is the first priority to prevent transmission to others.
C. A lumbar puncture is needed to confirm the diagnosis of meningitis, but isolation protocols should be established first to prevent spread.
D. Blood cultures are important for diagnosing bacterial meningitis but are secondary to ensuring proper isolation to prevent contagion.

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A home health nurse is developing a plan of care for a child diagnosed with hemiplegic cerebral palsy. Which of the following goals is the priority for the nurse to include in the plan of care?

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