A home health nurse is developing a plan of care for the parents of a toddler who has hemophilia A. Which of the following instructions should the nurse include?

Administer aspirin for pain.

Place knee pads on the child.

Perform passive range-of-motion exercises following an acute episode.

Use a firm-bristled toothbrush for dental care.

Answer and Explanation

The Correct Answer is B

A. Administer aspirin for pain. Aspirin increases the risk of bleeding and is contraindicated in clients with hemophilia. Acetaminophen is recommended instead.
B. Place knee pads on the child. Protective gear like knee pads can help prevent joint injuries, which are common in toddlers with hemophilia.
C. Perform passive range-of-motion exercises following an acute episode. Active range-of-motion exercises are preferred after an acute episode to prevent joint damage. Passive exercises can exacerbate bleeding.
D. Use a firm-bristled toothbrush for dental care. A soft-bristled toothbrush should be used to minimize gum bleeding.

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Correct Answer is C

Explanation

A. "The infant exhibits a fear of strangers." Stranger anxiety typically develops around 6 to 9 months of age.
B. "The infant understands the word 'no'." Understanding simple words like "no" begins closer to 9 months to 1 year of age.
C. "The infant has an absent grasp reflex." The grasp reflex begins to disappear by 3 months of age, with voluntary grasping developing by 4 to 5 months.
D. "The infant rolls from their back to their abdomen." Rolling from back to abdomen usually occurs around 5 to 6 months.

A. Maintain NPO status. B. Administer an antipyretic. C. Initiate an infusion of IV fluids. D. Administer a cleansing enema. E. Prepare child and parents for ostomy placement. F. Educate child and parents about plan of care. G. Administer an analgesic. H. Administer antibiotics.

Correct Answer is ["A","B","C","F","G","H"]

Explanation

A. Maintain NPO status. The child is at risk for surgery, and maintaining NPO status reduces the risk of aspiration.
B. Administer an antipyretic. Reducing fever can improve comfort and decrease metabolic demand.
C. Initiate an infusion of IV fluids. IV fluids prevent dehydration, especially since the child has had poor oral intake and diarrhea.
D. Administer a cleansing enema. An enema is contraindicated as it may worsen abdominal inflammation or cause perforation.
E. Prepare child and parents for ostomy placement. While surgery may be needed, an ostomy is not always required for appendicitis.
F. Educate child and parents about plan of care. Providing education helps reduce anxiety and ensures understanding of the interventions.
G. Administer an analgesic. Pain management is essential for comfort and reduces physiologic stress.
H. Administer antibiotics. Antibiotics are started preoperatively to manage infection or prevent complications if perforation is suspected.

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A home health nurse is developing a plan of care for the parents of a toddler who has hemophilia A. Which of the following instructions should the nurse include?

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a 4-month-old infant at a well-child visit. Which of the following findings should the nurse expect?

Correct Answer is C

Explanation

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Correct Answer is ["A","B","C","F","G","H"]

Explanation

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