A nurse in an emergency department is caring for a preschooler who experienced a near drowning and has hypothermia. Which of the following actions should the nurse take?

Place the child in a tub bath of tepid water.

Cover the child's head with a hat.

Administer acetaminophen every 4 hr.

Obtain a specimen for blood cultures.

Answer and Explanation

The Correct Answer is B

A) Place the child in a tub bath of tepid water: While tepid water can help in some situations of hyperthermia, it is not suitable for hypothermia. A more controlled and gradual rewarming method is necessary to prevent further complications such as rewarming shock.

B) Cover the child's head with a hat: Covering the child's head with a hat is an important step in rewarming because a significant amount of body heat is lost through the head. This helps in retaining body heat and stabilizing the child’s temperature.

C) Administer acetaminophen every 4 hr: Acetaminophen is typically used for reducing fever and managing pain. It is not indicated for treating hypothermia, as it does not aid in rewarming the body or addressing the underlying hypothermic condition.

D) Obtain a specimen for blood cultures: While obtaining blood cultures might be necessary if there is a suspicion of infection, it is not a primary intervention for treating hypothermia. Immediate focus should be on rewarming and stabilizing the child.

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Correct Answer is C

Explanation

A) "Gestational diabetes increases the risk of your baby having hemorrhagic disease after birth." Hemorrhagic disease of the newborn is typically related to vitamin K deficiency, not gestational diabetes. Thus, this response does not directly address the risks associated with gestational diabetes.

B) "Gestational diabetes increases the risk of your baby having a cleft lip or palate." Cleft lip and palate are congenital conditions that are more related to genetic and environmental factors during the early stages of pregnancy. Gestational diabetes does not increase the risk of these specific congenital abnormalities.

C) "Gestational diabetes increases the risk of your baby having hypoglycemia after birth." This is correct. Infants born to mothers with gestational diabetes are at risk for hypoglycemia shortly after birth due to the high levels of insulin produced in response to maternal hyperglycemia during pregnancy.

D) "Gestational diabetes increases the risk of your baby having a low birth weight." Gestational diabetes more commonly leads to macrosomia (large birth weight) rather than low birth weight. The excessive glucose levels in the mother’s blood can result in increased fetal insulin production, leading to increased growth and fat deposits.

A. Request return instructions in the client's own words. B. Provide brochures that reflect a seventh-grade reading level. C. Limit teaching materials to written information. D. Avoid repetition of information within each session.

Correct Answer is A

Explanation

A) Request return instructions in the client's own words:
Asking the client to repeat instructions in their own words is an effective strategy for ensuring understanding, especially for individuals with low health literacy. This technique, known as the "teach-back" method, allows the nurse to assess the client’s comprehension and clarify any misunderstandings.

B) Provide brochures that reflect a seventh-grade reading level:
While providing materials at a lower reading level can be helpful, it may not be sufficient for individuals with very low health literacy. It is essential to use multiple strategies, including verbal communication and interactive methods, to ensure understanding.

C) Limit teaching materials to written information:
Relying solely on written information is not advisable for clients with low health literacy. Visual aids, demonstrations, and verbal explanations should be included to enhance comprehension and retention of information.

D) Avoid repetition of information within each session:
Repetition is actually beneficial for clients with low health literacy. Repeating key information helps reinforce learning and ensures that the client retains the essential points discussed during the teaching sessions.

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A nurse in an emergency department is caring for a preschooler who experienced a near drowning and has hypothermia. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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