A nurse is caring for a 10-year-old child who is receiving chemotherapy. The child's guardian asks about managing adverse effects. Which of the following statements should the nurse make?
"Use a soft-bristled toothbrush when platelet levels are low."
"Encourage eating by providing your child with their favorite foods."
"Rinse your child's mouth with chlorhexidine mouthwash if they develop stomatitis."
"Ensure you administer an antiemetic for 12 hr after chemotherapy."
The Correct Answer is A
A. Chemotherapy can decrease platelet count, increasing the risk of bleeding. A soft-bristled toothbrush helps prevent gum bleeding.
B. This might help stimulate appetite but it doesn't address the specific concerns related to chemotherapy side effects.
C. If stomatitis develops, which is a painful inflammation and ulceration of the mouth, rinsing with a mild saline solution is generally recommended rather than chlorhexidine mouthwash, which can sometimes cause irritation.
D. Antiemetics should be administered as needed based on the child's symptoms, not on a fixed schedule.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. While it is important to check for skin irritation at the cast edges, this is not the most immediate concern compared to other potential complications. Skin irritation can occur, but it is a less urgent issue compared to signs of more serious problems like impaired circulation or swelling.
B. Itching is a common issue with casts, and using a hair dryer on a cool setting can help relieve this discomfort. However, this is a comfort measure and does not address the more critical aspects of cast care and potential complications.
C. Restricting strenuous activities is important to prevent complications and ensure proper healing, but it is not the most immediate concern following cast application. The timeframe may also need to be
longer than just 3 days, depending on the type of surgery and cast. Specific activity restrictions should be based on the child's condition and the surgeon's recommendations.
D. Monitoring for pallor and swelling is critical because these signs can indicate compromised circulation or other serious complications related to the cast. Swelling and changes in skin color can suggest that the cast is too tight or that there is a problem with blood flow. Immediate attention is needed if these symptoms are observed to prevent further complications.
Correct Answer is A
Explanation
A. A quick-release knot allows for the restraints to be removed swiftly in case of an emergency. This is important to ensure that the child can be freed quickly if needed, such as if there is a sudden change in the child’s condition or an emergency arises.
B. This is not adequate for ensuring the child’s safety. Regular assessments are critical for monitoring the child's physical condition, circulation, and overall comfort while in restraints. Typically, the child should be assessed at least every 15-30 minutes, depending on the facility’s policy and the child’s condition, to prevent complications such as skin breakdown, impaired circulation, or increased distress.
C. The renewal of a restraint order typically must occur more frequently than every 48 hours. According to most regulations and facility policies, restraint orders are usually valid for a shorter period, often 24 hours, and must be renewed daily by a provider.
D. This is not appropriate and can be dangerous. Restraints should never be tied to bed rails because this can cause serious injury if the child moves or if there is any sudden movement of the bed. Instead, restraints should be secured to a part of the bed frame that moves with the bed and does not pose a risk of injury. Proper restraint attachment helps avoid entrapment and injury.
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