A nurse is caring for a 6-month-old who had a cardiac catheterization.
Choose words from the choices below to fill in each blank in the following sentence. Which of the following should the nurse plan to include in the discharge teaching?
The nurse should plan to include_____and______ in the discharge instructions for the guardians.
remove pressure dressing four hours after discharge
administer acetaminophen or ibuprofen oral solution if needed for pain
call provider if right leg feels cool to touch in comparison to left leg
maintain clear liquid diet for 24 hr after discharge
tub bath is permitted 24 hr after procedure
Correct Answer : B,C
The nurse should plan to include Target 1: administer acetaminophen or ibuprofen oral solution if needed for pain and Target 2: call provider if right leg feels cool to touch in comparison to left leg in the discharge instructions for the guardians.
Rationale:
- Administer acetaminophen or ibuprofen oral solution if needed for pain: This instruction is important for managing post-procedure discomfort and promoting the child's comfort.
- Call provider if right leg feels cool to touch in comparison to left leg: This is a critical instruction, as it can indicate potential complications like bleeding or thrombosis. Early identification of these issues is essential for timely intervention.
The other options are not appropriate for discharge teaching in this case:
- Remove pressure dressing four hours after discharge: This is typically done in the hospital setting under the supervision of healthcare professionals.
- Maintain clear liquid diet for 24 hr after discharge: A clear liquid diet may not be necessary after discharge, especially if the child is tolerating oral intake well.
- Tub bath is permitted 24 hr after procedure: While bathing is generally allowed after the procedure, specific instructions regarding water temperature and avoiding submerging the incision site should be provided.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Egocentric thinking is characteristic of younger children in the preoperational stage, not adolescents.
B. Preoperational thinking applies to preschool-aged children and involves intuitive rather than logical reasoning.
C. Concrete thinking is typical of school-aged children in the concrete operational stage, where they think logically about concrete objects but may struggle with abstract concepts.
D. Abstract thinking develops during adolescence, allowing individuals to think logically about hypothetical situations, reason about moral issues, and engage in critical thinking.
Correct Answer is B
Explanation
A. Supraventricular tachycardia (SVT) typically has identifiable P waves; the absence of P waves suggests a different condition.
B. Atrial fibrillation is characterized by an irregular rhythm, inability to identify P waves, and varying intervals. This interpretation aligns with the client's ECG findings.
C. Sinus bradycardia would show identifiable P waves and a regular rhythm with a heart rate less than 60 bpm, which does not match the provided information.
D. First-degree heart block would also show identifiable P waves and regularity in the rhythm with a prolonged PR interval, which is not indicated here.
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