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A nurse is caring for a 6-week-old infant.

Exhibits

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Answer and Explanation

The Correct Answer is []

Condition Most Likely Experiencing

Pyloric stenosis causes projectile vomiting, dehydration, and hunger.
Cystic fibrosis causes chronic respiratory infections, steatorrhea, and failure to thrive.
The condition that the infant is most likely experiencing is congestive heart failure, which can cause poor weight gain, tachypnea, decreased appetite, and periorbital edema.
Respiratory syncytial virus bronchiolitis causes wheezing, coughing, and respiratory distress.

Actions to Take

Digoxin is a medication commonly prescribed to manage congestive heart failure in infants by improving cardiac contractility and reducing heart rate.
Elevating the head of the bed helps reduce venous return to the heart, thereby decreasing preload and relieving symptoms of congestion in congestive heart failure.
Contact precautions are not indicated for congestive heart failure, but for infections that are transmitted by direct or indirect contact.
Chest physiotherapy and postural drainage are not indicated for congestive heart failure, but for conditions that cause excessive mucus production and retention.

Parameters to Monitor

Number of steatorrhea stools is not relevant for congestive heart failure, but for cystic fibrosis or other malabsorption disorders.
Monitoring intake and output is crucial in assessing fluid balance, especially in congestive heart failure where fluid retention can lead to volume overload.
Monitoring respiratory status is essential in congestive heart failure to assess for signs of pulmonary congestion and respiratory distress, such as tachypnea, retractions, and crackles.
Presence of periorbital edema is not a parameter to monitor, but a sign of fluid overload.

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Free Nursing Study Resources

Correct Answer is C

Explanation

A. Riding the bicycle against the flow of traffic increases the risk of collisions with oncoming vehicles. Children should ride with the flow of traffic to be more predictable and visible to drivers.
B. Keeping the bicycle at least 3 feet from the curb while riding in the street is a good safety practice to prevent collisions with parked cars or opening car doors.
C. Walking the bicycle through intersections allows the child to safely navigate intersections as pedestrians, reducing the risk of accidents with vehicles.
D. The height of the child's feet when seated on the bicycle is not directly related to safety at intersections. However, it is important for the child to be able to touch the ground with their feet while seated to maintain balance and control while stopping and starting.

A. "You should cut and file your child's fingernails frequently." B. "You should use a mild detergent for your child's laundry." C. "You should apply a thick layer of pimecrolimus cream to your child's lesions." D. "Your child will experience occasional flare-ups of this condition." E. "Your child's condition is contagious when lesions are present." F. "You can apply gloves to your child's hands." G. "You should apply emollients to your child's skin after bathing.

Correct Answer is ["A","B","D","F","G"]

Explanation

A. Cutting and filing the child's fingernails frequently can help prevent excessive scratching and further damage to the skin.
B. Using a mild detergent reduces the risk of skin irritation and exacerbation of atopic dermatitis.
C. Pimecrolimus cream should be applied thinly, not in a thick layer, to the affected areas to avoid potential side effects.
D. Atopic dermatitis tends to have periodic flare-ups, so it's important to inform the guardian about this aspect of the condition.
E. Atopic dermatitis itself is not contagious, although the child may be prone to skin infections if lesions are present.
F. Applying gloves to the child's hands can prevent scratching and further skin damage.

G. Emollients help to moisturize the skin and improve its barrier function, which is important in managing atopic dermatitis.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching the parent of a school-age child about bicycle safety. Which of the following instructions should the nurse include in the teaching?

Correct Answer is C

Explanation

A nurse in the emergency department is preparing to discharge a 3-year-old child. Exhibits Which of the following statements should the nurse plan to include in the discharge instructions for the child’s guardian? Select all that apply.

Correct Answer is ["A","B","D","F","G"]

Explanation

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