A nurse is caring for a preschooler who is in an acute care facility. Which of the following actions should the nurse take?

Establish a new routine for the child to follow while in the facility.

Use medical terminology when discussing procedures with the child.

Encourage the child to play with toys such as a pounding board.

Perform the morning assessments when the parent is not in the room.

Answer and Explanation

The Correct Answer is C

A. Establish a new routine for the child to follow while in the facility. This is incorrect because preschoolers find comfort in familiar routines. Maintaining their usual routines as much as possible helps reduce anxiety.
B. Use medical terminology when discussing procedures with the child. This is incorrect because preschoolers have a limited understanding of medical terms. Using simple, age-appropriate language helps them better comprehend what is happening.
C. Encourage the child to play with toys such as a pounding board. This is correct because preschoolers benefit from play to express emotions and relieve stress. Toys like a pounding board allow them to release frustration in a safe and developmentally appropriate way.
D. Perform the morning assessments when the parent is not in the room. This is incorrect because having a parent present provides comfort and security, which can help the child remain calm during assessments.

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Correct Answer is A

Explanation

A. Small clots with tissue in the urine. It is expected for a client 2 days post-TURP to have small clots and tissue debris in the urine as part of the healing process. Continuous bladder irrigation (CBI) often helps clear these.

B. Dark red urine. Bright red or dark red urine can indicate active bleeding, which is not expected 2 days post-op and requires immediate intervention.

C. Urinary output 25 mL/hr. This is too low (normal output should be at least 30 mL/hr) and could indicate catheter blockage, dehydration, or renal impairment, which is not expected.

D. Pain of 8 on a scale of 0 to 10. Mild discomfort is expected, but severe pain (8/10) is abnormal and could indicate bladder spasms, catheter blockage, or another complication requiring intervention.

A. Ask the child to complete homework in an area with minimal distractions. B. Have the child write assignments by hand instead of using a computer. C. Vary the child's scheduled activities each day. D. Encourage the child to read a book during an outdoor school activity period.

Correct Answer is A

Explanation

A. Minimizing distractions helps children with ADHD focus better and improves concentration.
B. Writing by hand does not necessarily enhance concentration and may actually increase frustration for some children with ADHD.
C. A structured and predictable routine is beneficial for children with ADHD, so varying activities daily may be counterproductive.
D. Encouraging a child to read during an outdoor activity period may limit needed physical movement, which can help manage ADHD symptoms.

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A nurse is caring for a preschooler who is in an acute care facility. Which of the following actions should the nurse take?

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