A nurse is creating a plan of care for a toddler who is recovering following a routine surgical procedure. Which of the following interventions should the nurse include?

Encourage the toddler to use an incentive spirometer.

Place a cooling blanket on the toddler.

Administer IV dantrolene sodium to the toddler.

Administer aspirin to the toddler as needed for pain.

Answer and Explanation

The Correct Answer is A

A. This is the correct intervention. Encouraging the toddler to use an incentive spirometer helps promote lung expansion and prevent atelectasis (collapsed lung tissue), which is
important for postoperative respiratory function.

B. Placing a cooling blanket on the toddler is not a standard intervention following routine surgery. It's important to monitor the toddler's temperature and use appropriate measures if they experience hyperthermia.

C. Administering IV dantrolene sodium is used for the treatment of malignant hyperthermia, a rare but life-threatening reaction to certain medications used during anesthesia. It is not a routine postoperative intervention.

D. Aspirin is generally not recommended for pain relief in children due to the risk of Reye's syndrome. Other pain management options, such as acetaminophen or ibuprofen, are typically used for postoperative pain in children.

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Correct Answer is D

Explanation

A. Changing positions frequently may be distracting and confusing for the child. It is important to find a comfortable and quiet environment for communication.

B. Exaggerating the pronunciation of words may distort the natural flow of speech and make it more difficult for the child to understand. It is best to speak clearly and at a normal pace.

C. Using light touch when initiating conversation is not effective for a child with hearing loss, as they rely primarily on visual and auditory cues for communication.

D. This is the correct action. Maintaining a neutral facial expression allows the child to observe facial cues and expressions that are important for understanding non-verbal communication. It also helps create a comfortable and natural environment for conversation.

A. Assist the child into supine position. B. Obtain a throat culture. C. Initiate droplet isolation precautions. D. Check oxygen saturation every 4 hr.

Correct Answer is C

Explanation

A. Assisting the child into a supine position is contraindicated in acute epiglottitis. This can lead to airway obstruction. The child should be allowed to assume a position of comfort, which is typically sitting up and leaning forward.

B. While obtaining a throat culture may be indicated for diagnostic purposes, it is not the first priority in the care of a child with acute epiglottitis. The immediate concern is ensuring airway patency and providing appropriate respiratory support.

C. This is the correct action. Acute epiglottitis is a potentially life-threatening condition that can rapidly lead to airway obstruction. Initiating droplet isolation precautions helps protect healthcare providers and other patients from potential transmission of the causative organism (often Haemophilus influenzae type B).

D. Checking oxygen saturation every 4 hours is important for monitoring respiratory status, but in the case of acute epiglottitis, continuous monitoring of oxygen saturation is often necessary due to the risk of sudden airway obstruction. This action does not address the immediate priority of ensuring a patent airway.

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A nurse is creating a plan of care for a toddler who is recovering following a routine surgical procedure. Which of the following interventions should the nurse include?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

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