A nurse is preparing to collect a blood specimen from a preschooler. Which of the following actions should the nurse take?

Give the child a pacifier that has been dipped in an oral sucrose solution during the procedure.

Apply a eutectic mixture of local anesthetics cream to the intended puncture site 1 hr before the procedure.

Instruct the parent how to perform kangaroo care during the procedure.

Administer aspirin to the child 1 hr before the procedure.

Answer and Explanation

The Correct Answer is A

Choice A reason:

Using a pacifier dipped in an oral sucrose solution can help provide comfort and alleviate pain during the procedure, making it a suitable option for blood specimen collection in preschoolers.

Choice B reason:

Applying a eutectic mixture of local anesthetics cream may not be the most appropriate option for blood specimen collection in preschoolers, as it may not provide sufficient pain relief for the procedure.

Choice C reason:

Kangaroo care involves skin-to-skin contact between an infant and a parent, which is beneficial for bonding and comfort but may not be directly applicable to a blood specimen collection procedure.

Choice D reason:

Placing the infant in a prone position for sleeping is not related to blood specimen collection and may not be appropriate immediately postoperatively.

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Correct Answer is A

Explanation

Choice A reason:

Frequent urination is a common symptom of urinary tract infections. It helps to flush out bacteria from the urinary tract.

Choice B reason:

Wiping from back to front can introduce bacteria from the anal area to the urethra, increasing the risk of urinary tract infections. The correct technique is to wipe from front to back

Choice C reason:

Nylon underwear can trap moisture, creating an environment conducive to bacterial growth. Cotton underwear is recommended for better air circulation.

Choice D reason:

Testing urine for ketones is not directly related to preventing urinary tract infections. Ketone testing is more relevant for individuals with diabetes to monitor for ketoacidosis.

A. Suction the client's airway every 2 hr. B. Maintain the client's head of the bed at 30°. C. Keep the client's room well lit. D. Check the client's temperature every 8 hr.

Correct Answer is B

Explanation

A: Suctioning the client's airway every 2 hours is not indicated based on the provided information. The adolescent does not have a condition that compromises airway clearance, and routine suctioning can cause trauma or stimulate a vagal response, potentially leading to bradycardia.

B: Maintaining the client's head of the bed at 30° is appropriate for reducing intracranial pressure and facilitating venous drainage. The patient's symptoms of nuchal rigidity and severe headache suggest increased intracranial pressure, possibly due to meningitis, which is supported by the diagnostic results.

C: Keeping the client's room well lit is not advisable as the patient reports photophobia, which is a sensitivity to light. A well-lit room could exacerbate discomfort and pain.

D: Checking the client's temperature every 8 hours is important but not the priority intervention. The patient's condition requires more frequent monitoring due to the positive blood culture and sensitivity, indicating an active infection. More frequent temperature checks would be warranted.

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A nurse is preparing to collect a blood specimen from a preschooler. Which of the following actions should the nurse take?

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Naxlex Comprehensive Predictor Exams

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