A nurse is preparing to teach the parents of a child who has cystic fibrosis. Which of the following instructions should the nurse plan to include?

Trim the fat from red meat prior to cooking.

Give the child hot foods to reduce the sense of fullness.

Administer pancreatic enzymes 30 min after meals.

Provide a diet high in protein and calories.

Answer and Explanation

The Correct Answer is D

A. Trim the fat from red meat prior to cooking: Children with cystic fibrosis (CF) require a high-calorie, high-fat diet due to malabsorption from pancreatic insufficiency. Trimming fat would reduce caloric intake and fat-soluble vitamin absorption, which is contraindicated in CF nutritional management.

B. Give the child hot foods to reduce the sense of fullness: Food temperature does not significantly affect satiety or nutrient absorption in CF. The focus should be on calorie density and nutrient content rather than temperature, as energy needs are significantly increased in these children.

C. Administer pancreatic enzymes 30 min after meals: Pancreatic enzyme replacement therapy should be given with meals or immediately before eating to optimize digestion of fats, proteins, and carbohydrates. Administering enzymes after meals would reduce nutrient absorption and worsen malnutrition.

D. Provide a diet high in protein and calories: Children with CF have increased metabolic demands and impaired nutrient absorption, making a high-calorie, high-protein diet essential to support growth, maintain weight, and compensate for malabsorption.

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Correct Answer is A

Explanation

A. Prime the tubing with 0.9% sodium chloride: Blood products must be administered with 0.9% sodium chloride to prevent hemolysis. Priming the tubing with saline ensures compatibility and maintains patency, allowing safe and effective transfusion without compromising the integrity of red blood cells.

B. Attach a single-line administration set: Blood transfusions require a specialized Y-type or filtered tubing to reduce the risk of clots, debris, and air embolism. Using a single-line set without a filter could allow microaggregates to enter the circulation.

C. Use tubing that does not have a filter in the drip chamber: A filter is essential for removing clots, debris, and cellular aggregates from the blood product. Administering blood without a filter increases the risk of complications such as emboli and febrile reactions.

D. Use an IV catheter that is at least 24-gauge: A 24-gauge catheter is too small for safe transfusion of blood products. A larger-bore catheter, typically 18–20 gauge, is recommended to allow adequate flow and prevent hemolysis or catheter rupture during transfusion.

A. Use a 15° angle for the injection. B. Roll the syringe gently to ensure mixture of the insulins. C. Draw up regular insulin prior to NPH insulin. D. Inject into the vastus lateralis.

Correct Answer is C

Explanation

A. Use a 15° angle for the injection: Subcutaneous insulin injections should be administered at a 90° angle for most adults and children with adequate subcutaneous tissue. A 15° angle is too shallow and may result in intradermal administration, affecting absorption.

B. Roll the syringe gently to ensure mixture of the insulins: Only the NPH insulin vial should be gently rolled between the hands to resuspend the cloudy insulin. Regular insulin is clear and should not be shaken, and the mixture occurs in the syringe after drawing up each insulin in the correct sequence.

C. Draw up regular insulin prior to NPH insulin: Drawing up regular (clear) insulin before NPH (cloudy) insulin prevents contamination of the short-acting insulin with intermediate-acting insulin, maintaining proper pharmacologic action and preventing altered onset or peak times.

D. Inject into the vastus lateralis: The preferred sites for subcutaneous insulin injections are the abdomen, upper arm, or anterior thigh. The vastus lateralis can be used in infants but is not the standard site for older children or adults.

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A nurse is preparing to teach the parents of a child who has cystic fibrosis. Which of the following instructions should the nurse plan to include?

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