A nurse is providing instructions to the parent of a 10-year-old child who has recently been diagnosed with type 1 diabetes mellitus (DM). The parent expresses a fear of needles and is unable to perform the procedure of administering subcutaneous insulin injections to the child.
What action should the nurse take?

Evaluate the parent’s ability to care for the child.

Determine if the child can administer the insulin.

Encourage the parent to handle the needles.

Inquire if there is another person who can assist with the injections.

Answer and Explanation

The Correct Answer is B

Choice A rationale
While it’s important to evaluate the parent’s ability to care for the child, this does not directly address the parent’s fear of needles. The parent’s fear of needles is a specific issue that needs to be addressed in order to ensure the child receives the necessary insulin injections.
Choice B rationale
Determining if the child can administer the insulin is a potential solution to the parent’s fear of needles. Some children as young as 10 years old may be able to administer their own insulin injections with proper training and supervision. This would allow the child to manage their diabetes independently and alleviate the parent’s fear of needles.
Choice C rationale
Encouraging the parent to handle the needles may not be effective if the parent has a significant fear of needles. It’s important to respect the parent’s fear and find alternative solutions, such as having the child administer the insulin or finding another person who can assist with the injections.
Choice D rationale
Inquiring if there is another person who can assist with the injections is a potential solution to the parent’s fear of needles. If there is another person available who is comfortable administering the insulin injections, this could alleviate the parent’s fear and ensure the child receives the necessary care.

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Correct Answer is C

Explanation

Choice A rationale
Administering oxygen via a facemask is an intervention that can be used if the baby shows signs of distress or if the decelerations do not improve with other interventions. However, it is not the first action that should be taken.
Choice B rationale
Turning off the oxytocin infusion could be an appropriate action if the mother is receiving oxytocin and the baby is showing signs of distress. However, it is not the first action that should be taken.
Choice C rationale
Changing the client’s position is the correct first action for variable decelerations. This can relieve potential cord compression and improve fetal oxygenation.
Choice D rationale
Assessing cervical dilation is an important part of monitoring labor progress, but it is not the first action that should be taken in response to variable decelerations.

A. Praise the client for her actions and offer to discuss ways to decrease consumption even more. B. Insist that the client stop all alcohol use and draw a blood alcohol level at each prenatal visit. C. Notify child protective services of the client’s illicit drug use and probable child endangerment. D. Refer the client to an outpatient alcohol abuse program for disulfiram therapy.

Correct Answer is A

Explanation

The correct answer is A. Praise the client for her actions and offer to discuss ways to decrease consumption even more.

Why? During pregnancy, any amount of alcohol poses a risk to the developing fetus, but abruptly shaming or forcing action may not be effective. The best approach is motivational interviewing, which involves acknowledging the client's reduction while encouraging further progress. A supportive conversation can help guide the client toward complete cessation of alcohol use.

Here’s why the other options are incorrect:

B. Insist that the client stop all alcohol use and draw a blood alcohol level at each prenatal visit – While alcohol cessation is the goal, forcing the client without a supportive approach can lead to resistance. Routine blood alcohol testing is not standard unless substance dependence is suspected.
C. Notify child protective services of the client’s illicit drug use and probable child endangerment – Alcohol is not classified as an illicit drug, and reporting at this stage would be premature unless clear evidence of abuse or harm to the fetus exists.
D. Refer the client to an outpatient alcohol abuse program for disulfiram therapy – Disulfiram (Antabuse) is not recommended in pregnancy, as it may cause adverse effects. Instead, behavioral counseling and support groups are preferred interventions.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A laboring client has a variable deceleration on the fetal monitor. What is the first action that the nurse should take?

Correct Answer is C

Explanation

A client at 9-weeks gestation informs the nurse that she has reduced her alcohol intake but still consumes at least one alcoholic drink every evening before bedtime. What action should the nurse take?

Correct Answer is A

Explanation

A woman is in the second stage of labor where the fetal head has just been born and the nurse observes the immediate retraction of the head against the perineum. What action should the nurse expect to perform to assist the healthcare provider?

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The nurse is providing information to a parent of a six-month old about vaccinations. Which statement made by the parent should the nurse recognize as understanding the information?

The nurse is reviewing the patient’s condition and vital signs following the placement of a 5% dextrose intravenous line. Which medications should the nurse anticipate the healthcare provider will order? Select all that apply.

A 3-year-old male was brought into the emergency room this morning with a sudden onset of “fast and noisy breathing”. What other symptoms is the nurse likely to note in a child diagnosed with epiglottitis?

The nurse is educating parents on how to prevent recurrent otitis media in their infant. What advice should the nurse give?

What other symptoms is the nurse likely to note in a child diagnosed with epiglottitis?

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