A nurse is providing teaching about home care to a parent of a 3-year-old child who has a fever. Which of the following instructions should the nurse include in the teaching?

Apply a light blanket if the child begins to shiver.

Wake the child every 4 hr during the night to drink 118.3 mL (4 oz) of apple juice.

Take the child's temperature every 10 min after administering acetaminophen.

Place ice packs on the child's armpits and groin.

Answer and Explanation

The Correct Answer is A

A. "Apply a light blanket if the child begins to shiver." Shivering can increase body temperature, so a light blanket can provide comfort while preventing excessive heat retention. Over-bundling should be avoided.

B. "Wake the child every 4 hr during the night to drink 118.3 mL (4 oz) of apple juice." Encouraging fluid intake is important, but waking a sleeping child is unnecessary unless there are concerns about dehydration. Instead, fluids should be offered frequently while the child is awake.

C. "Take the child's temperature every 10 min after administering acetaminophen." Checking the temperature this frequently is not necessary and could cause unnecessary stress for the child. Acetaminophen typically takes 30–60 minutes to take effect, so temperature checks should be spaced appropriately.

D. "Place ice packs on the child's armpits and groin." Using ice packs can cause shivering, which increases body temperature. Instead, cooling measures like a lukewarm sponge bath or removing excess clothing are preferred.

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Correct Answer is B

Explanation

A. "I wish I knew what I did to cause my child to be sick." This statement reflects self-blame and guilt, which are signs of poor coping.
B. "I saw on the internet that there's a new treatment option." This demonstrates hope and proactive coping, as the guardian is seeking information and exploring options.
C. "I don't want my family to know about my child's diagnosis." Avoiding support from family may indicate denial or isolation, which are maladaptive coping strategies.
D. "I am not sure how to care for my dying child." Expressing uncertainty about caregiving suggests distress and a need for additional support and education, rather than positive adjustment.

A. Obtain a blood culture. B. Request a referral for physical therapy. C. Administer IV antibiotics. D. Record intake and output.

Correct Answer is A

Explanation

A. Obtain a blood culture. The first action is to obtain a blood culture to identify the causative organism before starting antibiotic therapy. This ensures that the appropriate antibiotic is selected.
B. Request a referral for physical therapy. Physical therapy may be needed later, but it is not the priority during admission.
C. Administer IV antibiotics. Antibiotics should be given after obtaining a blood culture to avoid altering the test results.
D. Record intake and output. While monitoring fluid balance is important, it is not the priority action during admission.

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