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A pediatrician has evaluated the child and has written new prescriptions.

The nurse is preparing to assist with a lumbar puncture. Which of the following actions should the nurse take? Select all that apply.

Apply pressure to the puncture site following the procedure.

Limit the child's fluid intake following the procedure.

Position the child in a prone position during the procedure.

Ensure the guardian has signed the consent form prior to the procedure.

Ensure the child voids prior to the procedure.

Insert an indwelling urinary catheter during the procedure.

Monitor for paresthesia and tingling in extremities following the procedure.

Answer and Explanation

Correct Answer : A,D,E,G

A. Apply pressure to the puncture site following the procedure. Applying pressure helps prevent cerebrospinal fluid (CSF) leakage and reduces the risk of complications.

B. Limit the child's fluid intake following the procedure. Fluids should be encouraged to help replenish lost CSF and reduce the risk of post-lumbar puncture headache.

C. Position the child in a prone position during the procedure. The correct positioning for a lumbar puncture is the side-lying fetal position or sitting with the back curved forward to widen the space between the vertebrae.

D. Ensure the guardian has signed the consent form prior to the procedure. A lumbar puncture is an invasive procedure, so informed consent is required before proceeding.

E. Ensure the child voids prior to the procedure. Having the child empty their bladder before the procedure helps prevent discomfort and reduces the risk of bladder distention during positioning.

F. Insert an indwelling urinary catheter during the procedure. A urinary catheter is not necessary for a lumbar puncture unless there is another medical indication.

G. Monitor for paresthesia and tingling in extremities following the procedure. Paresthesia or tingling could indicate nerve irritation or injury, which requires prompt assessment and intervention.

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Correct Answer is ["A","B","D","F","H"]

Explanation

A. Neurologic assessment. Neurologic changes can indicate worsening infection, sepsis, or other serious conditions, requiring immediate follow-up.

B. Hemoglobin. The child's hemoglobin level (9.5 g/dL) is below the normal range (10 to 15.5 g/dL), indicating anemia, which requires monitoring and possible intervention.

C. Peripheral pulses. There is no indication of circulatory compromise or perfusion issues in the given data.

D. WBC. The elevated WBC count (14,000 mm³) suggests an active infection or inflammation, which requires immediate follow-up.

E. Glucose. The glucose level (90 mg/dL) is within normal limits and does not require immediate attention.

F. Abdominal assessment. If the child has an infection, especially a serious bacterial infection, monitoring for abdominal distension, tenderness, or signs of peritonitis is crucial.

G. Pain assessment. While pain assessment is always important, it does not require immediate follow-up unless there are specific pain-related concerns in the provided data.

H. Temperature. Fever is a key sign of infection. Monitoring the child’s temperature is crucial in identifying worsening infection or sepsis.

A. Redcurrant, jelly-like stools B. Increased hemoglobin level C. Pale, oily stools D. Hematemesis

Correct Answer is C

Explanation

A. Redcurrant, jelly-like stools. This is more characteristic of intussusception, a different gastrointestinal condition, rather than celiac disease.

B. Increased hemoglobin level. Celiac disease often leads to malabsorption, which can cause iron-deficiency anemia, leading to a decreased hemoglobin level, not an increased one.

C. Pale, oily stools. Children with celiac disease have difficulty absorbing fats, leading to steatorrhea (pale, oily stools). This is a classic sign of malabsorption in celiac disease.

D. Hematemesis. Hematemesis (vomiting blood) is not a typical sign of celiac disease. It may indicate a different GI issue, such as gastric bleeding.

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A pediatrician has evaluated the child and has written new prescriptions. The nurse is preparing to assist with a lumbar puncture. Which of the following actions should the nurse take? Select all that apply.

Nursing Test Bank

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A pediatrician has evaluated the child and has written new prescriptions.

The nurse is preparing to assist with a lumbar puncture. Which of the following actions should the nurse take? Select all that apply.