A6-week-old infant with pyloric stenosis is scheduled for a pyloromyotomy, Which pre- operative nursing action has highest priority?
Mark an outline of the "olive-shaped mass in the right epigastric area
Initiate a continuous infusion of IV Fluids per prescription.
Monitor amount of intake and infant's response to feedings.
Instruct parents regarding care of the incisional area.
The Correct Answer is B
A. Marking an outline of the "olive-shaped mass" in the right epigastric area is important for diagnosis, but not a priority pre-operatively.
B. Initiating a continuous infusion of IV fluids is crucial to ensure the infant is properly hydrated before the procedure, as pyloric stenosis can cause severe dehydration.
C. Monitoring the amount of intake and the infant's response to feedings is part of ongoing care, but immediate pre-operative hydration takes precedence.
D. Instructing parents regarding care of the incisional area is necessary post-operatively, not before the surgery.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Reposition the infant every 2 hours: This ensures that all areas of the infant's skin receive equal exposure to the phototherapy light, which is important for the effective treatment of jaundice.
B. Cover with a receiving blanket: This is incorrect because the phototherapy light needs to reach the infant's skin directly. Covering the infant with a blanket would block the light and reduce the effectiveness of the treatment.
C. Perform diaper changes under the light: While it is important to minimize the time the infant is away from the phototherapy light, diaper changes should be done quickly and efficiently, not necessarily under the light, to ensure cleanliness and to prevent any potential discomfort or safety issues.
D. Feed the infant every 4 hours: Feeding the infant is important, but the frequency of feeding should be based on the infant's needs and not specifically tied to the phototherapy schedule. Additionally, frequent feeding can help promote bowel movements, which can aid in the excretion of bilirubin.
Correct Answer is ["A","B","C","E"]
Explanation
A. It is important to add the egg allergy to the client's identification arm band to alert all healthcare providers of the allergy, ensuring the safety of the client by preventing accidental exposure.
B. Asking the client to describe her reactions can help the healthcare team understand the severity of the allergies and tailor care appropriately.
C. Entering the new allergy information into the client's electronic medical record is crucial for maintaining an up-to-date health record and ensuring that all team members are aware of the allergies.
D. Eliminating chicken from the client's menu is not necessary unless the client has specifically stated an allergy to chicken. Lactose intolerance and egg allergy do not automatically imply a chicken allergy.
E. Notifying the dietary department of the client's egg intolerance is essential to prevent the inclusion of eggs in the client's meals, which could lead to an allergic reaction.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.