After diagnosis and initial treatment of a pre-school age child with cystic fibrosis, the nurse provides home care instructions to the parents. Which statement by the child's parents indicates that understanding of the home care treatment to promote pulmonary function?

"Chest physiotherapy should be performed twice a day before a meal.”

"Administer a cough suppressant every 8 hours."

"Energy should be conserved by scheduling minimally strenuous activities."

"Maintain supplemental oxygen at 4 to 6 L/minute."

Answer and Explanation

The Correct Answer is A

Rationale:
A. "Chest physiotherapy should be performed twice a day before a meal.” Chest physiotherapy helps clear mucus from the lungs and is most effective when done before meals to prevent vomiting and optimize lung function and oxygenation.

B. "Administer a cough suppressant every 8 hours." Cough suppressants are generally avoided in cystic fibrosis because coughing is necessary to mobilize and expel thick secretions from the airways.

C. "Energy should be conserved by scheduling minimally strenuous activities." Physical activity is encouraged to enhance lung expansion and mucus clearance. Energy conservation is not the priority unless the child is acutely ill.

D. "Maintain supplemental oxygen at 4 to 6 L/minute." High-flow oxygen is not routinely used and may suppress respiratory drive. Oxygen is used with caution and only as prescribed in advanced disease or during exacerbations.

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Correct Answer is ["D","E","G"]

Explanation

Rationale:

A. Indigestion: Although indigestion may mimic early symptoms of abdominal pathology, the client has not explicitly described heartburn or acid-related symptoms. It is a non-specific complaint and less concerning than the signs suggesting a vascular emergency.

B. Tiredness: Fatigue in older adults is often non-specific and may be related to underlying chronic conditions like atrial fibrillation or age-related decline. However, it is not as urgent or directly life-threatening as other findings suggesting vascular compromise.

C. Extremity pulse 2+: Pulses rated 2+ are considered normal and symmetric, indicating that peripheral perfusion is currently intact. This finding is stable and does not require immediate follow-up in the context of this clinical picture.

D. Pain level in abdomen and back: Severe, gnawing abdominal and back pain raises concern for a potentially rupturing or expanding abdominal aortic aneurysm (AAA). This symptom needs immediate evaluation due to the risk of hemodynamic collapse.

E. Pulsatile mass: A pulsatile abdominal mass is a hallmark sign of an AAA. When found on physical exam, especially with accompanying pain, it indicates a life-threatening condition that can lead to sudden rupture and requires emergency imaging and surgical consultation.

F. Liquid diarrhea: Although a change in bowel pattern may be relevant, the client reports that this is not unusual for him. Diarrhea is not immediately threatening in this context and is unlikely to be the primary cause of the abdominal symptoms.

G. Abdominal bruit: A bruit over a pulsatile abdominal mass indicates turbulent blood flow, further supporting suspicion of aortic aneurysm. This is a critical sign that suggests vascular pathology and requires urgent diagnostic confirmation and intervention.

A. Give the spouse a straw to help facilitate the client's drinking. B. Assist the spouse and carefully give the client small sips of water. C. Ask the spouse to stop and assess the client's swallowing reflex. D. Obtain thickening powder before providing any more fluids.

Correct Answer is C

Explanation

Rationale:

A. Give the spouse a straw to help facilitate the client's drinking: Using a straw can increase aspiration risk in clients with impaired swallowing or facial weakness. It promotes rapid fluid intake, bypassing normal protective reflexes.

B. Assist the spouse and carefully give the client small sips of water: Offering fluids before assessing swallowing can be dangerous. Clients with possible CVA and facial paralysis are at high risk for aspiration pneumonia due to impaired gag and swallow reflexes.

C. Ask the spouse to stop and assess the client's swallowing reflex: This is the safest and most appropriate action. A swallowing assessment helps determine aspiration risk before any oral intake is provided, especially in neurologically impaired clients.

D. Obtain thickening powder before providing any more fluids: Thickened fluids may help prevent aspiration, but they should not be used before confirming the client’s ability to safely swallow. A full assessment is the priority first step.

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After diagnosis and initial treatment of a pre-school age child with cystic fibrosis, the nurse provides home care instructions to the parents. Which statement by the child's parents indicates that understanding of the home care treatment to promote pulmonary function?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Exhibits The primary nurse reviews the client's history and vital signs. Select the 3 priority assessment findings that require immediate follow up.

Correct Answer is ["D","E","G"]

Explanation

Correct Answer is C

Explanation

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