Exhibits

A nurse is caring for a child who is 2 hr postoperative. Which of the following actions should the nurse take first? (Click the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.)

Assess the child's pain level.

Recheck the child's temperature.

Determine the child's sedation level.

Compare the child's pedal pulses.

Answer and Explanation

The Correct Answer is D

A.   While assessing pain level is important, ensuring adequate perfusion and circulation takes precedence.
B.   Rechecking the child's temperature may be necessary but is not as immediately critical as assessing pedal pulses.
C.   Determining the child's sedation level is important for monitoring postoperative status but is not the priority at this time.
D.   Assessing the child's pedal pulses is crucial following a motor-vehicle crash and surgical procedures involving the lower extremities. It helps to evaluate the perfusion and circulation to the extremities, especially after a leg open reduction and fixation surgery.

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Correct Answer is A

Explanation

A. The nurse should weigh the child once per day, preferably in the morning and using the same scale and clothing, to monitor fluid status and response to treatment. Weight is the most accurate indicator of fluid balance in children with nephrotic syndrome.
B. Positioning the child supine at bedtime is not specifically indicated for the acute stage of nephrotic syndrome. This can worsen edema and respiratory distress.
C. Limiting calorie intake to 45 cal/kg/day is too low and can cause malnutrition and growth failure. The nurse should provide a high-calorie, high-protein, low-sodium diet to meet the child's nutritional needs and prevent muscle wasting.
D. Increasing fluid intake to 2 L/day is contraindicated in a child with nephrotic syndrome, as it can exacerbate edema and fluid overload. The nurse should restrict fluid intake according to the provider's orders and based on the child's weight and urine output.

A. Dietitian B. Occupatonal therapist C. Speech-language pathologist D. Physical therapist

Correct Answer is A

Explanation

A. A dietitian can provide essential guidance on appropriate nutrition and caloric intake, which is crucial for managing cystic fibrosis.
B. Occupational therapists focus on improving fine motor skills and daily living activities, which may not be the primary concern for a child with cystic fibrosis.
C. Speech-language pathologists primarily address speech and language disorders, which may not be directly related to cystic fibrosis.
D. Physical therapists focus on improving mobility and strength, which may be important but may not be the priority in the early management of cystic fibrosis.

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Exhibits A nurse is caring for a child who is 2 hr postoperative. Which of the following actions should the nurse take first? (Click the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.)

Nursing Test Bank

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Exhibits

A nurse is caring for a child who is 2 hr postoperative. Which of the following actions should the nurse take first? (Click the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.)