The caregiver of a 2-year-old calls the clinic concerned that her child may have pushed paper into her ears, and she asks the nurse what to do. The mother found the child pushing on her ears with torn paper on the floor in front of her. What would be the appropriate response by the nurse?
“Sterilize a pair of narrow tweezers. While someone else holds the child’s head still, carefully insert the tweezers and remove the paper if there is any.”
“Wait for a day or two to see if the child’s ears seem irritated. If they do, bring her in.”
“The child should be seen by a care provider. Don’t put anything in her ear and bring her in right away.”
“Wash her ear out using warm water and an ear syringe then the paper will flush out with the water.”
The Correct Answer is C
Choice A reason: Using tweezers risks ear canal injury or pushing paper deeper in a 2-year-old, potentially causing trauma. Professional evaluation ensures safe removal, making this dangerous and incorrect compared to advising immediate medical attention to address the potential foreign object in the child’s ear safely.
Choice B reason: Delaying care for irritation risks complications like infection or eardrum damage from a foreign object in a 2-year-old. Immediate provider assessment is safer, making this inadequate and incorrect compared to prioritizing prompt medical evaluation for the child’s potential ear issue.
Choice C reason: Immediate care provider evaluation ensures safe removal of any paper, preventing ear damage or infection in a 2-year-old. Advising against inserting objects protects the child, aligning with pediatric safety protocols, making this the correct response to address the caregiver’s concern effectively.
Choice D reason: Washing the ear with a syringe may push paper deeper or injure a 2-year-old’s delicate ear canal. Professional intervention is needed, making this risky and incorrect compared to seeking immediate medical evaluation to safely address the potential foreign object in the child’s ear.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Scoliosis screening is typically prioritized in older children (10-14 years), as curvature often appears during puberty. Vision and hearing screenings are critical for 6-8-year-olds to support learning, making this less urgent and incorrect for the prioritized screening in this elementary school age group.
Choice B reason: Vision and hearing screenings are critical for 6-8-year-olds, as deficits can impair academic performance and development. Early detection ensures timely intervention, aligning with pediatric school health guidelines, making this the prioritized screening for elementary students to support their educational and health needs.
Choice C reason: Assessing nutritional needs is important but less standardized as a routine screening compared to vision and hearing, which directly impact learning. These screenings take precedence, making this less critical and incorrect for the nurse’s priority in routine health checks for 6-8-year-olds.
Choice D reason: Reviewing immunization records ensures compliance but is administrative, not a health screening like vision and hearing, which detect active issues. These screenings are more urgent, making this incorrect compared to prioritizing assessments that directly affect the health of 6-8-year-old students.
Correct Answer is A
Explanation
Choice A reason: Burn fluid replacement follows the Parkland formula, with half the total volume (24 ounces = 12 ounces) given in the first 8 hours. From 10:00 AM to 6:00 PM (8 hours), the child receives 12 ounces, aligning with pediatric burn care protocols, making this the correct choice.
Choice B reason: By 4:00 PM (6 hours), the child receives less than half the 24 ounces, as half (12 ounces) is given over 8 hours. The 12-ounce mark is reached by 6:00 PM, making this incorrect, as it overestimates fluid delivery in the shorter timeframe for burn treatment.
Choice C reason: 18 ounces by 4:00 PM (6 hours) exceeds the standard rate, as only half (12 ounces) of 24 ounces is given in 8 hours. The correct amount is 12 ounces by 6:00 PM, making this incorrect for burn fluid replacement timing in the pediatric patient’s treatment.
Choice D reason: 18 ounces by 6:00 PM (8 hours) is incorrect, as only half the total (12 ounces) is administered in the first 8 hours per burn protocols. The correct volume is 12 ounces, making this incorrect for the standard fluid replacement schedule in pediatric burn care.
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