The caregiver of an infant keeps removing the pulse oximetry sensor claiming it’s too tight on the baby. Which response should the nurse prioritize in addressing this situation?

Place the probe of the oximeter on the child’s chest and secure it with tape.

Explain that pulse oximetry is done to detect respiratory retractions.

Explain that pulse oximetry measures the oxygen saturation of arterial hemoglobin.

Ensure the oximeter probe site is checked every 8 hours for possible reactions.

Answer and Explanation

The Correct Answer is C

Choice A reason: Placing the probe on the chest is not a standard pulse oximetry site and yields inaccurate readings. Explaining the device’s purpose addresses the caregiver’s concern, making this ineffective and incorrect compared to educating about the sensor’s role in monitoring the infant’s oxygen levels.

Choice B reason: Pulse oximetry measures oxygen saturation, not respiratory retractions, which are observed visually. Explaining its true purpose reassures the caregiver, making this inaccurate and incorrect compared to clarifying the device’s function to address concerns about the sensor’s use on the infant.

Choice C reason: Explaining that pulse oximetry measures oxygen saturation clarifies its importance, reassuring the caregiver about its necessity and addressing tightness concerns. This aligns with pediatric nursing education principles, making it the prioritized response to ensure compliance with monitoring the infant’s respiratory status.

Choice D reason: Checking the probe site every 8 hours prevents skin issues but doesn’t address the caregiver’s concern about tightness. Explaining the device’s purpose promotes understanding, making this secondary and incorrect compared to educating to maintain the sensor’s use on the infant.

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Correct Answer is C

Explanation

Choice A reason: Having the nurse do everything may disrupt the toddler’s trust in parents, hindering adaptation. Following home routines provides familiarity, making this counterproductive and incorrect compared to maintaining continuity to ease the toddler’s transition from home to the hospital environment.

Choice B reason: Telling a toddler expectations assumes cognitive understanding beyond their developmental stage, potentially increasing anxiety. Home routines offer comfort, making this less effective and incorrect compared to the nurse’s focus on familiarity to support the toddler’s hospital adaptation process.

Choice C reason: Following home routines maintains familiarity, reducing stress and aiding a toddler’s adaptation to the hospital. This aligns with pediatric psychosocial care principles, making it the most beneficial action for the nurse to implement to ease the toddler’s transition from home to hospital.

Choice D reason: Allowing a toddler to dictate actions disregards necessary medical routines, potentially compromising care and safety. Home routines provide structure, making this impractical and incorrect compared to the nurse’s role in maintaining familiarity to support the toddler’s hospital adaptation.

A. "Set a good example. Wear your own seat belt every time you drive." B. "Reward the child with candy or some other treat each time the child keeps the seat belt on." C. "Stop the car any time the preschooler unbuckles the restraints." D. "Explain that wearing a seat belt is a law and the police officer will give a ticket if the seat belt is not buckled."

Correct Answer is A

Explanation

Choice A reason: Setting a good example by always wearing a seat belt models safe behavior, which children are likely to emulate. This prioritizes consistent safety habits, aligning with pediatric safety education principles, making it the most effective instruction for promoting car safety in families during a health fair presentation.

Choice B reason: Rewarding with candy for seat belt use may encourage compliance but risks unhealthy eating habits and extrinsic motivation. Modeling seat belt use fosters intrinsic safety habits, making this less effective and incorrect compared to the nurse’s priority of setting a consistent example for car safety.

Choice C reason: Stopping the car for unbuckled restraints addresses behavior but may be impractical and unsafe on busy roads. Modeling seat belt use prevents issues by reinforcing norms, making this reactive approach less prioritized and incorrect for the primary car safety instruction in a family setting.

Choice D reason: Explaining seat belt laws may inform but is less effective for young children who respond better to role modeling than legal consequences. Parental example drives behavior, making this less impactful and incorrect compared to prioritizing consistent seat belt use by adults in the family.

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The caregiver of an infant keeps removing the pulse oximetry sensor claiming it’s too tight on the baby. Which response should the nurse prioritize in addressing this situation?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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