The mother of a 4-year-old boy who has been hospitalized multiple times asks the nurse how she can help her other children who are asking about their brother. To help the siblings cope with their brother's illness, which suggestion is best for the nurse to provide this mother?
Provide opportunities for the grandparents to visit the children at home.
Encourage the children to make small gifts and mementos for their brother.
Tell the children stories using a scrapbook with pictures of their brother.
Prepare the children for any changes in their brother before visiting in the hospital.
The Correct Answer is D
Choice A rationale
While grandparent support is valuable, it doesn't directly address the siblings' need to understand their brother's specific illness and hospitalization. The siblings require accurate, age-appropriate information about their brother's condition to reduce fear and anxiety, which external family visits do not provide. The focus should be on direct communication about the changes their brother is experiencing.
Choice B rationale
Making gifts can be a positive coping mechanism, but it does not address the underlying need for factual information. Without understanding what is happening to their brother, the siblings may still experience anxiety, confusion, or fear. The primary need is for clear, honest communication to help them process the situation effectively.
Choice C rationale
Using a scrapbook can be a helpful tool for reminiscence, but it might not adequately prepare children for the immediate and potentially frightening changes they will observe during a hospital visit. The primary goal is to manage expectations and provide accurate information about the brother's current state to prevent distress.
Choice D rationale
Preparing siblings for changes in their brother, such as different appearances or equipment, reduces fear and anxiety by providing a cognitive framework for what they will see. This anticipatory guidance allows them to mentally process the situation, normalizing the hospital environment and their brother's condition. This promotes emotional resilience and reduces potential trauma.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
A blood pressure of 130/70 mm Hg is within the normal range for a pregnant woman and does not indicate a hypertensive disorder. Normal blood pressure in pregnancy can fluctuate, but this reading is well below the threshold for preeclampsia or gestational hypertension, which is typically 140/90 mm Hg or higher.
Choice B rationale
Trace or 1+ proteinuria can be a normal finding in pregnancy and does not, in isolation, suggest a significant pathology. It is important to note that proteinuria, when part of a cluster of symptoms, is a diagnostic criterion for preeclampsia; however, a 1+ reading alone is often benign and may be related to factors like dehydration.
Choice C rationale
A temperature of 101.2° F (38.4° C) is a significant finding that indicates a fever, which can be a sign of infection. An infection in a pregnant woman, especially at term, can pose a risk to both the mother and the fetus and may necessitate immediate medical intervention, such as antibiotic therapy or a more extensive workup.
Choice D rationale
Mild pedal edema is a common and expected finding in the third trimester of pregnancy due to increased blood volume and pressure on the vena cava by the gravid uterus. This physiological change often leads to fluid retention in the lower extremities and is not typically a cause for concern unless it is severe, sudden, or accompanied by other signs of preeclampsia.
Correct Answer is B
Explanation
Choice A rationale
Chlamydia trachomatis is a sexually transmitted infection that can cause neonatal conjunctivitis and pneumonia if the newborn is exposed during vaginal delivery. However, if the infection was treated at least 7 days prior to delivery, the risk of transmission is significantly reduced, and a cesarean section is not indicated for this reason.
Choice B rationale
Active herpes simplex virus (HSV) lesions on the perineum present a significant risk of transmitting the virus to the neonate during vaginal delivery. Neonatal herpes is a serious, often fatal, condition. Therefore, a primary cesarean section is performed to prevent the newborn from coming into contact with the lesions.
Choice C rationale
A positive Western blot for HIV indicates the presence of the virus. A cesarean section is sometimes recommended to reduce the risk of perinatal HIV transmission, but a vaginal birth is not an absolute contraindication, especially if the client has a low viral load from effective antiretroviral therapy.
Choice D rationale
Group B Streptococcus (GBS) is a common bacterium that can colonize the vagina and rectum. It can cause serious infections in newborns. However, the standard of care is to administer intrapartum antibiotic prophylaxis to the mother, not to perform a cesarean section, to prevent transmission.
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