The parents of a school-aged child newly diagnosed with asthma are receiving discharge education.
What information should the nurse emphasize to address the need for follow-up appointments?

The child with asthma will receive routine follow-up care during the annual check-up.

The illness trajectory of asthma indicates that the child will need to follow-up more than other chronic illnesses usually require.

Asthma is an illness that is unique because it requires close monitoring.

A child with a chronic illness needs regular care monitoring and follow-up and should work to develop a positive relationship with the health care team.

Answer and Explanation

The Correct Answer is D

Choice A rationale

Suggesting that a child with asthma only needs an annual check-up is scientifically incorrect and dangerous. Asthma is a chronic inflammatory airway disease characterized by variable airflow obstruction and bronchial hyperresponsiveness. It requires frequent assessment of symptom control, lung function via peak flow or spirometry, and adjustment of pharmacological therapy. Waiting a full year for follow-up can lead to poorly managed inflammation, increased exacerbations, and potential permanent airway remodeling. Regular monitoring is essential to adapt the treatment plan to environmental triggers.

Choice B rationale

While asthma does require frequent monitoring, stating that it requires more follow-up than all other chronic illnesses is a subjective and potentially inaccurate comparison. Chronic conditions like Type 1 Diabetes or Cystic Fibrosis also require intensive, frequent medical oversight. Focusing on a comparative trajectory might confuse the parents rather than highlighting the specific clinical needs of asthma management. The goal of education should be to emphasize the importance of the asthma action plan and regular evaluation of the child's respiratory status and inhaler technique.

Choice C rationale

Asserting that asthma is unique because it requires close monitoring is a vague statement that does not provide sufficient scientific rationale for the parents. Many chronic pediatric conditions require close monitoring to prevent complications. This choice fails to explain the necessity of the healthcare relationship or the specific goals of long-term asthma management. Parents need to understand that monitoring is required to keep the child in the "green zone" of their asthma action plan, minimizing the need for emergency department visits and oral corticosteroids.

Choice D rationale

This is the most appropriate information to emphasize because it fosters a comprehensive approach to chronic disease management. For a child with asthma, regular care monitoring allows the provider to assess the frequency of rescue inhaler use and nocturnal symptoms. Developing a positive relationship with the health care team ensures that the parents feel comfortable reporting changes in the child's condition and adhering to long-term controller medications. Continuous follow-up is necessary to achieve the clinical goal of maintaining normal activity levels and pulmonary function. .

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Correct Answer is B

Explanation

Choice A rationale

Macrosomia refers to excessive birth weight, typically defined as greater than 4000 grams or 4500 grams. While this is a very common complication of gestational diabetes due to fetal hyperinsulinemia in response to maternal hyperglycemia, it is not considered a congenital anomaly. It is an overgrowth of otherwise normal tissues occurring later in the pregnancy. Congenital anomalies are structural defects that occur during organogenesis in the first trimester, whereas macrosomia develops during the second and third trimesters.

Choice B rationale

Neural tube defects, such as spina bifida or anencephaly, are significant structural malformations that occur when the neural tube fails to close properly during early embryonic development. Hyperglycemia during the first trimester acts as a teratogen, disrupting the molecular pathways and gene expressions necessary for proper neural development. Mothers with pre-existing or early-onset gestational diabetes are at a significantly higher risk of having offspring with these specific defects if glucose levels are not tightly controlled.

Choice C rationale

Breech presentation occurs when the fetus is positioned buttocks or feet first in the birth canal rather than head first. This is a variation of fetal positioning and is not a congenital anomaly resulting from metabolic or teratogenic influences. While certain maternal factors or uterine shapes can influence fetal position, early first-trimester hyperglycemia does not have a known causal link to the physical orientation of the fetus at the time of delivery or late-term development.

Choice D rationale

A cesarean delivery is an operative procedure used to deliver a baby through incisions in the abdomen and uterus. It is a mode of delivery, not a congenital anomaly. While women with gestational diabetes have a higher rate of cesarean sections due to complications like macrosomia or fetal distress, the surgery itself is a medical intervention. It does not fall under the category of a structural birth defect caused by high glucose levels during the embryonic period.

A. A patient with a history of perineal laceration. B. A patient receiving oxytocin for induction of labor. C. A patient whose fetus is experiencing shoulder dystocia. D. A patient who had an episiotomy during a previous delivery. E. A patient who had an episiotomy during a previous delivery.

Correct Answer is C

Explanation

Choice A rationale

A history of perineal laceration does not automatically necessitate an episiotomy. In many cases, the perineal tissue may have healed with scar tissue that is less flexible, but the goal of modern midwifery and obstetrics is to allow the tissue to stretch naturally or tear spontaneously, which often results in less severe injury than a surgical incision. Routine episiotomy is no longer recommended based on history alone, as it increases the risk of deep extensions.

Choice B rationale

The use of oxytocin for induction is not an indication for an episiotomy. Oxytocin serves to stimulate uterine contractions and manage the progress of labor, but it does not dictate the need for surgical enlargement of the vaginal opening. The decision to perform an episiotomy is based on the immediate needs of the fetus or the integrity of the perineum during the crowning process, rather than the pharmacological method used to initiate or maintain the labor contractions.

Choice C rationale

Shoulder dystocia is a true obstetric emergency where the fetal head is delivered but the anterior shoulder becomes impacted behind the maternal symphysis pubis. An episiotomy may be performed to provide more room for the provider to perform internal maneuvers, such as the Woods' screw or Rubin maneuver. While the episiotomy does not bony obstruction, it increases the space available for the clinician's hands to rotate the fetus and relieve the impaction quickly.

Choice D rationale

Having an episiotomy during a previous delivery is not a clinical indication for a repeat procedure. Evidence suggests that routine repeat episiotomies contribute to long-term pelvic floor dysfunction and increased incidence of third and fourth-degree tears. Each labor is managed based on the current presentation of the perineum. The current standard of care emphasizes perineal massage and controlled delivery of the head to minimize the need for surgical incisions regardless of previous obstetric history.

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The parents of a school-aged child newly diagnosed with asthma are receiving discharge education. What information should the nurse emphasize to address the need for follow-up appointments?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A pregnant client at 10 weeks gestation has been diagnosed with Gestational diabetes. The nurse is discussing the risks of congenital anomalies due to hyperglycemia during the first trimester. Which congenital anomalies should the nurse include in the discussion? Select all that apply.

Correct Answer is B

Explanation

A nurse is assisting with a vaginal delivery in the second stage of labor. Which client finding would cause the nurse to anticipate the provider performing an episiotomy?

Correct Answer is C

Explanation

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The parents of a school-aged child newly diagnosed with asthma are receiving discharge education.
What information should the nurse emphasize to address the need for follow-up appointments?