This is a 3-year-old with a history of ventricular septal defect. He was born vaginally at 35 weeks and was in the neonatal intensive care unit (NICU) for 3 weeks due to poor feeding. He lives with his parents and an older sibling, who has no medical conditions. The client is here for a follow-up visit. The nurse educates the parents on post-discharge care for the child.
What should the nurse include in post-discharge care education? Select all that apply.
Keep a pressure dressing on the site for one week
The child may take ibuprofen for pain
Alert the physician if the site bleeds or swells
Give only clear liquids for several days
Avoid any kind of bath or shower
Monitor for fever
Correct Answer : C,F
In post-discharge care education for a 3-year-old with a history of ventricular septal defect, the nurse should include the following:
C. Alert the physician if the site bleeds or swells: This is important because it may indicate complications or issues related to the ventricular septal defect.
F. Monitor for fever: Fever can be a sign of infection or other concerns, so it's important to monitor for any changes in the child's temperature.
The other options are not applicable or advisable for post-discharge care in this context:
A. Keeping a pressure dressing on the site for one week is not typically necessary for ventricular septal defect and may not be appropriate for a 3-year-old.
B. Giving ibuprofen for pain is not relevant in this context, as pain management for ventricular septal defect is not typically managed with ibuprofen.
D. Giving only clear liquids for several days is not indicated for ventricular septal defect or post-discharge care.
E. Avoiding any kind of bath or shower is not a standard practice for post-discharge care for a child with a ventricular septal defect.
The focus should be on monitoring for signs of complications, such as bleeding, swelling, or fever, and seeking medical attention when necessary.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Discontinue the ointment once drainage resolves.The ophthalmic antiinfective ointment should be used for the full prescribed duration, even if symptoms improve, to ensure the infection is completely treated and to prevent recurrence or resistance.
B. Remove secretions by wiping toward the opposite eye.Secretions should be removed by wiping away from the eye, from the inner canthus (near the nose) outward, to prevent spreading infection to the unaffected eye.
C. Use a disposable moist wipe to remove eye crusts.While it is important to keep the eye clean, the primary discharge instruction in this context should focus on the expected side effect of blurry vision.
D. Prepare child for blurry vision after ointment application:Ophthalmic antiinfective ointments can cause temporary blurry vision due to their consistency. Caregivers should be informed about this expected effect and reassured that it is temporary. This helps manage expectations and ensures adherence to the treatment plan.
Correct Answer is ["A","D","E","F"]
Explanation
A. Edema can be a symptom to watch for, as it may indicate fluid retention or imbalance, especially in a client who has received intravenous fluids.
D. Dry skin may be a symptom to observe, as it could suggest dehydration or fluid imbalances.
E. Intense thirst is a symptom to be alert for, as it may be an indication of dehydration or an electrolyte imbalance.
F. Muscle weakness is a potential symptom to monitor for, as it could be related to electrolyte imbalances or other complications following surgery and injury.
B, C, and G are not the primary symptoms to expect based on the client's information and history, but they should still be monitored as part of routine assessment. Irritability and fatigue can be nonspecific symptoms that may occur in various clinical situations. Hypertension may or may not be a symptom, and it is essential to assess the client's blood pressure in the context of their overall condition.
The client's history and the presence of medical devices and surgical intervention indicate the need for close monitoring of fluid balance and electrolyte status.
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