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A child has undergone a tonsillectomy, and a nurse is providing postoperative care. What is an important nursing intervention?
- A. Encouraging deep breathing exercises
- B. Encouraging the child to eat
- C. Administering antibiotics
- D. Applying ice to the throat
Correct Answer: C
Rationale: Administering antibiotics is a crucial nursing intervention after a tonsillectomy because it helps prevent infections, which are a common postoperative complication. Encouraging deep breathing exercises (Choice A) is also important for promoting lung expansion and preventing respiratory complications. Encouraging the child to eat (Choice B) may not be appropriate immediately after a tonsillectomy due to the risk of throat irritation and discomfort. Applying ice to the throat (Choice D) is generally not recommended post-tonsillectomy as it may cause vasoconstriction and hinder the healing process.
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A 2-year-old child is admitted to the hospital with a diagnosis of Kawasaki disease. What is the primary goal of therapy during the acute phase?
- A. Preventing coronary artery aneurysms
- B. Reducing fever
- C. Improving cardiac function
- D. Preventing dehydration
Correct Answer: A
Rationale: The primary goal of therapy during the acute phase of Kawasaki disease is to prevent coronary artery aneurysms. Kawasaki disease is characterized by systemic vasculitis and the most serious complication is the development of coronary artery aneurysms. While reducing fever and improving cardiac function are important aspects of managing Kawasaki disease, the primary focus in the acute phase is to prevent the development of coronary artery aneurysms. Preventing dehydration is also essential but not the primary goal in managing Kawasaki disease.
A child who had surgery for a congenital heart defect is being discharged. What is an important aspect of the discharge teaching?
- A. Teaching the parents about signs of infection
- B. Providing instructions on wound care
- C. Scheduling follow-up appointments
- D. Explaining the use of prescribed medications
Correct Answer: D
Rationale: Explaining the use of prescribed medications is crucial as it helps ensure the proper management of the child's condition post-discharge. Understanding how and when to administer medications is essential for the child's recovery. While teaching the parents about signs of infection, providing wound care instructions, and scheduling follow-up appointments are also important aspects of care, ensuring the correct use of prescribed medications takes precedence to prevent complications and promote the child's well-being.
When teaching a class of new parents about positioning their infants during the first few weeks of life, which position is safest?
- A. On the back, lying flat
- B. On either side, lying flat
- C. Head slightly elevated on the left side
- D. Head slightly elevated on the right side
Correct Answer: A
Rationale: The correct answer is A: 'On the back, lying flat'. Placing infants on their back to sleep is recommended to reduce the risk of sudden infant death syndrome (SIDS). This position helps ensure the baby's airway remains clear and reduces the likelihood of suffocation. Choices B, C, and D are not as safe as placing the infant on their back, as they may increase the risk of accidental suffocation or SIDS.
A child sitting on a chair in a playroom starts to have a tonic-clonic seizure with a clenched jaw. What is the nurse's best initial action?
- A. Attempt to open the jaw.
- B. Place the child on the floor.
- C. Call out for assistance from staff.
- D. Place a pillow under the child's head.
Correct Answer: B
Rationale: The best initial action during a tonic-clonic seizure is to place the child on the floor. This action helps prevent injury by providing a safe environment and allows for better management of the seizure episode. Attempting to open the jaw is not recommended as it may cause harm to the child or the nurse. Calling out for assistance is important but should not delay ensuring the child's safety first. Placing a pillow under the child's head is not advisable during a seizure as it can pose a risk of suffocation or choking.
A major developmental milestone of a toddler is the achievement of autonomy. What should the parents do to enhance their toddler's need for autonomy?
- A. Teach the child to share with others.
- B. Help the child learn society's roles.
- C. Teach the child to accept external limits.
- D. Help the child develop internal controls.
Correct Answer: D
Rationale: Toddlers striving for autonomy need to develop internal controls to foster their independence. Teaching the child to share (Choice A) focuses more on social skills rather than autonomy. Helping the child learn society's roles (Choice B) is important but not directly related to enhancing autonomy. Teaching the child to accept external limits (Choice C) is contrary to promoting autonomy as it emphasizes conformity to external rules rather than internal self-regulation.