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A preschool child is scheduled for an echocardiogram. Parents ask the nurse whether they can hold the child during the procedure. The nurse should answer with which response?
- A. "You will be able to hold your child during the procedure."
- B. "Your child can be active during the procedure, but can't sit in your lap."
- C. "Your child must lie quietly; sometimes a mild sedative is administered before the procedure."
- D. "The procedure is invasive so your child will be restrained during the echocardiogram."
Correct Answer: A
Rationale: The correct response is that "You will be able to hold your child during the procedure." It is common for parents to be allowed to hold their child during an echocardiogram to provide comfort and reassurance. This can help the child stay calm and cooperative during the procedure. Holding the child can also create a familiar and secure environment, making it easier for the healthcare provider to perform the echocardiogram successfully.
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What is the best age for solid food to be introduced into the infant's diet?
- A. 2 to 3 months
- B. 4 to 6 months
- C. When birth weight has tripled
- D. When tooth eruption has started
Correct Answer: B
Rationale: The American Academy of Pediatrics recommends introducing solid foods into an infant's diet between 4 to 6 months of age. At this stage, most infants have developed the necessary motor skills to start eating solid foods, such as being able to sit up and hold their head steady. Additionally, their digestive system has matured enough to handle solid foods. Introducing solid foods too early, such as at 2 to 3 months (Option A), can increase the risk of digestive issues and allergies. Waiting for tooth eruption (Option D) is not a reliable indicator as some infants may begin teething earlier or later than others. Waiting for the birth weight to triple (Option C) is not necessary as infants can start on solid foods once they reach the appropriate developmental stage around 4 to 6 months.
Seventy-two hours after cardiac surgery, a young child has a temperature of 101° F. Which action should the nurse take?
- A. Keep child warm with blankets.
- B. Apply a hypothermia blanket.
- C. Record temperature on nurses' notes.
- D. Report findings to physician.
Correct Answer: D
Rationale: A temperature of 101°F after cardiac surgery in a young child, especially 72 hours post-surgery, is a concerning finding that should be reported to the physician. This elevated temperature could indicate infection or another complication following the surgery. It is important for the physician to evaluate the child's condition and determine the appropriate course of action. Simply recording the temperature on nurses' notes or keeping the child warm with blankets is not adequate management in this situation. Applying a hypothermia blanket would also not be appropriate as the child is already febrile. The priority in this scenario is to report the findings to the physician for further assessment and intervention.
How many drops per minute should be delivered?
- A. 6
- B. 17
- C. 50
- D. 100
Correct Answer: B
Rationale: The standard drip factor for an IV infusion set is typically 15 drops per milliliter. To calculate drops per minute, you would multiply the flow rate in milliliters per hour by the drip factor and divide by 60 minutes per hour.
A patient has cloudy penile discharge. For which additional symptoms of urethritis should the nurse assess?
- A. Throat or rectal infection
- B. Chancres or vesicles on the genitals
- C. Painful and frequent urination
- D. Oliguria and flank pain
Correct Answer: C
Rationale: Cloudy penile discharge is a common symptom of urethritis, which is inflammation of the urethra usually caused by an infection, such as a sexually transmitted infection (STI) like gonorrhea or chlamydia. Painful and frequent urination are also classic symptoms of urethritis. Painful urination, or dysuria, may occur due to the irritation and inflammation of the urethra. Frequency of urination can be a result of the body's response to the infection or inflammation. Therefore, assessing for these additional symptoms helps in confirming the diagnosis of urethritis and determining the appropriate treatment for the patient.
Kimberly, age 3 years, is being admitted for about 1 week of hospitalization. Her parents tell the nurse that they are going to buy her "a lot of new toys, because she will be in the hospital." The nurse's reply should be based on an understanding of which concept?
- A. New toys make hospitalization easier.
- B. New toys are usually better than older ones for children of this age.
- C. At this age, children often need the comfort and reassurance of familiar toys from home.
- D. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt.
Correct Answer: C
Rationale: The correct response is based on the understanding that at the age of 3, children often find comfort and reassurance in familiar toys from home. This familiarity can help them cope with the stress and unfamiliar environment of being hospitalized. Introducing new toys may not provide the same level of comfort and may even add to the child's sense of disorientation during their stay in the hospital. It is essential to prioritize the child's emotional well-being and provide them with familiar items that can offer a sense of security during their hospitalization.