Assessment sabado
1. A home health nurse is providing teaching about post seizure management to the parents of a school age child who has epilepsy and experiences tonic-clonic seizures. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)
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1. A home health nurse is providing teaching about post seizure management to the
parents of a school age child who has epilepsy and experiences tonic-clonic seizures.
Which of the following instructions should the nurse include in the teaching?
(Select all that apply.)
"Hyperextend your child's head for 5 minutes following a seizure."
"Immediately following a seizure, give your child 6 ounces of
water."
"Following a seizure, record the length and characteristics of your child's seizure."
"Administer rectal diazepam to your child following a seizure."
"Call for emergency medical services if the size of your child's pupils are unequal after a
seizure."
2. A nurse in a pediatric clinic is discussing the pathophysiology of Reye syndrome
with a newly licensed nurse. Which of the following statements by the newly
licensed nurse indicate an understanding of the disorder?
"Reye syndrome causes fatty changes in the liver."
"Reye syndrome leads to venous thrombus formation."
"Reye syndrome is associated with misuse of acetaminophen."
"Reye syndrome is linked to decreased serum ammonia levels
3. A nurse is teaching the parents of a toddler about strategies to manage temper
tantrums. Which of the following instructions should the nurse include in the
teaching?
"Honor the child's request if she holds her breath."
"Establish a structured daily routine for the child."
"Place the child in her room alone until the temper tantrum ends."
"Comfort the child during the temper tantrum."
4. A nurse is completing an assessment following suctioning of a child who has a
tracheostomy. Which of the following findings should the nurse identify as
an indication that the procedure has been effective?
Increased respiratory rate
, Decreased oxygen saturation
Clear breath sounds
Increased oral secretions
5. A nurse is developing a plan of care for a 4-year-old child who has hemophilia and is
experiencing acute hemarthrosis. Which of the following interventions should the
nurse include in the plan?
Have the child perform passive range-of-motion exercises.
Administer aspirin as needed for pain.
Place ice packs on the affected joints.
Position the lower extremities below the level of the heart.
6. A nurse in the emergency department is caring for a preschooler who has
epiglottitis. Which of the following actions should the nurse take?
Place the child in a left lateral position.
Obtain a specimen from the child's throat for a culture.
Inspect the child's throat with a padded tongue
depressor. Initiate droplet precautions for the child.
7. A nurse is providing teaching to the parent of a child about home care following a
cardiac catheterization. Which of the following statements should the nurse
include?
"You should give your child aspirin if they report pain at the site."
"You can remove the pressure dressing 8 hours after the
procedure." "Your child can soak in the bathtub 24 hours after the
procedure."
"Your child should avoid strenuous physical activities for several days."
8. A nurse is admitting a child who has pertussis. Which of the following isolation
precautions should the nurse initiate?
Droplet
Contact
Airborne
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