A nurse is providing anticipatory guidance to a pregnant woman who has another child. Which information should the nurse plan to include? (Select all that apply.)
A.
School-age: can fully grasp the reality of the pregnancy
B.
School-age: too young to attend sibling classes
C.
Teen: may feel resentment and embarrassment
D.
Toddler: may be excited to play with the new baby
E.
Toddler: may regress in behavior
ANS: C, E
Toddlers typically inhabit their own little world in which they are the center. They may react with indifference and also may regress in their behavior. School-age children may be interested, but they are unable to fully grasp the situation. Sibling preparation classes are a good way to involve and educate them. The teenager may feel resentment or be embarrassed that his or her parents are sexual beings.
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The nurse is assisting the health care provider to collect cerebrospinal fluid for testing to rule out meningitis. Which are the nurse's responsibilities?
Select all that apply. 1. Explain the procedure and obtain signed consent. 2. Teach the client how to assist during the procedure by maintaining proper positioning. 3. Observe sterile technique when preparing the equipment for the procedure. 4. Label all specimens collected and send them to the lab. 5. Assess the client before, during, and after the procedure.
Increased oxygen tension in the arterial blood of a newborn infant causes:
a. closure of the ductus arteriosus. b. hyperinflation of the lungs. c. passive respiratory movements. d. reopening of the foramen ovale.
Identify the assessment found by a nurse on a client who is admitted with a possible accidental overdose of imipramine (Tofranil) that would require the most immediate intervention
a. Depressed deep tendon reflexes and Glasgow Coma Scale of 11 b. Sinus tachycardia of 128 with a QRS complex of 0.14 second c. Ecchymotic areas on arms and an HCT of 33% d. Distended abdomen and decreased bowel sounds
Which should be the major consideration when selecting toys for a child who is cognitively impaired?
a. Safety b. Age appropriateness c. Ability to provide exercise d. Ability to teach useful skills