Cystic Fibrosis Case Study (Exam 1)

Based on her previous conversation with Pamela, what is the best response by the nurse? "You are afraid your wife is going to leave you. Tell me more about what makes you think that." "I will sit with Darla so you and your wife can talk. We have a quiet room you can use that is private and close by." "Ethically, I cannot discuss what your wife told me. Likewise, I cannot tell her what you say, either." "Most parents are anxious during situations like this. Would you like me to set you up with a support group?"

"I will sit with Darla so you and your wife can talk. We have a quiet room you can use that is private and close by."

Which statement by the nurse is correct? "It is care such as the sweat test and DNA testing that Darla received." "It includes mainly teaching information about Darla's cystic fibrosis." "This is the nursing care we do when we are taking care of Darla here in the hospital." "It is care that includes giving Darla immunizations to prevent specific diseases."

"It is care such as the sweat test and DNA testing that Darla received."

What response reflects that the nurse values the principle of beneficence? "No one ever knows when they will die. Darla could live for a long time." "This seems like an ethical dilemma to me. I'll refer it to the ethics committee." "I think you probably should contact an attorney to discuss this if you're really serious." "Pamela, I know this has to be a very scary and difficult time for you. What can I do to help you?"

"Pamela, I know this has to be a very scary and difficult time for you. What can I do to help you?"

What response is most appropriate by the primary nurse? "It should be administered as soon as possible." "The second MMR is given between 4 and 6 years of age." "I think the HCP will probably let you know." "It will not be given until 11 to 12 years of age."

"The second MMR is given between 4 and 6 years of age."

Which statement by the mother supports the diagnosis of CF?

"When I kiss my daughter, her skin tastes like salt."

At what rate should the nurse set the infusion pump? (Enter numerical value only. If rounding is necessary, round to the whole number.)

30 12 kg x (2.5 mg)/2mg/ml = 15 ml 15ml/0.5 hrs = 30 ml

Which documentation further supports the diagnosis of CF? A history of frequent respiratory infections. An elevated white blood cell count (WBC). Reports of episodic abdominal pain and crying. A sweat chloride level of 35 mEq/L. Reports of foul-smelling stools that have white streaks and are sticky.

A history of frequent respiratory infections. Reports of foul-smelling stools that have white streaks and are sticky.

Which intervention should the nurse implement first? Notify the CF nurse educator to help support Darla's parents. Administer IV antibiotic therapy. Insert a 24 gauge intravenous line. Administer oxygen 6 L/min via simple face mask.

Administer oxygen 6 L/min via simple face mask.

Which nursing diagnosis has the highest priority? Anticipatory grieving related to a potentially fatal diagnosis. Ineffective coping (family) related to chronic illness. Risk for altered growth and development related to stress of illness and hospitalization. Altered nutrition: less than body requirements related to poor intestinal absorption.

Altered nutrition: less than body requirements related to poor intestinal absorption.

Which action should the primary nurse implement first? Assess Darla and the child that received the wrong medication. Administer the antibiotic to the correct clients. Complete a medication incident report. Notify the HCP immediately.

Assess Darla and the child that received the wrong medication.

Which rationale best supports this referral? Community resources often provide support groups for parents of children with CF. This foundation will provide health insurance for children with CF. The CFF offers information on alternative therapy and treatment modalities. Referrals for resources offer parents hope that a cure may one day be found.

Community resources often provide support groups for parents of children with CF.

What is the nurse educator's responsibility when discussing immunizations? Explain that Darla should receive all routine childhood immunizations. Instruct the parents to ask the pediatrician which immunizations Darla should get. Discuss why immunizations are not given to children with chronic respiratory illnesses. Teach Pamela and Donald that Darla's immunizations will be delayed due to the CF.

Explain that Darla should receive all routine childhood immunizations.

Which statement by the parents indicates a correct understanding of a proper nutritional protocol of a client with CF? Darla's diet should consume more calories than an unaffected child. Darla should use a salt substitute in place of regular table salt with her meals. Darla should consume pancreatic enzymes one hour after consuming her meals. Darla should take vitamin A, D, E, and K supplementation along with her diet. Her diet should consist of 3 meals/day of high fat, high protein, and 2 to 3 snacks/day.

Darla's diet should consume more calories than an unaffected child. Darla should take vitamin A, D, E, and K supplementation along with her diet. Her diet should consist of 3 meals/day of high fat, high protein, and 2 to 3 snacks/day.

What nursing task can be safely delegated to the UAP? Discontinue a child's peripheral IV. Empty the Foley bag. Change the rate on an IV pump controller. Complete an admission assessment.

Empty the Foley bag.

What action should the charge nurse take? Ask the play therapist to take the vital signs. Interrupt the play therapy session to take the vital signs. Reprimand the primary nurse for delaying the taking of the vital signs. Explain that play therapy is an intervention and should not be interrupted for vital signs.

Explain that play therapy is an intervention and should not be interrupted for vital signs.

What information will the nurse include when teaching about the sweat test? Informed consent will be needed for this invasive, diagnostic test. It will take 2 hours to obtain the sweat. This procedure must be done twice a week for 3 weeks before confirming diagnosis. It is a simple, painless, reliable test that measures the chloride in sweat.

It is a simple, painless, reliable test that measures the chloride in sweat

Donald and Pamela have been at Darla's bedside since she was admitted to the hospital. Donald asks to speak to the nurse outside in the hall. He tells the nurse that Pamela is telling everyone that Darla is going to be fine and that there has just been a mistake and everything will be all right as long as they pray. What action should the RN take first? Schedule an appointment for Pamela with the hospital's chaplain. Suggest that Donald and his wife sit down and talk about the situation. Refer Pamela to a professional counselor. Make arrangements to meet with Pamela privately at the first opportunity.

Make arrangements to meet with Pamela privately at the first opportunity.

Which instruction should the nurse educator give Darla's parents concerning the use of pancreatic enzymes as an oral prescription? Administer pancreatic enzymes in the morning and at night. Mix the pancreatic enzymes with hot, starchy foods such as macaroni or pasta. Open the capsules and mix the beads in a nonprotein food such as applesauce. Ensure that Darla swallows the pancreatic enzyme capsule whole.

Open the capsules and mix the beads in a nonprotein food such as applesauce.

Which instruction indicates to the nurse educator that the parents need more instruction about the respiratory care of the child with CF complications? Placing Darla in a prone position when she is having a dyspneic episode. Darla's chest percussions and postural drainage should be perform no sooner than 1 hour before meals or 1.5 hours after meals. Encourage Darla's parents to have her participate in physical activities such as running, skipping, and swimming. Perform Darla's chest percussion and postural drainage after the administration of bronchodilators or nebulized medications as prescribed.

Placing Darla in a prone position when she is having a dyspneic episode.

Which is the best explanation for the nurse to provide to the student? Standards of care are published statements that describe the level of care that the client can expect from nurses. Standards of care are laws mandated by the legislature of each state that ensure safe care for clients. Standards of care are rules that help health care professionals deal with the ethical issues involved in the care of a client. Standards of care for working with clients with cystic fibrosis (or other diseases) are outlined in the Nursing Practice Acts of each state.

Standards of care are published statements that describe the level of care that the client can expect from nurses.

How should the CF nurse educator respond? Wish them a happy vacation and tell them nothing special needs to be done. Suggest that they add extra salt to Darla's diet and watch her for dehydration. Explain that the beach is not a good vacation place for Darla. Encourage them to limit Darla's play time at the beach to 30 minutes a day

Suggest that they add extra salt to Darla's diet and watch her for dehydration.

What actions should the nurse educator take to address this? Teach Darla to take a deep breath and then exhale while whispering the word "huff." Instruct the parents to perform chest physiotherapy (CPT) either 1 hour before meals or 2 hours after meals, if possible. Explain the importance of increasing fluid intake during acute exacerbations. Discuss the use of a short-term oral glucocorticoid steroid therapy. Discuss the possibility of long-term oxygen administration to help with mobilizing secretions.

Teach Darla to take a deep breath and then exhale while whispering the word "huff." Instruct the parents to perform chest physiotherapy (CPT) either 1 hour before meals or 2 hours after meals, if possible. Explain the importance of increasing fluid intake during acute exacerbations.

Which statement should the nurse record as the expected outcome for this nursing diagnosis? The child will maintain an oxygen saturation level greater than 95%. The parents will list three symptoms that require notification of the healthcare provider (HCP). The child will be able to remove mucus from the airway by coughing. The child will rest comfortably and participate in age-appropriate activities.

The child will be able to remove mucus from the airway by coughing.

While discussing pancreatic enzymes, the nurse educator explains that the dosage of the pancreatic enzyme is adjusted according to stool formation, which indicates how well Darla is digesting her food. Which adjustment would the nurse anticipate will be required, if Darla has loose, fatty stools? The pancreatic enzymes would not be administered for 24 hours. The amount of pancreatic enzymes would be decreased at each meal. The pancreatic enzymes would be increased with each meal and snack. No adjustment in the dosage would be made at this time.

The pancreatic enzymes would be increased with each meal and snack.

What laboratory result warrants immediate intervention? Serum potassium level of 3.8 mEq/L. White blood cell count (WBC) is 20,000 mm3. Platelet count is 200,000 mm3. Darla has a serum chloride level of 101 mEq/L.

White blood cell count (WBC) is 20,000 mm3.