CF HESI RN Case Study

What response reflects that the nurse values the principles of beneficence?

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

Which statement by the nurse is correct?

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

Which instruction should the nurse educator give the client's parents concerning the use of pancreatic enzymes as an oral prescription? (select all that apply.)

- Ensure that enzymes are administered within 30 minutes of consuming meals and snacks

If the child attends a daycare center, what should be shared with the daycare workers? (select all that apply.)

- Proper handwashing between care of the other children - Isolate the child from any children with upper respiratory infections -Correct techniques for performing chest physiotherapy.

Which documentation further supports the diagnosis of CF? (select all that apply.)

- history of frequent respiratory infections - bulky loose stools

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

34 Medication to infuse within 30 minutes -> 17 mL/30 min :: (x) mL/60 min = 34 mL/60 min or 34 mL/hour is the rate for the syringe infusion pump to be set.

Which intervention should the nurse implement first?

Administer oxygen at 4L/min via high-flow nasal cannula.

Which action should the primary nurse implement first?

Assess the client and the child who received the wrong medication.

Which rationale best supports this referral?

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

What action should the charge nurse take?

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

What is the CNS's responsibility when discussing immunizations?

Explain that the client 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? (Select all that apply. One, some, or all options may be correct.)

Her diet should include more calories than an unaffected child. Client should take vitamin A, D, E, and K supplementation along with her diet. Her diet should consist of high fat, high protein, and unrestricted fats.

Based on her previous conversation with the mother, what is the best statement by the nurse?

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

What actions should the nurse educator take to address this? (Select all that apply. One, some, or all options may be correct.)

Instruct the parents to perform chest physiotherapy (CPT) either 2 hours before meals or 2 hours after meals. Aerosolized medications should be adminstered before CPT. Encourage "blowing" activities, such as bubbles or pinwheels.

what information will the nurse include when teaching about the sweat test?

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

What action should the nurse take first?

Make arrangements to meet privately at the first opportunity.

The nurses recognize that energy needs are increased as a result of malabsorption of nutrients and that extra effort is needed for respirations and frequent pulmonary infections. The nurse teaches the client's parents about pancreatic replacement enzymes. Which of the following statements by the parents would indicate a correct understanding of the teaching?

Pancreatic enzymes are needed to digest fats and proteins.

Which action indicates to the nurse educator that the parents need more instruction about the respiratory care of the child with CF complications?

Placing the child 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.

How should the CNS respond?

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

What nursing task can be safely delegated to the UAP?

Taking vital signs.

Which statement should the nurse record as the expected outcome for this nursing problem?

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

Which adjustment would the nurse anticipate will be required if the has constipation?

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

What information provided by the nurse is correct?

The second immunization is given between ages 4 and 6 years of age.

Which assessment supports the diagnosis of CF

Weight loss and delayed growth despite a hearty appetite

What laboratory result warrants immediate intervention?

White blood cell count (WBC) is 20,000/mcL (20 x 109/L).