PEDS

The condition of a child dying of leukemia deteriorates and the child becomes comatose. The parents state that a relative told them that they should not allow the child to be resuscitated, but they are unsure. Which response by the nurse best demonstrates recognition of the ethical issues involved?

"The final decision must be made by you and your doctor, but it's important to talk about it.". the parents that they and the health care provider must make the final call but that it's important to discuss the issue is an ethically sound response that clearly defines who is involved in the decision-making and allows parental expression of ideas and thoughts. Discussion of the implication of a do-not-resuscitate order should not take place until after the family has spoken with the practitioner. Although telling the parents to discuss the issue with the health care provider and offering to make the call promotes the practitioner-client relationship, it stops nurse-client interaction. Telling the parents to discuss the issue with the health care provider and religious adviser abdicates nursing responsibility, and the parents may have no desire to involve a religious adviser in the decision-making process.

After taking spironolactone (Aldactone), a potassium-sparing diuretic, the client inquires about foods and fluids that are low in potassium. Which juice should the nurse teach the client contains the least amount of potassium?

Cranberry juice contains approximately 46 mg of potassium per 8 ounces. Apple juice contains approximately 295 mg of potassium per 8 ounces. Orange juice contains approximately 496 mg of potassium per 8 ounces. Tomato juice contains approximately 535 mg of potassium per 8 ounces.

Based on the client's reported pain level, the nurse administers 8 mg of the prescribed morphine. The medication is available in a 10 mg syringe. Wasting of the remaining 2 mg of morphine should be done by the nurse and a witness. It is most appropriate for the nurse to ask which member of the health care team to be the witness?

LPN. The wasting of controlled substances should be witnessed by two licensed personnel according to federal regulations; this can be done by a registered nurse (RN) or LPN. Although the nursing supervisor is licensed and may perform this function, it is not an efficient use of this individual's expertise. Federal regulations do not require the participation by the client's health care provider in this situation. A nursing assistant is not a licensed person who can take responsibility for the wasting of controlled substances.

A client with rheumatoid arthritis does not want the prescribed cortisone and informs the nurse. Later, the nurse attempts to administer cortisone. When the client asks what the medication is, the nurse gives an evasive answer. The client takes the medication and later discovers that it was cortisone. The client states an intent to sue. What factors in this situation must be considered in a legal action? Select all that apply.

Nurses are required to answer clients truthfully. The health care provider should have been notified. Clients have a right to refuse treatment.. who are mentally competent have the right to refuse treatment; the nurse must respect this right. Client's questions must always be answered truthfully. The health care provider should be notified when a client refuses an intervention so that an alternate treatment plan can be formulated. This is done after the nurse explores the client's reasons for refusal. The client had a discussion with the nurse that indicated that the client had sufficient information to make the decision to refuse the medication. The client has a right to refuse treatment; this right takes precedence over the health care provider's prescription.

The nurse is planning therapeutic group sessions for regressed long-term clients. The nurse understands that these clients need to:

Regressed long-term clients need structure and external controls to help organize their thought processes. These clients need gentle assistance to deal with conflict situations. Most regressed long-term clients would be too anxious to assume a leadership role. Such experiences are beyond the capability or psychological tolerance of these clients.

A client is admitted to the hospital for an adrenalectomy. The nurse is providing postoperative care before the client's replacement steroid therapy is regulated fully. The nurse should monitor the client for:

Sodium retention.Because of instability of the vascular system and the lability of circulating adrenal hormones after an adrenalectomy, hypotension frequently occurs until the hormonal level is controlled by replacement therapy. Hyperglycemia is a sign of excessive adrenal hormones; after an adrenalectomy, adrenal hormones are not secreted. Sodium retention is a sign of hyperadrenalism; it does not occur after the adrenals are removed. Potassium excretion is a response to excessive adrenal hormones; after an adrenalectomy, adrenal hormones are decreased until replacement therapy is regulated.

A client who has participated in caring for her infant in the neonatal intensive care unit for several days in preparation for the infant's discharge comes to the unit on the last hospital day with an alcohol odor on her breath and slurred speech. What action should the nurse take?

Talk with the mother about her condition and assess her willingness to participate in an alternate discharge plan.Confrontation about the active substance abuse and the mother's diminished ability to care for the infant safely at this time is necessary to help the mother get help and to protect the infant. Decisions should not be made without input from the mother. Continuing with the discharge procedure and alerting the home health nurse that the mother needs an immediate follow-up visit is unsafe; the mother may not be capable of caring for the infant.

After assessing a client that is in cardiac arrest, a health care provider prescribes a dose of medication that is much higher than is recommended for the clinical situation, and directs the nurse to give the medication immediately. Which response by the nurse is most appropriate?

The response "That dose is more than I can give legally. However, if the dose is medically indicated, please administer it yourself" informs the health care provider of the nurse's dilemma and legal position without creating an adversarial professional position. A confrontational response may make the health care provider look and feel incompetent and jeopardize the collegial relationship. "The dose is too high. I do not feel comfortable administering this dose," "Please tell me how you arrived at this dose. I think your calculations are incorrect," and "You're probably thinking of another drug. This is beyond the safe dosage limits indicated for this drug" are confrontational responses that may make the health care provider look and feel incompetent and jeopardize the collegial relationship.

Wilms tumor

A disease in which malignant (cancer) cells are found in the kidney, and may spread to the lungs, liver, or nearby lymph nodes. Wilms tumor usually occurs in children younger than 5 years old.

While undergoing a soapsuds enema, the client reports abdominal cramping. What action should the nurse take?

Abdominal cramping during a soapsuds enema may be due to too rapid administration of the enema solution. Lowering the height of the enema bag slows the flow and allows the bowel time to adapt to the distention without causing excessive discomfort. Stopping the infusion is not necessary. Advancing the enema tubing is not appropriate. Clamping the tube for several minutes then restarting the infusion may be attempted if slowing the infusion does not relieve the cramps.

Absence or weakness of which of the following reflexes during the newborn assessment should the nurse report to the health care provider?

Absence or diminution of the gag reflex could be life threatening. The infant might aspirate mucus or a feeding. The Moro, Babinski, and tonic neck reflexes may be delayed if the mother has been anesthetized

Alcohol deactivates the smallpox vaccine

Alcohol deactivates the smallpox vaccine

A client has a craniotomy for a meningioma. For what response should the nurse assess the client in the postanesthesia care unit?

Blurred vision is a sign of increasing intracranial pressure, which may follow a craniotomy. Dehydration, wound infection, and narrowing pulse pressure will take time to develop; they will not be observable immediately after surgery. The pulse pressure widens with increased intracranial pressure.

A 20-year-old developmentally disabled woman is a resident in a group home. She has had four abortions in the past 2 years, and the agency supervisor recommends that she be sterilized. It is obvious that the client is unable to exercise informed consent for sterilization. The nurse understands that the procedure cannot be performed without legal consent from the:

Court-appointed individual or group.In the United States each state has its own restrictions; the approval of a court-appointed individual or group is required to give legal consent. The other options do not meet the legal requirements for consent. The states have an obligation to oversee the best interests of the mentally disabled, and the court must be involved.

A client with obstructive airway disease reports to the nurse about experiencing spasms of coughing. What suggestion should the nurse provide to help the client successfully manage this problem?

Extreme temperature changes should be avoided, especially environmental heat or cold, because they promote bronchospasms. Food restrictions usually are not necessary. Aerosol sprays increase exposure to irritating and noxious substances that irritate bronchial mucosa and initiate bronchospasms. Exercise in the presence of breathing difficulties will exacerbate dyspnea.

The nurse manager of the unit comes to work obviously intoxicated. The staff nurse's ethical obligation is to:

Have the supervisor validate the observation. The staff nurse should call the supervisor to confirm and deal with the problem. The security guard has no authority in this situation. Although sending the nurse manager home removes the nurse manager from the clinical setting, it does not provide for documentation of the situation; also, the nurse manager may be in no condition to go home independently. Drinking coffee does not make a person less intoxicated.

What should the nurse do initially when obtaining consent for surgery?

Determine whether the client's knowledge level is sufficient to give consent. consent means the client must comprehend the surgery, the alternatives, and the consequences. Describing the risks involved in the surgery is not within nursing's domain. Although obtaining a signature is routine, explaining that obtaining the signature is routine for any surgery does not determine the client's ability to give informed consent. Although witnessing the client's signature will be done, the nurse first should assess the client's knowledge of the surgery.

A nurse is planning to teach a class of nursing assistants how to compare the behaviors of psychotic clients and people who function acceptably in society. What type of behavior is considered acceptable?

When it reflects the standards accepted by one's society.An accepted practice in some parts of the world may be considered unacceptable behavior in others (e.g., pica). Every person needs relief from tension from time to time and makes use of defense mechanisms to accomplish this. If the behavior is aggressive or destructive, although it might accurately reflect the individual's thoughts and feelings, it is not considered acceptable. If the behavior is aggressive or destructive, even if it helped reach a goal, it is not considered acceptable.

What should nursing care for the affected arm of an infant born with Erb-Duchenne paralysis (brachial palsy) include?

teach parents to manipulate arm muscles. Gentle massage and manipulation of the arm muscles help prevent contractures. The parents can perform these activities at home. Keeping the arm immobilized is dangerous because this may lead to the development of permanent contractures. The length of the arm will not change on a daily basis. Passive range-of-motion exercises should be delayed for 10 days to prevent additional injury to the brachial plexus.