A 2-year-old is admitted to the hospital with possible encephalitis, and a lumbar puncture is scheduled. Which information should the nurse provide this child concerning the procedure?

Correct Answer: A

Rationale: The correct answer is A) Describe the side-lying, knees to chest position that must be assumed during the procedure. This is the most appropriate information to provide to a 2-year-old child before a lumbar puncture for several reasons. Firstly, children at this age have limited cognitive abilities and may not fully understand complex explanations or instructions. Describing the position in a simple and concrete manner helps the child visualize what will happen during the procedure, reducing anxiety and fear. Additionally, using age-appropriate language and providing a clear expectation of what is expected can help the child cooperate better during the procedure. Option B) Tell the child to expect loud clicking noises during the procedure that may be slightly annoying is incorrect because it introduces a potential negative element that may increase the child's anxiety. It is important to focus on reassuring and preparing the child rather than introducing potentially distressing details. Option C) Reassure the child that there will be no restrictions on activity after the procedure is completed is incorrect because it does not address the immediate concerns or preparation needed for the procedure itself. While it is important to provide reassurance, information about the procedure should take precedence. Option D) Explain that fluids cannot be taken for 8 hours before the procedure and for 4 hours after the procedure is incorrect because it provides information that may not be developmentally appropriate or relevant for a 2-year-old child. This level of detail regarding fluid restrictions is more suitable for older children or adults who can understand and follow such instructions.

Correct Answer: A

Rationale: Administering a bronchodilator is the priority action in managing an acute asthma exacerbation in a child. Bronchodilators help to relax the muscles around the airways, opening them up and improving breathing. This intervention aims to address the immediate breathing difficulty and should be done promptly to provide relief for the child.

Correct Answer: D

Rationale: In this scenario, the correct response is option D) Position the infant on the stomach occasionally when awake and active. This option is the most appropriate because it promotes tummy time, which helps prevent or improve flat spots on the infant's head and encourages neck and upper body strength development. Option A is incorrect because consistently placing the infant on the left side can lead to positional plagiocephaly. Option B is incorrect as propping the infant in a sitting position with a cushion can increase the risk of suffocation and is not recommended for unsupervised sleeping. Option C is also incorrect as the use of pillows in the sleep environment poses a suffocation hazard for infants under one year of age. Educationally, it is important for pediatric nurses to understand the significance of tummy time in preventing flat spots on an infant's head and promoting overall development. By educating parents on the benefits of supervised tummy time and appropriate sleep positioning, nurses can help promote safe and healthy practices for infant care.

Correct Answer: A

Rationale: The correct instruction for the nurse to provide to the parents is to wash the child's bed linens and clothing in hot soapy water. This is essential to eliminate head lice as they can survive on bedding and clothing. It is also important to wash any other items that the child may have used or come into contact with, such as brushes and combs, to prevent reinfestation. Rewashing the child's hair following an isolation period is not necessary, and taking the child to a hair salon for a shampoo and shorter haircut is not a recommended treatment for head lice.

Correct Answer: A

Rationale: In a child presenting with ear pain and fever, asking if the child has had a runny nose is crucial in assessing for possible ear infection causes. Respiratory infections can lead to secondary ear infections, so exploring symptoms related to upper respiratory tract infections, like a runny nose, can help in the evaluation and management of the child's condition.