The nurse is teaching the parents of a child who has head lice (pediculosis capitis). Which information will the nurse include in the teaching session?

Correct Answer: C

Rationale: The correct answer is C. Head lice are highly contagious and can spread to furniture and other people if not treated promptly. Informing the parents about the potential spread of head lice emphasizes the importance of thorough treatment and prevention measures. Choice A is incorrect as regular shampoo is not typically effective in treating head lice. Choice B is incorrect as products containing lindane are not recommended due to safety concerns. Choice D is incorrect as manual removal, though labor-intensive, is a crucial step in effectively treating head lice infestations, but it is not the most pertinent information to include in the teaching session.

Correct Answer: C

Rationale: The 72-year-old recovering from surgery after a hip replacement 2 hours ago should be seen first due to the potential for immediate post-operative complications. This patient is in the immediate postoperative period and requires close monitoring for any signs of complications such as bleeding, infection, or impaired circulation. The other patients are relatively stable compared to the patient who just had surgery and therefore can wait for assessment and care without immediate risk. The 16-year-old had surgery ten hours ago, which is longer than the 72-year-old and is at a lower risk for immediate complications. The 20-year-old in skeletal traction for two weeks is stable in his current condition. The 75-year-old in skin traction before planned surgery does not require immediate attention as the surgery has not yet taken place.

Correct Answer: D

Rationale: The correct answer is to proceed with the triage process in the same manner as any adult client. In this scenario, since the teenager is legally married, they have the legal authority to consent to their own treatment. Choice A is incorrect because the teenager, being legally married, can provide their own consent. Choice B is incorrect as it unnecessarily delays treatment by waiting for telephone consent from the partner, which is not required in this case. Choice C is incorrect as the teenager can receive appropriate care in the current emergency department setting without the need for referral.

Correct Answer: C

Rationale: The appearance of eyeballs that appear to 'pop' out of the client's eye sockets, known as exophthalmos, requires quick intervention as it is a severe symptom of Graves' disease. Exophthalmos can indicate an acute condition and may lead to serious complications such as optic nerve damage or corneal ulceration. Weight loss, restlessness, and irritability are common manifestations of hyperthyroidism but do not pose immediate risks compared to the ocular complications associated with exophthalmos.

Correct Answer: C

Rationale: The correct response, option C, "Keep in mind that for the age this is a normal response to being in the hospital," is the best choice for several reasons. Firstly, it acknowledges the mother's concerns while providing reassurance based on the child's developmental stage. Understanding child development is crucial in nursing, as it helps nurses address parents' worries effectively. By explaining that the child's behavior is typical for their age, the nurse validates the mother's experience and helps her feel supported. Option A is incorrect because it does not address the mother's emotional concerns and may not be feasible for all families due to various reasons such as work commitments or family dynamics. Option B is incorrect as it dismisses the mother's worries and does not provide any helpful information. Option D is also incorrect as it suggests a strategy that may lead to trust issues between the child and parent, affecting the child's emotional well-being. In an educational context, this scenario highlights the importance of understanding child development and family dynamics in nursing practice. Nurses must possess knowledge of age-appropriate behaviors to provide holistic care and support to both the child and their family members during hospitalization. Effective communication and empathy are key skills nurses need to address parental concerns and promote positive outcomes for pediatric patients.