What is the procedure Look-Listen-Feel used for?

Correct Answer: C

Rationale: The Look-Listen-Feel procedure is a fundamental aspect of pediatric patient assessment, particularly in emergency situations. In this context, the correct answer is C) To assess for breathing. This procedure involves visually inspecting the chest for rise and fall, listening for breath sounds, and feeling for airflow to determine if the patient is breathing adequately. Option A) To assess for responsiveness, is not the correct choice because assessing responsiveness involves different actions such as tapping the patient and asking if they are okay to determine if they are conscious and alert. Option B) To assess for airway patency is incorrect as it involves checking for any obstructions in the airway, such as foreign objects or the tongue blocking the airway. Option D) To assess for circulation involves checking for a pulse and signs of perfusion, which is a separate aspect of pediatric assessment. Understanding the Look-Listen-Feel procedure is crucial for pediatric nurses as it forms the foundation of assessing a child's breathing status, which is vital for their overall well-being. By mastering this technique, nurses can quickly identify respiratory distress in pediatric patients and initiate appropriate interventions promptly, ultimately improving patient outcomes.

Correct Answer: B

Rationale: The correct answer is B) 12 mmol/L. In the treatment of hypernatremia, it is crucial to correct the elevated serum sodium levels gradually to prevent complications such as cerebral edema. A rapid decrease in serum sodium levels can lead to osmotic demyelination syndrome, a severe neurological disorder. The recommended maximum rate of correction is around 8-12 mmol/L per 24 hours. Option A) 8 mmol/L is lower than the recommended rate of correction for hypernatremia. It may be too slow to effectively treat the condition, especially in severe cases where a more rapid correction is necessary. Option C) 16 mmol/L and Option D) 20 mmol/L exceed the safe rate of correction for hypernatremia. Rapidly decreasing serum sodium levels can lead to serious neurological complications, outweighing the benefits of correcting hypernatremia. In an educational context, it is essential for pediatric nurses to understand the delicate balance required when treating electrolyte imbalances in children. By adhering to the recommended guidelines for correcting hypernatremia, nurses can ensure safe and effective care for pediatric patients, minimizing the risk of adverse outcomes associated with rapid electrolyte shifts.

Correct Answer: A

Rationale: In the context of pediatric nursing, understanding the physiological responses to serious illness is crucial for providing effective care to young patients. In this question, the correct answer is option A) Blood pressure. During serious illness, the body often initiates a stress response leading to an increase in heart rate, respiratory rate, and activation of accessory respiratory muscles as compensatory mechanisms to maintain oxygenation and circulation. However, blood pressure may not always increase and can actually decrease in certain conditions as a result of shock or other factors. Option B) Heart rate is often increased as part of the body's response to stress and illness to ensure an adequate supply of oxygenated blood to vital organs. Option C) Respiratory rate can also increase to enhance oxygen intake and carbon dioxide elimination during illness. Option D) Action of accessory respiratory muscles may be seen in conditions where there is respiratory distress or increased work of breathing. Educationally, this question highlights the importance of recognizing and understanding the various physiological responses that can occur in pediatric patients with serious illnesses. It underscores the need for nurses to monitor vital signs closely and interpret them in the context of the individual patient's condition to provide timely and appropriate interventions. By knowing the expected responses to serious illness, nurses can better assess and manage pediatric patients, ultimately improving outcomes and quality of care.

Correct Answer: C

Rationale: In this question, the correct answer is C) Dilute artificial formula. Total body sodium depletion occurs when there is an inadequate amount of sodium in the body compared to the amount of water. Dilute artificial formula can lead to total body sodium depletion in infants due to the low sodium content in the formula. A) SIADH (syndrome of inappropriate antidiuretic hormone) is associated with water retention, not sodium depletion. B) Psychogenic polydipsia is excessive thirst leading to water intake but does not directly relate to sodium depletion. D) Nephrotic syndrome involves protein loss in the urine but not necessarily total body sodium depletion. Educationally, understanding the relationship between sodium intake and body balance is crucial in pediatric nursing. Nurses must be able to identify the causes and symptoms of sodium imbalances in children to provide appropriate care and interventions. Monitoring sodium levels in infants on formula is essential to prevent complications related to total body sodium depletion.

Correct Answer: B

Rationale: The correct answer is B) Medullary relapse. In acute leukemia, medullary relapse is the most common type of relapse. This is because leukemia primarily affects the bone marrow where blood cells are produced. Medullary relapse refers to the recurrence of leukemia in the bone marrow. Option A) Clinical relapse is incorrect because clinical relapse is a broader term that encompasses various types of relapse, including medullary, CNS, and testicular relapse. It does not specify the specific location of the relapse. Option C) CNS relapse is incorrect because while relapse can occur in the central nervous system (CNS), it is less common than medullary relapse in acute leukemia. Option D) Testicular relapse is incorrect because this type of relapse is specific to leukemia spreading to the testicles, which is less common than medullary relapse. In an educational context, understanding the types of relapse in leukemia is crucial for pediatric nurses caring for children with this condition. Recognizing the most common type of relapse, which is medullary relapse, helps nurses in monitoring and managing the disease effectively. It also highlights the importance of regular assessments and follow-up to detect relapse early and initiate appropriate interventions.