When caring for a child that has undergone a tonsillectomy, the nurse should do which of the following?

Correct Answer: A

Rationale: When caring for a child that has undergone a tonsillectomy, the nurse should observe for continuous swallowing. Continuous swallowing may indicate bleeding, and it is important to monitor for this postoperatively as it can be a sign of hemorrhage, which is a potential complication following a tonsillectomy. Encouraging the child to take sips of clear fluids can help in assessing if there is bleeding. Observing for any signs of bleeding, such as frequent swallowing, along with monitoring vital signs and overall assessment, is crucial during the initial postoperative period.

Correct Answer: B

Rationale: The current recommendations for hepatitis B (HBV) vaccine state that the first dose should be administered between ages 12 and 15 months. The vaccine series typically consists of three doses, with the second dose administered 1-2 months after the first dose, and the third dose given at least 8 weeks after the second dose. This schedule is recommended by the Centers for Disease Control and Prevention (CDC) to provide optimal protection against the hepatitis B virus. Starting the vaccine series at 12-15 months ensures that the child's immune system is mature enough to respond effectively to the vaccine and generate lasting immunity.

Correct Answer: C

Rationale: Osteomyelitis is an infection of the bone often caused by bacteria. When a client is diagnosed with Osteomyelitis, the nurse would expect to assess for positive wound cultures. This means that the wound site is likely to show growth of infectious organisms, confirming the presence of infection in the bone. A positive wound culture result helps guide appropriate antibiotic therapy to treat the infection effectively. Therefore, option C is the most appropriate assessment finding to expect in a client diagnosed with Osteomyelitis.

Correct Answer: D

Rationale: The characteristic movement of Parkinson's disease is the pronation-supination of the hand and forearm, also known as the "pill-rolling" tremor. This movement interferes with normal hand activities and is a common early sign of Parkinson's disease. Exaggerated muscle flaccidity leading to frequent falls and hyperextension of the back and neck are not typically associated with Parkinson's disease.

Correct Answer: C

Rationale: Administering analgesics before removing chest tubes from a child is an important nursing consideration because the procedure may cause pain or discomfort. While it is ideal to minimize pain during and after the removal, it is essential to anticipate the possibility of discomfort and provide appropriate pain management to ensure the child's comfort and well-being. By administering analgesics before the procedure, nurses can help alleviate any potential pain and promote a more positive experience for the child.