When providing care for a client following bronchoscopy, which assessment finding should the nurse immediately report to the healthcare provider?

Correct Answer: D

Rationale: In the context of pediatric nursing and cardiovascular disorders, the correct answer to the question is option D) No gag reflex after thirty minutes. This is the most critical assessment finding that the nurse should immediately report to the healthcare provider following a bronchoscopy in a pediatric patient. A lack of gag reflex after thirty minutes could indicate a potential complication such as airway compromise, aspiration, or neurological deficit, which require prompt intervention to prevent respiratory distress or other serious consequences. Option A) Slight blood-tinged sputum is a common and expected finding post-bronchoscopy, usually resolving on its own without intervention. Option C) Sore throat and hoarseness are also common after the procedure due to irritation from the scope and typically do not require immediate intervention. Option B) Dyspnea and dysphagia could be concerning symptoms, but they are not as immediately critical as the absence of a gag reflex. Dyspnea and dysphagia may be expected to some extent after a bronchoscopy and can be managed with close monitoring and supportive care unless they worsen or persist. Understanding these assessment findings in the context of pediatric nursing and cardiovascular disorders is crucial for providing safe and effective care to pediatric patients undergoing bronchoscopy procedures. Early identification and reporting of concerning signs and symptoms can help prevent complications and ensure timely interventions to promote positive patient outcomes.

Correct Answer: A

Rationale: In this scenario, the nurse should review the complete blood count (CBC) of the client. Pernicious anemia is primarily caused by a deficiency in Vitamin B12, which can lead to megaloblastic anemia characterized by enlarged and immature red blood cells. Folate supplementation can mask the anemia associated with Vitamin B12 deficiency, but it does not address the neurological symptoms that can occur. Reviewing the CBC will provide information on the client's red blood cell count, hemoglobin levels, and mean corpuscular volume, which can indicate whether the anemia is improving or worsening despite the Vitamin B12 injections. An increase in fatigue could be a sign of worsening anemia, so monitoring the CBC is crucial in this case. The other options are not directly related to the management of pernicious anemia. Serum ferritin levels are more indicative of iron stores in the body, not Vitamin B12 levels. Serum potassium levels are important in conditions affecting electrolyte balance, which is not the primary concern in this case. Liver function tests are not typically affected by pernicious anemia unless there are other underlying liver conditions present. Understanding the importance of monitoring specific laboratory values in patients with different conditions is crucial in nursing practice, especially in pediatric patients who may present with atypical symptoms or complications. Regular monitoring and assessment help in early detection of complications and timely intervention, ensuring optimal patient outcomes.

Correct Answer: A

Rationale: In the acute phase of burn recovery, fluid resuscitation is critical to maintain adequate tissue perfusion and prevent complications like hypovolemic shock. The correct fluid to administer in this scenario is Ringer's Lactate. Ringer's Lactate is preferred due to its composition containing electrolytes (sodium, potassium, calcium) that closely resemble those lost in burn injuries, helping to restore intravascular volume and electrolyte balance. Normal saline (Option B) is isotonic and lacks the electrolyte composition found in Ringer's Lactate, which may not adequately address the electrolyte imbalances seen in burn patients. Dextrose 5% in water (D5W - Option C) is a hypotonic solution that primarily provides free water without addressing the electrolyte needs in burn patients. Hypertonic saline (Option D) is not typically used in the initial resuscitation phase of burn patients and may lead to further electrolyte imbalances. Educationally, understanding the rationale behind fluid choices in burn patients is crucial for nurses caring for these patients. By grasping the principles of fluid resuscitation in burn injuries, nurses can provide optimal care to ensure positive outcomes and prevent complications in this vulnerable population.

Correct Answer: A

Rationale: In this scenario, the correct action for the nurse to take first is to determine the client's current glucose level (Option A). This is crucial in assessing the client's condition and identifying if the symptoms of diaphoresis, rapid heartbeat, and feeling shaky are related to hypoglycemia, a common adverse effect of insulin therapy. Option B, administering 10 units of fast-acting insulin, is incorrect as it can further lower the client's blood glucose levels, exacerbating the symptoms of hypoglycemia. Option C, offering a snack with high protein, is not the first priority as assessing the glucose level is necessary to determine the appropriate intervention. Option D, increasing the IV infusion rate of normal saline, is not indicated for addressing hypoglycemia associated with insulin therapy. Educationally, this scenario highlights the importance of prompt assessment and intervention in managing potential complications of insulin therapy in diabetic patients. Nurses need to prioritize assessing the client's glucose levels to guide appropriate interventions and prevent further complications. Understanding the signs and symptoms of hypoglycemia and the appropriate nursing actions is essential in providing safe and effective care to patients with diabetes.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) A change has recently occurred in his handwriting. This symptom suggests AIDS dementia because it is a common neurological manifestation of advanced HIV infection in pediatric patients. AIDS dementia complex can present with cognitive impairment, behavioral changes, motor dysfunction, and alterations in handwriting, which may include deterioration in fine motor skills. Option B) The client has a persistent cough and fever is incorrect because these symptoms are more indicative of respiratory infections common in HIV-positive pediatric patients, such as pneumonia or tuberculosis, rather than AIDS dementia. Option C) The client experiences shortness of breath is incorrect as it could be a sign of respiratory issues or cardiovascular problems in the context of HIV, but it is not specific to AIDS dementia. Option D) The client exhibits a loss of appetite is also incorrect since it is a non-specific symptom commonly seen in various conditions, including HIV infection, but not specifically indicative of AIDS dementia. Educationally, understanding the neurological manifestations of advanced HIV infection, such as AIDS dementia complex, is crucial for pediatric nurses caring for HIV-positive children. Recognizing subtle changes in handwriting can prompt early intervention and appropriate management to improve the quality of life for these patients. Regular neurological assessments and education for families on recognizing such symptoms are essential in the holistic care of pediatric patients with HIV.