a 5 year old boy is being admitted to the hospital to have his tonsils removed which information should the nurse collect before this procedure
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Nursing Elites

HESI A2

HESI A2 Practice Test Anatomy and Physiology

1. Before a child undergoes a tonsillectomy, what information should the nurse collect?

Correct answer: D

Rationale: Before a child undergoes a tonsillectomy, it is crucial for the nurse to gather information on the child's reactions to previous hospitalizations. This data helps in assessing potential fears or anxiety and in providing the necessary support and preparation for the upcoming tonsillectomy. Understanding the child's past reactions is vital for ensuring their comfort and well-being during the hospital admission and procedure. The other options provided are not directly relevant to the child's upcoming tonsillectomy procedure. Birth weight (Choice A) is not typically a factor considered before a tonsillectomy. The age at which a child crawled (Choice B) is a developmental milestone but not pertinent to the tonsillectomy. Having had measles (Choice C) is important for overall health history but not specifically crucial before a tonsillectomy.

2. What would be an appropriate nursing response when a mother reports that her 16-month-old toddler has an earache?

Correct answer: B

Rationale: The appropriate nursing response would be to assess the toddler's ear to determine if there is indeed an ear infection causing the earache. It is crucial to provide timely and suitable care for the child's pain and discomfort. Checking for an ear infection is a necessary step in evaluating the source of the toddler's earache. Choice A is incorrect as it assumes the earache is due to teething without proper assessment. Choice C questions the mother's report rather than focusing on the child's condition. Choice D is not as direct and focused as directly examining the ear for a possible infection.

3. During an interview, the nurse states, 'You mentioned shortness of breath. Tell me more about that.' Which verbal skill is used with this statement?

Correct answer: D

Rationale: The nurse's statement, 'Tell me more about that,' is an example of an open-ended question. Open-ended questions encourage the interviewee to provide detailed information and expand on their responses. This type of question is useful for gathering narrative information and allows the interviewee to express themselves freely. Reflection involves restating or paraphrasing the client's words, facilitation encourages the client to say more, and direct questions typically elicit specific, close-ended responses, unlike open-ended questions.

4. Among many Asians there is a belief in the yin\yang theory, rooted in the ancient Chinese philosophy of Tao. The nurse recognizes which statement that most accurately reflects "health" in an Asian with this belief?

Correct answer: C

Rationale: In Asian belief systems like the yin\yang theory rooted in Tao philosophy, health is seen as existing when all aspects of a person are in perfect balance. This means that physical, mental, emotional, and spiritual elements need to be harmonized for an individual to be considered healthy. The other statements do not encapsulate this holistic perspective on health.

5. When working with children from different cultural perspectives, the healthcare provider may find it particularly challenging because:

Correct answer: A

Rationale: Children's spiritual needs are influenced by their stages of development, not just by what is happening in their homes. Understanding these needs requires knowledge of how children's spiritual beliefs evolve as they grow. Different cultural perspectives can bring varying beliefs and practices regarding children's spiritual development, which may challenge healthcare providers in addressing these needs effectively. Choice B is incorrect because children's spiritual needs are not solely reflections of their home environments but are shaped by various factors. Choice C is incorrect as it discusses the impact of parents' religious beliefs on illness views rather than focusing on children's spiritual needs. Choice D is incorrect as it addresses parental awareness of children's spiritual needs, which is not the primary challenge faced by healthcare providers in this context.

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