Author Question: Parents tell the nurse they found their 3-year-old daughter and a male cousin of the same age ... (Read 64 times)

bcretired · **on:** Jun 28, 2018

Parents tell the nurse they found their 3-year-old daughter and a male cousin of the same age inspecting each other closely as they used the bathroom. What is the most appropriate recommendation for the nurse to make?

a. Punish the children so this behavior stops.
b. Neither condone nor condemn the curiosity.
c. Get counseling for this unusual and dangerous behavior.
d. Allow the children unrestricted permission to satisfy this curiosity.

Question 2

The nurse is caring for a child after cardiac surgery. What interventions should the nurse implement with regard to chest tubes placed to a water-seal drainage system? (Select all that apply.)

a. Maintain sterility.
b. Check for tube patency.
c. Do not interrupt the water-seal drainage system.
d. Clamp the chest tube when ambulating the child.
e. Measure the drainage by emptying the collection chamber every shift.

Pamela.irrgang@yahoo.com · **Reply #1 on:** Jun 28, 2018

Answer to Question 1

ANS: B
Three-year-old children become aware of anatomic differences and are concerned about how the other sex works. Such exploration should not be condoned or condemned. Children should not be punished for this normal exploration. This is age appropriate and not dangerous behavior. Encouraging the children to ask their parents questions and redirecting their activity is more appropriate than giving permission.

Answer to Question 2

ANS: A, B, C
Nursing considerations with regard to chest tubes attached to a water-seal drainage system include (1) do not interrupt water-seal drainage unless the chest tube is clamped, (2) check for tube patency (fluctuation in the water-seal chamber), and (3) maintain sterility. The chest tube should not be clamped when ambulating the child and the drainage is measured in the collection chamber, not emptied.