The nurse is caring for a nine-month-old who just returned from ...

[Metfan725]

The nurse is caring for a nine-month-old who just returned from the PACU after a shunt placement for hydrocephalus. Which of the physician's orders would the nurse question?
 
  1. Vital signs and neuro checks hourly
  2. Small, frequent formula feedings
  3. Elevate head of bed
  4. Daily head circumference

Question 2

The nurse is monitoring the urine specific gravity and pH on a child receiving chemotherapy. The nurse will try to maintain the urine values at:
 
  1. Specific gravity 1.030; pH 6.
   2. Specific gravity 1.030; pH 7.5.
   3. Specific gravity 1.005; pH 6.
   4. Specific gravity 1.005; pH 7.5.

[jointhecircus]

Answer to Question 1

3
Rationale 1: Frequent vital signs and neuro checks are needed postoperatively.
Rationale 2: Small, frequent feedings are appropriate to decrease the chance of vomiting.
Rationale 3: The nine-month-old should be placed in a flat position so that CSF drainage is not too rapid.
Rationale 4: Daily head circumferences are needed to help evaluate shunt functioning.
Global

Answer to Question 2

4
Rationale:

1. A specific gravity higher than 1.010 can mean fluid intake is not high enough, and a pH of less than 7 means acidosis.
2. A specific gravity higher than 1.010 can mean fluid intake is not high enough.
3. A specific gravity higher than 1.010 can mean fluid intake is not high enough, and a pH of less than 7 means acidosis.
4. Because the breakdown of malignant cells releases intracellular components into the blood, and electrolyte imbalance causes metabolic acidosis, the patient should remain well hydrated, with the urine specific gravity at less than 1.010 and the pH at 77.5.