Author Question: The nurse is ready to take vital signs on a 6-year-old child. The child has just enjoyed a grape ... (Read 101 times)

shofmannx20 · **on:** Jul 22, 2018

The nurse is ready to take vital signs on a 6-year-old child. The child has just enjoyed a grape popsicle. What is the most appropriate action for the nurse?

a. Take the rectal temperature.
b. Take the oral temperature as planned.
c. Have the child rinse out the mouth with warm water.
d. Wait 20 minutes and take the oral temperature.

Question 2

The nurse is caring for a patient intraoperatively. Primary roles of the circulating nurse include

a. Establishing and implementing the plan of care.
b. Maintaining a sterile field.
c. Assisting with applying sterile drapes.
d. Handing sterile instruments and supplies to the surgeon.

jordangronback · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

D
The nurse should wait 20 to 30 minutes before measuring the oral temperature.
The nurse should wait, rather than measuring the child's temperature rectally, as this is not an emergency situation.
Taking the oral temperature at this time would result in an inaccurate reading.
Rinsing the mouth with warm water also may provide an inaccurate reading of the child's actual body temperature. The nurse should wait 20 to 30 minutes and then measure the child's oral temperature.

Answer to Question 2

A
The circulating nurse must be a registered nurse and has the responsibilities of preoperative assessment, establishing and implementing the plan of care, evaluating the care provided, and ensuring continuity of care postoperatively. The scrub nurse, who can be a registered nurse, a licensed practical nurse, or a surgical technologist, maintains the sterile field, assists with applying the sterile drapes, and hands sterile instruments and supplies to the surgeon.