NCLEX questions

About the second question - When I took Peds a few months ago, the recommendation for pediatric patients with diarrhea was a diet called - MYCV (meat, yogurt, c? and vegetables). This is basically a normal diet. We used to use the BRAT diet - bananas, rice, applesauce and toast, but this was not sufficient to meet the nutritional needs of the child. I have provided a link to a more thorough discussion of diet related to diarrhea.

http://www.practicalgastro.com/pdf/June07/June07DuroArticle.pdf

1- upper airway obstruction. on my book says i had to follow the 5+5 rule, which is 5 back blows + 5 abdominal thrust. one the question says that a woman gasps for breath and grasp her throat. what do you have to do first?. i answer "lean the woman foward and administer back blows", but it says that the correct answer is ask the woman if she can speak. what if she can not?, do we do something different?

this is a basic cpr (bcls) class question. your first intervention is to say, "are you choking? can you speak?" if a person can speak, there is no airway obstruction, so the other interventions are not indicated. if she cannot, indicating object in airway so air cannot make vocal cords work, then proceed to back blows to dislodge it and heimlich to expel it.

2.- acute diarrhea ralated to gastroenteritis in 3 years old. no evidence of dehydratation. what do you should recommend?. on my book says that the clear liquid diet is for acute vomiting and diarrhea. but the correct answer is start the usual diet right away, offering food as tolerate. the rational for that is "once the rehydratacion has occured a normal diet is without addverse effect, decrease the duration and severity of the illness and improve weight gain. and it says that clear liquid by mouth is not recommended for managing diarrhea, bacause they are high in sugar and low in electrolytes.

you have a kiddo with diarrhea but he is not dehydrated. he also doesn't have acute vomiting. therefore he is in good shape for absorption. the rationale says that if rehydration has occurred a normal diet is ok because it helps the kid feel better faster and lets him gain weight. what's difficult to understand about that?

clear liquids that are high in sugar can increase fluid loss by osmosis; bad idea. low in electrolytes: kid has already lost electrolytes with his diarrhea. normal diet will restore them.

Regarding the first answer, you want to assess first....asking the woman if she can speak is a way to assess her airway. This is a question where you are given assessment and implementation answers. So you look at the stem of the question and ask if there is enough information there for you to act or do you need to do something in order to validate or determine the correct action to take next, and if so, then you pick the assessment. So in this case, you need to assess airway first....by asking her if she can speak.

Thanks guys.

I guess I misunderstood the question, as by the posture of the woman, I tought that she had the airway occluded.

And about the diarrhea, thanks for the info. I guess the key of the question is the hydratation status. What if the questions says the kid is dehydratated?, Do you start IV fluids or oral fluids?

Thanks

the point there is that you have to assess the most important things first-- and you won't find anything that says posture is a way to assess airway. the question wanted to know if you knew that.

if a child is dehydrated (fewer syllables, please ) your interventions depend on where you practice. we're assuming you are not in post-disaster haiti or somalia. here, you, the nurse, cannot start an iv unless it is part of a medical plan of care. if the child is not vomiting, he will be able to rehydrate himself with oral fluids but remember that he should have a normal diet and not be limited to clear liquids, for the reasons noted above, absent very specific conditions not given in your question.

I hope you dont mind if I build on this thread. Ive been using Kaplan to study and it says that you can assume you have a Dr order for any intervention that is listed. I have not at all found this to be so on the practice questions for most nclex questions. The statement in the answer will ussually be worded "as prescribed" or something along those lines. Who has taken nclex? Can we assumer orders for all interventions listed? If it states, give xyz med, is it okay to do so?

no, you ought never to assume this. if it is so, you will see "as prescribed" or something like that in the question. the reason for this is because a significant number of medication errors are made by nurses who give meds without a valid order. this question is only partly about the medication. it's mostly about whether you know whether to do the right thing, which is often more assessment but if that's not a choice, then it is sometimes nursing interventions.

keep this in mind: nclex doesn't want to know how/when you would turf off something to another specialty, whether it's chaplaincy, social work, dietary, physician, or anyone else. they want to know what you know and are going to do about nursing. hope that's helpful.