A nurse is monitoring the vital signs of a 6-year-old child following a surgical procedure. Which of the following findings should the nurse report to the provider?
Axillary temperature 37.3° C (99.1° F)
Respiratory rate 24/min
Heart rate 59/min
Blood pressure 96/58 mm Hg
The Correct Answer is C
A. An axillary temperature of 37.3° C (99.1° F) is within the normal range for a child and does not need to be reported.
B. A respiratory rate of 24/min is within the normal range for a 6-year-old child and does not need to be reported.
C. A heart rate of 59/min is slightly below the normal range for a 6-year-old and should be reported to the provider.
D. A blood pressure of 96/58 mm Hg is within the normal range for a 6-year-old child and does not need to be reported.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Alanine aminotransferase (ALT) is a liver enzyme and not typically relevant for diagnosing juvenile idiopathic arthritis.
B. Erythrocyte sedimentation rate (ESR) is a marker of inflammation and is commonly used in the evaluation and monitoring of juvenile idiopathic arthritis.
C. Potassium levels are not directly related to juvenile idiopathic arthritis and its diagnosis.
D. BUN (blood urea nitrogen) is a measure of kidney function and is not specific to juvenile idiopathic arthritis.
Correct Answer is A
Explanation
A. This statement reassures the child that they are not to blame for the maltreatment and supports their emotional well-being.
B. This statement could make the child feel guilty and is not supportive.
C. The nurse cannot promise confidentiality in cases of suspected abuse, as reporting is mandatory.
D. While this statement is supportive, it does not directly address the child's potential feelings of guilt or self-blame.
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