A nurse is preparing for an incoming storm. Which of the following clients should the nurse recommend for discharge planning?
An infant who has respiratory syncytial virus and a respiratory rate of 70b/min
An adolescent who has cystic fibrosis and is receiving their yearly tune-up
A child who has a new diagnosis of type 1 diabetes mellitus and is receiving IV insulin
A child who has leukemia and an absolute neutrophil count of 200/mm3 (2,500 to 8,000/mm3
The Correct Answer is B
A. An infant who has respiratory syncytial virus and a respiratory rate of 70/min: This infant is experiencing tachypnea, which indicates respiratory distress. Discharging during a storm would place the infant at high risk for decompensation and inadequate access to emergency care.
B. An adolescent who has cystic fibrosis and is receiving their yearly tune-up: A routine annual check-up indicates the adolescent is stable and does not require acute care. This client is the safest candidate for discharge during a storm, as their condition is not immediately life-threatening.
C. A child who has a new diagnosis of type 1 diabetes mellitus and is receiving IV insulin: This child requires close monitoring and titration of insulin therapy, making discharge unsafe. Early management of new-onset diabetes involves frequent assessments that cannot be delayed.
D. A child who has leukemia and an absolute neutrophil count of 200/mm³: Severe neutropenia places the child at high risk for infection. Discharge during a storm could prevent timely access to emergency care if complications arise.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D"]
Explanation
A. Answers questions asked by the nurse: Responding verbally shows the child is engaged and able to understand and participate in the interaction, indicating readiness to cooperate during the assessment.
B. Plays with toys in the examining room: While playing indicates comfort in the environment, it may also reflect distraction or avoidance rather than readiness to cooperate with the nurse’s instructions. Play alone is not a reliable indicator of cooperation.
C. Makes eye contact with the nurse: Eye contact demonstrates attention and willingness to engage with the nurse, which is a positive sign that the child is prepared to follow directions during data collection.
D. Allows the nurse to touch him on the arm: Tolerating touch shows trust and comfort with the nurse’s presence and interventions, signaling the child is ready to participate in the assessment.
E. Sits on his parent's lap when the nurse enters the room: Sitting on a parent’s lap may indicate the child is seeking comfort and security rather than being ready to cooperate independently. This behavior alone does not confirm readiness for assessment.
Correct Answer is A
Explanation
A. Grapes: Grapes are a common choking hazard for toddlers because of their size, shape, and firmness. They can easily block a child’s airway if not cut into small, manageable pieces. Including grapes in the pamphlet raises awareness for parents and caregivers to prevent choking.
B. Potatoes: Cooked, soft potatoes are generally safe for toddlers to eat. They do not pose a significant choking risk when properly prepared, so they are not a primary concern in choking prevention education.
C. Corn: Whole corn kernels are usually safe for toddlers because they are small and soft enough to swallow. Corn does not commonly obstruct the airway unless the child has swallowing difficulties.
D. Oranges: Orange segments are soft and unlikely to cause choking. While seeds or membranes could pose minor risks, oranges are generally considered safe and are not a primary choking hazard for toddlers.
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