A nurse on a pediatric unit is receiving a report from an assistive personnel (AP). Which of the following clients should the nurse plan to visit first?
A 4-year-old preschooler who has status asthmaticus and a pulse oximetry of 95%
A 1-year-old infant who has roseola and a temperature of 39°C (102.2°F)
A 7-year-old child who has diabetes insipidus and a urine specific gravity of 1.002
A 10-year-old child who has sickle cell anemia and a pain rating of 6 on a 0 to 10 scale
The Correct Answer is C
A. A 4-year-old preschooler who has status asthmaticus and a pulse oximetry of 95%. While status asthmaticus is a serious condition, a pulse oximetry reading of 95% indicates adequate oxygenation, so this child is not in immediate distress.
B. A 1-year-old infant who has roseola and a temperature of 39°C (102.2°F). While the fever requires monitoring and treatment, roseola is typically a self-limiting illness, and this temperature, while high, is not immediately life-threatening.
C. A 7-year-old child who has diabetes insipidus and a urine specific gravity of 1.002. A urine specific gravity of 1.002 indicates very dilute urine, which is concerning for diabetes insipidus and potential dehydration. This condition requires immediate attention to prevent severe dehydration and electrolyte imbalance.
D. A 10-year-old child who has sickle cell anemia and a pain rating of 6 on a 0 to 10 scale. While managing pain in sickle cell anemia is important, the child’s condition is stable, and pain relief can be addressed after assessing the more urgent case of potential dehydration in the child with diabetes insipidus.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["3.8"]
Explanation
Convert the child’s weight to kg:
22 lb ×1kg/2.2lb = 10 kg
Calculate the daily dose:
1.5 mg/kg/day × 10 kg=15mg/day
Divide the total daily dose by the number of doses per day (every 6 hours):
15mg/day ÷ 4doses/day =3.75mg/dose
Convert the dose to mL using the concentration:
3.75mg × 1 mL/1 mg = 3.75 mL
Round to the nearest tenth:
3.75mL≈ 3.8 mL
Answer: The nurse should administer 3.8 mL per dose.
Correct Answer is B
Explanation
A. Gently reinsert the tubes. Tympanostomy tubes should not be reinserted by the parent. Inserting the tubes requires medical expertise and should be performed by a healthcare professional to avoid damaging the ear.
B. Call the health care clinic to report that the tubes have fallen out. This is the correct action. The healthcare provider needs to be informed to assess if new tubes are necessary. Tubes may naturally fall out as part of the healing process, but professional evaluation is essential to determine the next steps.
C. Reassure the mother that the tubes will not fall out. It is incorrect to reassure the parent that the tubes will not fall out. Tubes can fall out naturally as the eardrum heals, and parents should be prepared for this possibility and know the appropriate steps to take.
D. Take the child to an emergency department. This is generally not necessary unless there are signs of complications such as severe pain, infection, or significant hearing loss. Routine follow-up at the clinic is sufficient for a non-emergency situation like a tube falling out.
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