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

Answer and Explanation

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.

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Correct Answer is C

Explanation

A. "SIDS is directly correlated to diphtheria, tetanus, and pertussis vaccines." This statement is incorrect and misleading. There is no direct correlation between SIDS and vaccinations like the diphtheria, tetanus, and pertussis (DTP) vaccines. In fact, immunizations are an important part of a child's health and can help prevent diseases that could lead to complications, including those that might be indirectly related to SIDS risk factors.

B. "SIDS rates have been rising over the last 10 years." This statement is false. SIDS rates have generally been decreasing, especially since the introduction of public health campaigns promoting safe sleep practices, such as placing infants on their backs to sleep.

C. "You should place your baby on her back when sleeping to decrease the risk of SIDS." This is the correct and evidence-based recommendation. Placing a baby on their back to sleep significantly reduces the risk of SIDS. This practice is part of the "Back to Sleep" campaign, which has been shown to lower the incidence of SIDS.

D. "Sleep apnea is the main cause of SIDS." This statement is incorrect. While sleep apnea has been studied as a potential risk factor, it is not considered the main cause of SIDS. The exact cause of SIDS is still unknown, but it is believed to be related to multiple factors, including sleep environment and infant physiology.

A. Initiate droplet precautions. B. Initiate a protective environment. C. Initiate contact precautions. D. Initiate airborne precautions.

Correct Answer is A

Explanation

A. Initiate droplet precautions. Pertussis (whooping cough) is transmitted via respiratory droplets. Droplet precautions are necessary to prevent the spread of the disease through coughs or sneezes.

B. Initiate a protective environment. A protective environment is used for patients with severe immunocompromised conditions to protect them from infections, not to prevent the spread of respiratory infections like pertussis.

C. Initiate contact precautions. Contact precautions are used for infections spread by direct or indirect contact with the patient or their environment, such as MRSA. Pertussis is spread by droplets, not by contact.

D. Initiate airborne precautions. Airborne precautions are for diseases that are spread through airborne particles, such as tuberculosis or measles. Pertussis is not airborne but spread through larger respiratory droplets.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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