An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to.
Ask her why she wants to know.
Determine why she is so anxious.
Explain in simple terms how it works.
Tell her she will see how it works as it is used.
The Correct Answer is C
The correct answer is choice C. Explain in simple terms how it works.
Choice A rationale:
Asking the girl why she wants to know might be appropriate in some contexts, but children are naturally curious and seeking information is a common behavior. Explaining how the blood pressure apparatus works would likely be more beneficial than questioning her motivation.
Choice B rationale:
Determining why she is anxious assumes that the girl is anxious, which might not be the case. Additionally, the question she asked does not necessarily indicate anxiety, but rather a curiosity about the medical equipment.
Choice C rationale:
Explaining in simple terms how the blood pressure apparatus works is the most appropriate nursing action. This approach respects the child's curiosity and provides her with age-appropriate information, fostering a positive and educational interaction.
Choice D rationale:
Telling her that she will see how it works as it is used might not fully satisfy her curiosity or address her immediate question. Children often benefit from clear and concise explanations, especially when it comes to medical equipment.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The correct answer is choice C: Administering penicillin.
Choice A rationale:
Imposing strict bed rest for 4 to 6 weeks. This choice is not the most appropriate therapeutic management for rheumatic fever. While rest is important during the acute phase, strict bed rest for 4 to 6 weeks is excessive and could lead to physical deconditioning and psychological distress for the child.
Choice B rationale:
Administering corticosteroids if chorea develops. This choice is relevant to the management of rheumatic fever but is not the primary treatment. Chorea is a movement disorder that can occur as a complication of rheumatic fever. Corticosteroids may be used to manage chorea symptoms, but they are not the mainstay of treatment for rheumatic fever itself.
Choice C rationale:
Administering penicillin. This is the correct choice. Penicillin is the mainstay of treatment for rheumatic fever. It helps eradicate the group A streptococcal infection that triggers the inflammatory response leading to rheumatic fever. Penicillin is essential to prevent further complications such as rheumatic heart disease.

Choice D rationale:
Avoiding salicylates (aspirin). This choice is also relevant to the management of rheumatic fever. Salicylates, including aspirin, are used to relieve symptoms and reduce inflammation. However, in children with acute rheumatic fever, salicylates are contraindicated due to the risk of developing Reye's syndrome, a serious condition that affects the brain and liver.
Correct Answer is C
Explanation
The correct answer is choice C. Dyspnea.
Choice A rationale:
Orthopnea. Orthopnea refers to difficulty in breathing that occurs when lying flat. It is not the term used to describe labored breathing, which is the main concern in this question.
Choice B rationale:
Hypopnea. Hypopnea is a term used to describe shallow or slow breathing, usually during sleep. It is not the term used to describe the labored breathing mentioned in the question.
Choice C rationale:
Dyspnea. This is the correct term to describe labored breathing, which is characterized by a subjective sensation of discomfort or difficulty in breathing. In this context, the nurse is charting that the hospitalized child has labored breathing, indicating the need for further assessment and intervention to address this breathing difficulty.
Choice D rationale:
Tachypnea. Tachypnea refers to abnormally fast breathing. While it is a concern, especially in the context of a hospitalized child, it does not specifically describe labored breathing, which is the main focus of this question.
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