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An anxious and irritable preschooler arrives in the ER, refusing to lie down to be examined. The child sits, leans forward in onto the hand, and drools saliva. The child is warm to the touch, is using accessory muscles to breath, and pale in color. The nurse should: Place in the correct order from highest to lowest priority (assume you can only do one at a time).

Notify the physician

Take the child’s vital signs

Start an IV

Draw blood gasses

Prepare for intubation

Answer and Explanation

The Correct Answer is E,A,C,D,B

1. Prepare for intubation

2. Notify the physician

3. Start an IV

4. Draw blood gasses

5. Take the child's vital signs

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

a) Handwashing is the most important factor in reducing the spread of the virus: Correct, hand hygiene is crucial in preventing the transmission of Hepatitis A.

b) We understand that early treatments with gamma-globulins can help our child: Correct, gamma-globulin treatment can offer passive immunity.

c) We will clean contaminated surfaces with bleach: Correct, using bleach is effective in disinfecting contaminated surfaces.

d) We should feed our child a high-fat diet: Hepatitis A does not require a high-fat diet. In fact, a low-fat diet is often recommended during the acute phase of the illness to reduce stress on the liver. This statement indicates a need for further education.

A. The infant has blood in urine B. The infant has received two doses of morphine per PRN orders C. The infant has voided one time since returning from surgery D. Double diapering the infant has resulted in the stent being free from stool contamination

Correct Answer is A

Explanation

a) Blood in the urine after hypospadias repair could indicate postoperative bleeding, and it's a significant finding that should be reported promptly to the surgeon.

b) Administration of morphine according to PRN orders is a common postoperative pain management strategy and might not require immediate reporting unless there are concerns about the dosage or the child's response.

c) Voiding once after surgery is expected and not necessarily concerning unless there are additional issues or complications.

d) Ensuring the stent is free from stool contamination is important for postoperative care but doesn't require immediate reporting to the surgeon unless there are signs of infection or other complications.

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Naxlex Comprehensive Predictor Exams

The nurse is teaching the parents of a child diagnosed with Hepatitis A about care and prevention of transmission. Which of the following statements by the parents indicate more education is needed?

Correct Answer is D

Explanation

Following a hypospadias repair, the 10-month-old child returns from the operating room with a urethral stent. It is now 8 hours since the child’s surgery. Which assessment finding should be reported to the surgeon?

Correct Answer is A

Explanation

A 14-year-old boy who has experienced frequent ear infections has recently been diagnosed with conductive hearing loss. Which of the following should the clinic nurse assess?

You are caring for a 14-year-old patient in the ER following a motor vehicle accident. The patient is exhibiting moderate respiratory distress, with decreasing LOC and becoming hypotensive. On chest X:ray, there is air in the pleural space with tracheal deviation. You suspect which condition?

Expected symptoms in an infant with pyloric stenosis:

In the pediatric well-child clinical, the nurse explains the reason for an immunization series to the child’s mother. This action represents which term?

Which intervention is appropriate for a child receiving a high dose of steroids?

A parent questions how her toddler plays with other toddlers. Which response by the nurse displays the best description of the differences in play between the toddler and the preschool-age child?

A newborn is suspected of having cystic fibrosis. As the child is being prepared for transfer to the pediatric hospital, the mother asks the nurse which symptoms made the practitioner suspect cystic fibrosis. Which response by the nurse is most appropriate?

What is the cardinal sign a nurse would expect to observe with intussusception?