As a nurse caring for a school-age child, the nurse may anticipate which primary stressor/fear?

Loss of privacy and control.

Separation anxiety

Fear of pain/bodily injury.

Stranger anxiety.

Answer and Explanation

The Correct Answer is C

School-age children typically have a growing awareness of their bodies and an understanding of potential harm or pain. They may fear procedures or treatments that involve physical discomfort, such as injections, blood draws, or invasive procedures. The fear of experiencing pain or bodily injury can cause anxiety and distress in school-age children.

It is important for the nurse to acknowledge and address the child's fear of pain or bodily injury by providing age-appropriate explanations, offering reassurance, and implementing strategies to minimize discomfort. This may involve using distraction techniques, providing emotional support, and ensuring proper pain management during procedures.

While loss of privacy and control, separation anxiety, and stranger anxiety can also be stressors for school-age children, the fear of pain or bodily injury is often a significant concern that may require specific attention and interventions from the nurse.

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Correct Answer is B

Explanation

A blood glucose level of 40 mg/dL indicates severe hypoglycemia, which is a medical emergency requiring immediate attention. Hypoglycemia can lead to confusion, altered mental status, seizures, and loss of consciousness if not treated promptly. Therefore, it is crucial to assess and intervene quickly to raise the patient's blood glucose level to a safe range.

While the other clients mentioned also require attention and appropriate care, the severity and immediate risk associated with severe hypoglycemia make it the priority situation. The nurse should initiate appropriate treatment for hypoglycemia, such as administering glucose or glucagon, and closely monitor the patient's response.

A. Give 0.9% Sodium Chloride fluid bolus. B. Give Pantoprazole (Protonix 40 mg IV push dally. C. Give Acetaminophen (Tyler) 550 mg rectally. D. Give rapid acting insulin per sliding scale.

Correct Answer is A

Explanation

The patient's vital signs indicate signs of septic shock, including low blood pressure (70/46 mm Hg), tachycardia (136 beats/min), and tachypnea (32 breaths/min). The patient also has a high temperature of 104°F, indicating a fever. These findings suggest a systemic response to an infection that is leading to inadequate tissue perfusion.The initial treatment for septic shock includes fluid resuscitation to improve blood pressure and tissue perfusion. A fluid bolus of 0.9% Sodium Chloride (normal saline) is commonly used to restore intravascular volume in septic shock. It helps to increase blood pressure, improve organ perfusion, and stabilize the patient's condition.

The other interventions, such as administering Pantoprazole (Protonix) for gastrointestinal protection, giving Acetaminophen (Tylenol) for fever control, or administering rapid-acting insulin per sliding scale for hyperglycemia, are important aspects of care but should be implemented after the initial fluid resuscitation. The priority at this moment is to address the patient's hypotension and inadequate tissue perfusion through the administration of fluid bolus.

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As a nurse caring for a school-age child, the nurse may anticipate which primary stressor/fear?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

After a change-of-shift report, which client should the nurse assess first?

Correct Answer is B

Explanation

A patient with sepsis has a BP of 70/46 mm Hg, pulse of 136 beats/min, respirations of 32 breaths/min, temperature of 104°F, and blood glucose of 245 mg/dL. Which intervention ordered by the health care provider should the nurse implement first?

Correct Answer is A

Explanation

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