A school nurse is assessing a school-age child’s blood pressure while he is seated in a chair. The child starts to experience a tonic-clonic seizure. Which of the following actions should the nurse take first?
- A. Clear the immediate area around the child of hazardous objects
- B. loosen the child’s restrictive clothing
- C. assist the child to a side-lying position on the floor
- D. apply an oxygen mask to the child
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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Postanesthetic respiratory illness in premature infants should be avoided in infants younger than what postconceptual age?
- A. 44 weeks
- B. 46 weeks
- C. 48 weeks
- D. 50 weeks
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A healthcare professional is preparing to insert an intravenous catheter for a 7-year-old child. Which of the following actions should the professional take?
- A. Apply an anesthetic cream to the insertion site 1 hr before the procedure.
- B. Use a 16-gauge needle for the insertion.
- C. Insert the catheter into a vein of the child's dominant hand.
- D. Choose a site over the child's metacarpal veins.
Correct Answer: A
Rationale: Applying an anesthetic cream to the insertion site 1 hr before the procedure is crucial when inserting an intravenous catheter in a child to minimize pain and discomfort during the procedure. This practice is especially important in pediatric patients to ensure a more comfortable experience and improve cooperation during the insertion process.
A healthcare professional is planning care for an infant with hyperbilirubinemia receiving phototherapy. Which of the following actions should the healthcare professional include in the plan?
- A. Dress the infant in light, breathable clothing.
- B. Turn and reposition the infant every 4 hours.
- C. Offer the infant frequent, small feedings.
- D. Avoid using lotions on the infant's skin.
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
When planning care for a newborn with esophageal atresia and tracheoesophageal fistula, which is the priority nursing diagnosis?
- A. Ineffective Tissue Perfusion
- B. Ineffective Infant Feeding Pattern
- C. Acute Pain
- D. Risk for Aspiration
Correct Answer: D
Rationale: The priority nursing diagnosis for a newborn with esophageal atresia and tracheoesophageal fistula is 'Risk for Aspiration' because of the potential respiratory complications associated with these conditions. The newborn is at a higher risk of aspirating oral or gastric contents due to the abnormal connections between the esophagus and trachea, posing a serious threat to the airway and lungs. Addressing this risk is crucial to prevent respiratory distress and maintain the airway's patency, making it the priority nursing diagnosis in this scenario.
When the home health nurse visits the home of a 10-month-old child, she observes the environment for risks of injury to the child. Which observation will the nurse discuss with the mother?
- A. The mother leaves the filled mop bucket on the floor while in another room.
- B. The mother turns all pan handles to the back of the stove.
- C. The mother fills the bathtub before bringing the baby into the bathroom.
- D. When riding in a car, the child is in a car seat in the middle of the back seat.
Correct Answer: A
Rationale: The correct answer is A because leaving a filled mop bucket on the floor poses a drowning hazard for a 10-month-old child. Water in the bucket can be a potential drowning risk if the child falls into it. Pan handles turned to the back of the stove prevent accidental spills or burns. Filling the bathtub before bringing the baby into the bathroom helps in preventing burns from hot water. Placing the child in a car seat in the middle of the back seat provides safety by minimizing the risk of injury during a car ride.