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In a 12-year-old child with a history of epilepsy brought to the emergency department after experiencing a 10-minute seizure, what is the nurse's priority intervention?
- A. Administer oxygen
- B. Administer antiepileptic medication as prescribed
- C. Monitor the child's vital signs
- D. Check the child's blood glucose level
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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The nurse is measuring the frontal occipital circumference (FOC) of a 3-months old infant, and notes that the FOC has increased 5 inches since birth and the child's head appears large in relation to body size. Which action is most important for the nurse to take next?
- A. Measure the infant's head-to-toe length.
- B. Palpate the anterior fontanel for tension and bulging.
- C. Observe the infant for sunken eyes.
- D. Plot the measurement on the infant's growth chart.
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A 6-year-old child with a history of asthma is brought to the clinic with complaints of wheezing and shortness of breath. The nurse notes that the child is using accessory muscles to breathe. What should the nurse do first?
- A. Administer a bronchodilator
- B. Obtain a peak flow reading
- C. Apply oxygen
- D. Perform a complete respiratory assessment
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A 14-year-old adolescent with a history of substance abuse is brought to the emergency department by the parents, who suspect that the adolescent has relapsed. What is the nurse's priority action?
- A. Obtain a urine sample for toxicology screening
- B. Discuss treatment options with the parents
- C. Establish a therapeutic relationship with the adolescent
- D. Administer a medication to reverse the effects of the substance
Correct Answer: A
Rationale: In this scenario, the nurse's priority action should be to obtain a urine sample for toxicology screening. This step is crucial in identifying the substances involved in the relapse, which will guide appropriate treatment strategies. Establishing a therapeutic relationship and discussing treatment options come after obtaining necessary diagnostic information to ensure a comprehensive care plan.
The parents of a 3-month-old infant are being educated by the healthcare provider about safe sleep practices. Which statement by the parents indicates a need for further teaching?
- A. We will place our baby on their back to sleep
- B. We will use a firm mattress and avoid soft bedding
- C. We will keep our baby in our bed so we can monitor them closely
- D. We will avoid putting toys or pillows in the crib
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
When reinforcing information about the use of corticosteroids in treating asthma in children, which statement indicates that the parent understands the teaching?
- A. My child should take the medication only when experiencing symptoms.
- B. I will rinse my child's mouth after each use of the inhaler.
- C. I should discontinue the medication if my child seems better.
- D. Corticosteroids are used for quick relief during an asthma attack.
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.