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The nurse is evaluating a child's skills in self-administering insulin (see figure). The nurse should:
- A. Have the child use both hands on the syringe.
- B. Ask the child to place the needle at a 45 degree angle.
- C. Tell the child to use a site lower on her thigh.
- D. Remind the child to rotate sites.
Correct Answer: D
Rationale: Rotating insulin injection sites prevents lipodystrophy and ensures consistent absorption. Both hands are typically used, a 90-degree angle is standard for children, and site location depends on rotation.
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A toddler is brought to the emergency room after ingesting an undetermined amount of drain cleaner. The nurse should expect to assist with which of the following first?
- A. Administering an emetic.
- B. Performing a tracheostomy.
- C. Performing gastric lavage.
- D. Inserting an indwelling urinary (Foley) catheter.
Correct Answer: C
Rationale: Gastric lavage is the priority to remove the corrosive substance from the stomach, preventing further damage. Emetics are contraindicated for corrosives as they can worsen injury. Tracheostomy may be needed later for airway issues, and a urinary catheter is not relevant initially.
A 7-year-old child is experiencing pain after an appendectomy. Which data collection tool should the nurse use to assess the pain?
- A. Visual analog scale.
- B. Short Form McGill Questionnaire.
- C. FACES Pain Rating Scale.
- D. Numeric Pain Intensity Scale.
Correct Answer: C
Rationale: The FACES scale is age-appropriate for a 7-year-old to assess pain.
A 2-year-old always puts his teddy bear at the head of his bed before he goes to sleep. The parents ask if this behavior is normal. The nurse should explain to the parents that toddlers use ritualistic patterns to:
- A. Establish a sense of identity.
- B. Establish control over adults in their environment.
- C. Establish sequenced patterns of learning behavior.
- D. Establish a sense of security.
Correct Answer: D
Rationale: Ritualistic behaviors in toddlers provide comfort and security.
Which of the following diet plans would be appropriate for the nurse to discuss with the family of a child with acute renal failure?
- A. High carbohydrate and protein.
- B. High fat and carbohydrate.
- C. Low fat and protein.
- D. Low in carbohydrate and fat.
Correct Answer: A
Rationale: High carb/protein supports nutritional needs.
An 8-year-old has a body mass index (BMI) for age at the 90th percentile, but has no other risk factors. The nurse should:
- A. Refer for a weight management program.
- B. Prescribe a low-calorie diet.
- C. Order fasting glucose levels.
- D. Initiate daily exercise logs.
Correct Answer: A
Rationale: A BMI at the 90th percentile indicates overweight. A weight management program promotes healthy habits. Diet prescription, glucose testing, or exercise logs are premature without further risk assessment.