A nurse is providing discharge teaching to the parent of an 18-month old toddler who has dehydration as a result of acute diarrhea. Which of the following statments by the parent indicates an understanding of the teaching?
"I will monitor my child's number of wet diapers."
A nurse i caring for a preschooler who has been receiving IV fluids via a peripheral IV catheter. When preparing to discontinue the IV fluids and catheter, which of the following actions should the nurse plan to take?
1. Turn off the IV pump.
2. Occlude the IV tubing.
3. Remove the tape securing the catheter.
4. Apply pressure over the catheter insertion site.
A nurse i preparing to collect a sample from a toddler for a sickle-turbidity test. Which of the following actions should the nurse plan to take?
Perform a finger stick.
A nurse in an emergency department is performing a physical assessment on a 2-week-old male infant. Which of the following manifestations is the priority for the nurse to report to the provider?
Substernal retractions
A nurse is providing anticipatory guidance to the mother of a toddler. Which of the following expected behavior characteristics of toddlers should the nurse include in the teaching?
Expresses likes and dislikes
A nurse in a provider's office is caring for a school-age child who has varicella. The parent asks the nurse when her child will no longer be contagious. Which of the following responses should the nurse make?
When your child's lesions are crusted, 6 days after they appear.
A nurse is teaching the parents of a school-age child who has a new diagnosis of osteomyelitis of the tibia. The nurse should ID that which of the following statments by the parents indicates an understanding of the teaching?
My child will receive antibiotics for several weeks
A nurse is performing hearing screenings for children at a community health fair. Which of the following children should the nurse refer to a provider for a more extensive hearing evaluation?
An infant who is 8 months old and is not yet making babbling sounds
A nurse is caring for a 15 year old client following a head injury. Which of the following findings should the nurse ID as an indication that the child is developing syndrome of inappropriate antidiuretic hormone secretion?
Mental confusion
A nurse is caring for a preschooler who is scheduled for hydrotherapy treatment for wound debribement following a burn injury. Which of the following actions should the nurse take prior to the procedure?
Administer an analgesic to the child
A nurse is providing teaching to the parents of a preschooler who has heart failure and who is to begin taking digoxin twice daily. Which of the following instructions should the nurse include in the teaching?
"Brush the child's teeth after giving the medication"
A nurse in the emergency department is caring for a toddler who has partial-thickness burns on his right arm. Which of the following actions should the nurse take?
Cleanse the affected area with mild soup and water
A nurse in an emergency department is assessing a 3month old infant who has rotavirus and is experiencing acute vomiting and diarrhea. Which of the following manifestations should the nurse ID as an indication that the infant has moderate to severe dehydration?
Sunken anterior fontanel
A nurse is receiving change-of-shift report on four children. Which of the following children should the nurse assess first?
A toddler who has a concussion and an episode of forceful vomiting
A nurse is assessing a client who has a new diagnosis of celiac disease. Which of the following clinical manifestations should the nurse expect?
Steatorrhea
A nurse is teaching the parent of a newborn about ways to prevent SIDS. Which of the following instructions should the nurse include?
Give the infant a pacifier at bedtime
A nurse is assessing the vital signs of a 10 year old child following a burn injury. Which of the following clinical manifestations indicate early septic shock?
Temperature 39.1 C
A nurse at an urgent care clinic is assessing an adolescent client who has an upper respiratory tract infection. Which of the following findings should the nurse recognize as a manifestation of pertussis?
Dry, hacking cough
A nurse is auscultating the lungs of an adolescent who has asthma. The nurse should ID the sound as which of the following?
Tachypnea
A nurse is providing teaching to the family of a school-age child who has juvenile idiopathic arthritis. Which of the following instructions should the nurse include in the teaching?
Encourage the child to perform independent self-care
A nurse is assessing an adolescent who received a sodium polystyrene sulfonate enema. Which of the following findings indicate effectiveness of the medication?
The adolescent's serum potassium level is 4.1 mEq/L
A nurse is reviewing the lab report of an infant who is receiving treatment for severe dehydration. The nurse should ID that which of the following lab values indicates effectiveness of the current treatment?
Sodium 140 mEq/L
A nurse is planning care for a toddler who has a serum lead level of 4 mcg/dL. Which of the following actions should the nurse plan to take?
Schedule the toddler for a yearly rescreening
A charge nurse in an emergency department is preparing an in-service for a group of newly licensed nurses on the clinical manifestations of child maltreatment. Which of the following clinical manifestations should the charge nurse include as suggestive of potential physical abuse?
Symmetric burns of the lower extremities
A nurse is assessing an infant who has pneumonia. Which of the following findings is the priority for the nurse to report to the provider?
Nasal flaring
A nurse is creating a plan of care for a preschooler who has Wilms' tumor and is scheduled for surgery. Which of the following interventions should the nurse include?
Avoid palpating the abdomen when bathing the child before surgery
A nurse is creating a plan of care for a toddler who has minimal change nephrotic syndrome and 3+ pitting edema. Which of the following interventions should the nurse include in the plan?
Administer corticosteroids to the toddler
A nurse is creating an educational plan to teach parents about protecting their children from sunburns. Which of the following instructions should the nurse plan to include?
Choose a waterproof sunscreen with an SPF of at least 15
A nurse is preparing to administer an immunization to a 4 year old child. Which of the following actions should the nurse plan to take?
Administer the immunization using a 24-guage needle
A nurse is caring for a toddler who has spastic cerebral palsy. Which of the following clinical manifestations should the nurse expect?
Ankle clonus, exaggerated stretch reflexes, contractures
A nurse in an emergency department is caring for a school-age child who is experiencing an anaphylactic reaction. Which of the following is the priority action by the nurse?
Administer IM epinephrine to the child
A nurse in the emergency department is caring for a school-age child who has epiglottitis. Which of the following actions should the nurse take?
Monitor the child's oxygen saturation
A nurse in the emergency department is caring for an adolescent who has sever abdominal pain due appendicitis. Which of the folloiwng locations should the nurse ID as McBurney's point?
A-The lower right quadrant of the abdomen between the umbilicus and the anterior iliac crest as the location of McBurney's point
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?
Assist the child to a side-lying position on the floor
A nurse is teaching the parents of a toddler who has a cognitive impairment about toilet training. Which of the following instructions should the nurse include in the teaching?
`Award the child with a sticker when he sits on the potty chair.
A nurse is providing dietary teaching to the parent of the school-age child who has celiac disease. The nurse should recommend that the parent offer which of the follwoing foods to the child?
Rice pudding
A nurse is providing discharge teaching to the parents
