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A 13 year old adolescent is brought to the Emergency Department after a near-drowning/submersion event. The child is coughing and having difficulty breathing. 02 saturation is 90% in room air, RR=26/min, HR=102/min. What is the priority intervention for the nurse to take?

Administer sedation

Check capillary refill

Have the child sit in an upright position

Administer oxygen at 2L/min via face mask

Answer and Explanation

The Correct Answer is D

A. Sedation is not a priority; maintaining adequate oxygenation is critical first.

B. Capillary refill can be assessed but is not an immediate intervention.

C. Sitting upright can aid breathing but does not directly address hypoxia.

D. Administering oxygen helps correct hypoxemia, which is the immediate priority in respiratory distress.

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Correct Answer is A

Explanation

A. Children with Down syndrome often experience developmental delays, and explaining this helps reassure the parent.

B. While a physical therapist may be helpful, the nurse should first address the parent's concerns with information.

C. Asking about siblings does not address the parent's specific concern.

D. Asking about other milestones may shift focus away from the parent's immediate worry.

A. Hypotension B. Hyperthermia C. Weakened gag reflex D. Polyuria E. Absence of bowel sounds

Correct Answer is ["A","B","C","E"]

Explanation

A. Hypotension is common due to neurogenic shock in spinal cord injuries.

B. Hyperthermia can result from loss of autonomic control of temperature regulation.

C. A weakened gag reflex is possible with cervical spinal injuries, increasing the risk of aspiration.

D. Polyuria is not a common complication directly related to spinal cord injury.

E. Absence of bowel sounds can indicate paralytic ileus, a potential complication in spinal cord injuries.

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A 13 year old adolescent is brought to the Emergency Department after a near-drowning/submersion event. The child is coughing and having difficulty breathing. 02 saturation is 90% in room air, RR=26/min, HR=102/min. What is the priority intervention for the nurse to take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The clinic nurse talks with the parent of a child with Down syndrome. The parent states, "I thought my 1-year-old would be walking by now. I am concerned." What response by the nurse is best?

Correct Answer is A

Explanation

A nurse in the emergency department is monitoring a client who has a cervical spinal cord injury from a fall. The nurse should monitor the client for which of the following complications? (Select all that apply.)

Correct Answer is ["A","B","C","E"]

Explanation

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