A 3-year-old admitted to the hospital with croup has the following vital signs: heart rate 90, respiratory rate 48, blood pressure 100/52, and temperature 98.8°F (37.1°C). The parents ask the nurse if these vital signs are normal. The nurse's best response is:
"Your son's respiratory rate is elevated, but the other vital signs are within the normal range."
"Your son's heart rate is elevated, but the other vital signs are within the normal range."
"Your son's blood pressure is elevated, but the other vital signs are within the normal range."
"Your son's temperature is elevated, but the other vital signs are within the normal range."
The Correct Answer is A
Choice A reason: This is the correct choice. A respiratory rate of 48 is high for a 3-year-old, indicating that the croup is affecting his breathing.
Choice B reason: This choice is incorrect. A heart rate of 90 is within the normal range for a 3-year-old.
Choice C reason: This choice is incorrect. A blood pressure of 100/52 is within the normal range for a 3-year-old.
Choice D reason: This choice is incorrect. A temperature of 98.8°F (37.1°C) is within the normal range for a 3-year-old.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Adolescents are capable of more complex thinking and are less likely to view illness as a punishment for misdeeds.
Choice B reason: Infants do not have the cognitive ability to associate illness with punishment.
Choice C reason: This is the correct choice. Preschool-age children often engage in magical thinking and may view illness as a punishment for misdeeds.
Choice D reason: School-age children are beginning to understand the biological causes of illness and are less likely to view it as a punishment.
Correct Answer is C
Explanation
Choice A reason: Restricting calcium intake is not typically recommended for children with chronic renal failure as they may already be at risk for bone disease due to altered calcium metabolism.
Choice B reason: Eating three large meals per day and limiting snacks is not specific dietary advice for chronic renal failure; nutritional needs should be tailored to the individual.
Choice C reason: This is the correct choice. In chronic renal failure, the kidneys may not be able to remove excess potassium, leading to hyperkalemia, which can be dangerous.
Choice D reason: Increasing sodium intake is not generally recommended for chronic renal failure as it can contribute to hypertension and fluid retention.
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