A 9-year-old client presents to the emergency department after a bee sting and experiencing bouts of nausea and vomiting. The nurse notes the client's blood pressure is 68/40 mm Hg, pulse is 148 beats/minute. 02 saturation is 86%, and the child is dyspneic. Which action is the nurse's priority?

Administer benadryl.

Apply ice to the site.

Give epinephrine.

Determine if the sting is in situ

Answer and Explanation

The Correct Answer is C

A. Administering Benadryl may help with allergic reactions but is not the immediate priority when the patient is showing signs of severe hypotension and respiratory distress.

B. Applying ice to the site may help with local swelling but does not address the systemic reaction the child is experiencing.

C. Giving epinephrine is the priority action as it counteracts the anaphylactic reaction, improves blood pressure, and alleviates respiratory distress.

D. Determining if the sting is in situ is less critical than addressing the child's life-threatening symptoms.

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Correct Answer is ["B","F"]

Explanation

A. Small bladder capacity can contribute to enuresis but may not need to be ruled out before addressing psychological factors.

B. Urinary tract infections can cause enuresis and should be evaluated and treated before investigating psychological causes.

C. Stress incontinence typically refers to the involuntary loss of urine due to pressure and may be a psychological factor rather than a physiological cause.

D. Regression can be a behavioral response but is not a medical cause that needs to be ruled out.

E. Cognitive dysfunction can contribute to enuresis but is not primarily a medical cause that needs to be ruled out.

F. Diabetes mellitus can lead to increased urination (polyuria) and should be evaluated as a potential medical cause before considering psychological factors.

A. Encouraging frequent, thorough handwashing B. Having the child sleep in a single bed and room. C. Encouraging frequent close contact with visitors. D. Cheering up the environment with fresh flowers and plants. E. Protecting the central venous access device from non-sterile access

Correct Answer is ["C","D"]

Explanation

A. Frequent, thorough handwashing is essential to prevent infection, especially for immunocompromised children.

B. Having the child sleep in a separate bed and room may help minimize exposure to pathogens from family members.

C. Encouraging frequent close contact with visitors increases the risk of infections and should be avoided.

D. Fresh flowers and plants can harbor bacteria and should be avoided in the environment of an immunocompromised child.

E. Protecting the central venous access device is vital to prevent infections; this practice should be emphasized.

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A 9-year-old client presents to the emergency department after a bee sting and experiencing bouts of nausea and vomiting. The nurse notes the client's blood pressure is 68/40 mm Hg, pulse is 148 beats/minute. 02 saturation is 86%, and the child is dyspneic. Which action is the nurse's priority?

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Naxlex Comprehensive Predictor Exams

Which cause of pediatric enuresis must be ruled out before psychological causes are investigated? Select all that apply.

Correct Answer is ["B","F"]

Explanation

The nurse is caring for a child with leukemia, a central venous access device, and chemotherapy-induced immunosuppression. Which of the following SHOULD NOT be included in the teaching plan for the child and parents about reducing the child's risk for infection? Select all that apply

Correct Answer is ["C","D"]

Explanation

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A 9-year-old client presents to the emergency department after a bee sting and experiencing bouts of nausea and vomiting. The nurse notes the client's blood pressure is 68/40 mm Hg, pulse is 148 beats/minute. 02 saturation is 86%, and the child is dyspneic. Which action is the nurse's priority?