A child is brought to the emergency department with burns on the face and chest. What is the nurse's first priority?

Remove clothing.

Administer pain medication.

Assess respiratory status.

Insert a Foley catheter.

Answer and Explanation

The Correct Answer is C

A. Remove clothing. Removing clothing is important to prevent further injury from retained heat or chemicals, but it is not the first priority compared to ensuring a patent airway and adequate breathing.
B. Administer pain medication. Pain management is important but comes after ensuring the child's airway and respiratory status are stable.
C. Assess respiratory status. Burns on the face and chest can compromise the airway and breathing. Assessing respiratory status is the first priority to ensure the child’s airway is not obstructed and that they are receiving adequate oxygen.
D. Insert a Foley catheter. Inserting a Foley catheter may be necessary to monitor urine output and assess kidney function in severe burns, but it is not the first priority compared to assessing respiratory status.

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Correct Answer is C

Explanation

A. Take the prescribed insulin 30 minutes before practice or game time rather than in the morning. Insulin timing should generally be consistent with meal times to match insulin action with food intake. Adjusting timing without medical advice can lead to imbalanced blood sugar levels.
B. Eat half the amount of food normally eaten at lunchtime. Eating less food than usual can lead to hypoglycemia during prolonged physical activity and is not recommended.
C. Eat six graham crackers or drink a cup of orange juice before practice or game time. This action helps to prevent hypoglycemia during physical activity by providing quick-acting carbohydrates that can be readily absorbed and utilized by the body.
D. Take two times the amount of prescribed insulin on practice and game days. Doubling insulin doses without medical supervision can lead to hypoglycemia and is not appropriate for managing blood sugar during physical activity.

A. Projectile vomiting after feedings B. Absent bowel sounds C. Increased sodium level D. Golf ball-size mass over the left quadrant

Correct Answer is A

Explanation

A. Projectile vomiting after feedings: Projectile vomiting after feedings, especially occurring a short time after feeding, is a classic sign of pyloric stenosis due to obstruction at the pylorus.
B. Absent bowel sounds: Absent bowel sounds may occur in more advanced cases of bowel obstruction but are not specific to pyloric stenosis.
C. Increased sodium level: Increased sodium level is not typically associated with pyloric stenosis.
D. Golf ball-size mass over the left quadrant: A palpable mass in the left quadrant is not a typical finding in pyloric stenosis.

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A child is brought to the emergency department with burns on the face and chest. What is the nurse's first priority?

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Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

A nurse is collecting data from an infant. Which of the following is a clinical manifestation of pyloric stenosis?

Correct Answer is A

Explanation

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