A new client arrives for a first visit to the pediatric clinic. The nurse will prioritize which step in this appointment?

Determining the chief complaint.

Interviewing the caregiver.

Obtaining biographical data.

Recording the health history.

Answer and Explanation

The Correct Answer is A

Choice A reason: Determining the chief complaint identifies the primary reason for the visit, guiding the assessment and care plan for the child. This aligns with pediatric nursing triage principles, making it the prioritized step to ensure focused, efficient care during the first visit to the clinic.

Choice B reason: Interviewing the caregiver provides context but follows identifying the chief complaint, which directs the conversation. The complaint sets the visit’s focus, making this secondary and incorrect compared to prioritizing the reason for the child’s visit in the initial pediatric clinic appointment.

Choice C reason: Obtaining biographical data is administrative and less urgent than addressing the child’s health concern. The chief complaint drives the clinical encounter, making this less critical and incorrect compared to prioritizing the identification of the primary issue in the first clinic visit.

Choice D reason: Recording the health history is important but comes after understanding the chief complaint, which shapes the history-taking. Identifying the complaint ensures relevance, making this subsequent and incorrect compared to the prioritized step of determining the reason for the child’s visit.

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Correct Answer is C

Explanation

Choice A reason: Removing equipment reduces clutter but is less urgent than preventing falls, especially post-procedure when a child may be disoriented. Ensuring side rails and a low bed prioritizes safety, making this secondary and incorrect for the most immediate action in pediatric post-procedure care.

Choice B reason: Handling contaminated linens follows infection control but is not the immediate safety concern post-procedure. Preventing falls with side rails and a low bed is critical, making this less urgent and incorrect compared to the priority of ensuring the child’s physical safety after the procedure.

Choice C reason: Assessing side rails up and bed lowered prevents falls, the most immediate safety risk post-procedure when a child may be sedated or unsteady. This aligns with pediatric safety protocols, making it the correct statement for the most urgent action in post-procedure interventions.

Choice D reason: Documentation is essential but not immediate compared to fall prevention, which protects the child post-procedure. Side rails and bed positioning take precedence, making this subsequent and incorrect for the most urgent safety action required after a pediatric procedure in the hospital.

A. Hemophilia. B. Congestive heart failure. C. Kawasaki disease. D. Rheumatic fever.

Correct Answer is C

Explanation

Choice A reason: Hemophilia causes bleeding issues, not a strawberry tongue, which is a mucosal symptom. Kawasaki disease’s characteristic tongue appearance matches the description, making this unrelated and incorrect compared to the specific disorder associated with the child’s reported tongue manifestation in the assessment.

Choice B reason: Congestive heart failure affects cardiac function, not oral mucosa, and doesn’t cause a strawberry tongue. Kawasaki disease is the condition linked to this symptom, making this irrelevant and incorrect for the nurse’s recognition of the child’s tongue appearance in data collection.

Choice C reason: A strawberry tongue, with a red, bumpy appearance, is a hallmark of Kawasaki disease, often seen with fever and rash. This aligns with pediatric infectious disease criteria, making it the correct disorder the nurse recognizes based on the caregiver’s description of the child’s tongue.

Choice D reason: Rheumatic fever may cause oral symptoms but not a classic strawberry tongue, which is specific to Kawasaki disease. The latter’s mucosal findings are distinctive, making this less accurate and incorrect compared to identifying Kawasaki disease as the cause of the tongue manifestation.

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A new client arrives for a first visit to the pediatric clinic. The nurse will prioritize which step in this appointment?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is discussing post-procedure interventions with new pediatric nurses. Which statement addresses the most immediate safety action required?

Correct Answer is C

Explanation

The nurse is collecting data from a caregiver, and the caregiver states that the child has had a “strawberry-colored tongue.” The nurse recognizes this as a manifestation of which disorder?

Correct Answer is C

Explanation

The nurse has an order to administer a rectal suppository to a 3-month-old child. In addition to lubricating the suppository, which intervention will help assure appropriate administration of the medication?

The nurse is collecting data on a 4-month-old child brought to the clinic by the caregiver. The nurse observes the child’s mouth and notes a white coating that looks like milk curds. Which of the following questions would be most important for the nurse to ask the caregiver?

The parents of a 16-year-old male are worried about recent changes in his behavior, ignoring his schoolwork and sports, and spending almost all of his free time interacting with his girlfriend. Which suggestion should the nurse point out would best address this situation?

The parents and their child with a chronic illness have been seen by the nurse in the pediatrician’s office since birth. Which situation is appropriate for instruction by the nurse?

The caregiver of a 2-year-old calls the clinic concerned that her child may have pushed paper into her ears, and she asks the nurse what to do. The mother found the child pushing on her ears with torn paper on the floor in front of her. What would be the appropriate response by the nurse?

The nurse is preparing a safety presentation for a health fair for families. Which instruction should the nurse prioritize when illustrating car safety and the family?

A young child has been admitted with a diagnosis of enterobiasis (pinworm infection). This child will most likely have a history of: