A nurse in the emergency department is caring for a toddler.

Exhibits
The nurse is reviewing the toddler's nurses' notes, vital signs, and intake and output record. For each clinical finding, click to specify if the finding indicates the condition has improved, has not changed, or has declined.

Heart rate

Respiratory rate

Urine output

Mucous membranes

Abdominal examination

Vomiting frequency

Answer and Explanation

The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"B"},"F":{"answers":"A"}}

Heart rate: Not changed

No specific mention of heart rate changes, so it remains unchanged.

Respiratory rate: Not changed

Respirations are described as clear and shallow, with no significant change noted over time. The child's respiratory rate appears stable.

Urine output: Improved

Initially, the output was 8 mL of concentrated urine over 2 hours, and by 1600, the output increased to 30 mL of yellow urine over 2 hours. The improvement in both the volume and color indicates that hydration status is improving.

Mucous membranes: Improved

At 1000, the mucous membranes were described as pale and dry. By 1200, they were pale and sticky, which is still a sign of dehydration, but by 1600, they are likely improving as the child is receiving intravenous fluids and hydration.

Abdominal examination: Not changed

The abdominal examination remains consistent, with mild tenderness on palpation and hyperactive bowel sounds observed throughout the shift. These findings indicate that the child is still experiencing gastrointestinal upset but without significant worsening.

Vomiting frequency: Improved

Vomiting frequency decreased from 8 times in the previous 24 hours to just 1 episode in the past 2 hours, indicating a significant improvement in vomiting control.

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Correct Answer is C

Explanation

A. While handwashing is important, it alone may not prevent the spread of meningitis.

B. Both children, not just the 2-year-old, should avoid contact with the infected infant.

C. Meningitis, especially bacterial forms, can be contagious, and close contact should be minimized to reduce the risk of transmission.

D. Meningitis can be highly transmissible, especially in young children, through respiratory droplets and close contact.

A. Avoid providing sensory stimulation or sensory experiences to prevent overwhelming the child. B. Encourage the child to participate in activities without making accommodations for their sensory impairment. C. Provide consistent routines and structured environments to promote a sense of security and familiarity. D. Minimize communication and interaction with the child to prevent overstimulation

Correct Answer is C

Explanation

A. Avoiding sensory stimulation or experiences entirely is not recommended. While it's important to be mindful of overstimulation, sensory experiences can be beneficial for the development of children with sensory impairments, and they should not be completely avoided unless they are overwhelming.

B. Encouraging the child to participate without accommodations is not appropriate. Children with sensory impairments often need tailored support and accommodations to ensure they can participate in activities safely and effectively.

C. Providing consistent routines and structured environments is crucial for children with sensory impairments. Children with sensory impairments may struggle to process sensory information, and a predictable environment helps them feel safe and secure. Consistency in daily routines can reduce anxiety and help the child engage more effectively in their surroundings.

D. Minimizing communication and interaction with the child can lead to isolation and hinder the development of social skills. Instead, communication should be adapted to meet the child's needs, ensuring they can engage appropriately without feeling overstimulated.

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A nurse in the emergency department is caring for a toddler. Exhibits The nurse is reviewing the toddler's nurses' notes, vital signs, and intake and output record. For each clinical finding, click to specify if the finding indicates the condition has improved, has not changed, or has declined.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for an infant diagnosed with meningitis. The parent of the infant asks how they can prevent the infection from being spread to their other children who are 2 and 4-years of age. Which of the following responses should the nurse make?

Correct Answer is C

Explanation

What is an important nursing consideration when caring for a pediatric client with sensory impairment?

Correct Answer is C

Explanation

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A nurse in the emergency department is caring for a toddler.

Exhibits
The nurse is reviewing the toddler's nurses' notes, vital signs, and intake and output record. For each clinical finding, click to specify if the finding indicates the condition has improved, has not changed, or has declined.