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A nurse is assessing an 8-year-old child who has early indications of shock. After establishing and stabilizing the child's respirations, which of the following actions should the nurse take next?

Measure weight and height.

Insert an indwelling urinary catheter.

Initiate IV access.

Maintain ECG monitoring.

Answer and Explanation

The Correct Answer is C

A. Measuring weight and height is not an immediate priority in the management of shock.

B. Inserting an indwelling urinary catheter is not a priority in the early management of shock.

C. Initiating IV access is crucial for fluid resuscitation and medication administration in a child with shock.

D. While ECG monitoring is important, it is not as immediately necessary as establishing IV access for shock management.

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Correct Answer is ["5.3"]

Explanation

Rationale:

Convert pounds to kilograms: 28 lb / 2.2 = 12.7 kg (rounded to the nearest tenth)

Calculate the required dose: 12.7 kg * 10 mg/kg = 127 mg

Calculate the volume to administer: (127 mg / 120 mg) * 5 mL = 5.3 mL (rounded to the nearest tenth).

A. Auscultating the rate and characteristics of the child's heart sounds B. Using a pain-rating tool to determine the severity of the joint pain C. Assessing the client's erythematous rash D. Identifying the degree of parental anxiety related to the diagnosis

Correct Answer is A

Explanation

A. Acute rheumatic fever can cause carditis, which may lead to heart murmurs, tachycardia, or heart failure. Assessing heart sounds is a priority to identify potential complications.

B. Joint pain is an important concern in acute rheumatic fever, but the immediate priority is assessing for signs of carditis or heart complications.

C. An erythematous rash is a characteristic of acute rheumatic fever but is less critical to address immediately compared to potential cardiac involvement.

D. Parental anxiety should be addressed, but the priority is assessing the child’s physical condition, particularly the heart.

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A nurse is assessing an 8-year-old child who has early indications of shock. After establishing and stabilizing the child's respirations, which of the following actions should the nurse take next?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer acetaminophen 10 mg/kg/dose to a child who weighs 28 lb. The amount available is acetaminophen 120 mg/5 mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["5.3"]

Explanation

A nurse is caring for an 8-year-old child who has acute rheumatic fever. Which of the following assessments is the nurse's priority immediately after admission?

Correct Answer is A

Explanation

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