Try Naxlex NCLEX-RN (Free-Trial)

A nurse is caring for a 2-year-old male toddler in the emergency department.

Exhibits

Which of the following findings should the nurse identify as an indication that the treatment plan is effective? (Select all that apply.)

Nasal flaring

Retractions

Oxygen saturation

Breath sounds in bilateral bases

Respiratory rate

Heart rate

Answer and Explanation

Correct Answer : C,D,E

Choice A rationale:

Nasal flaring is a sign of respiratory distress. The absence of nasal flaring would indicate improvement, but the presence of nasal flaring indicates ongoing respiratory distress.

Choice B rationale:

Retractions are also a sign of respiratory distress. The reduction or absence of retractions would indicate improvement, but their presence indicates ongoing respiratory distress.

Choice C rationale:

Oxygen saturation is a key indicator of respiratory function. An improvement in oxygen saturation levels (from 89% on room air to higher levels) indicates that the treatment plan is effective in improving the child’s oxygenation.

Choice D rationale:

Breath sounds in bilateral bases are important to assess for improvement in lung function. The presence of clear breath sounds or reduced wheezing indicates improvement in the child’s respiratory status.

Choice E rationale:

Respiratory rate is an important vital sign to monitor in respiratory conditions. A decrease in respiratory rate (from 42 breaths/min to a lower rate) indicates that the treatment plan is effective in reducing the child’s respiratory distress.

Choice F rationale:

Heart rate can be influenced by various factors, including fever, anxiety, and respiratory distress. While a decrease in heart rate may indicate improvement, it is not as specific an indicator of respiratory function as oxygen saturation and respiratory rate.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is D

Explanation

The correct answer is Choice D.

Choice A rationale

Sitting on a nurse’s lap leaning forward is a position that can be used for postural drainage in infants with cystic fibrosis. This position helps drain secretions from the upper lobes of the lungs.

Choice B rationale

The supine position (lying on the back) is also used for postural drainage to target different areas of the lungs. It is not contraindicated for infants with cystic fibrosis.

Choice C rationale

Sitting on a nurse’s lap leaning backward is another position that can be used for postural drainage. This position helps drain secretions from the lower lobes of the lungs.

Choice D rationale

The Trendelenburg position (lying flat on the back with the feet elevated higher than the head) is contraindicated for infants with cystic fibrosis. This position can increase the risk of gastroesophageal reflux and aspiration, which can worsen respiratory symptoms.

A. Vary the child’s schedule each day. B. Provide a daily session with a play therapist. C. Encourage the client to complete school work. D. Discourage visits from the client’s friends.

Correct Answer is C

Explanation

The correct answer is Choice C.

Choice A rationale

Varying the child’s schedule each day can create a sense of unpredictability and insecurity. According to Erikson’s theory of psychosocial development, children in this age group (10 years old) are in the stage of industry versus inferiority. They need a sense of routine and structure to develop a sense of competence and accomplishment. A consistent schedule helps them feel secure and focused on their tasks.

Choice B rationale

Providing a daily session with a play therapist can be beneficial for the child’s emotional well- being. However, it does not directly address the child’s need for a sense of competence and accomplishment. According to Erikson’s theory, children in this age group need to develop a sense of industry by mastering tasks and completing school work.

Choice C rationale

Encouraging the client to complete school work helps promote a sense of industry and competence. According to Erikson’s theory, children in this age group need to develop a sense

of accomplishment through mastering tasks. Completing school work provides them with a sense of purpose and achievement, which is essential for their psychosocial development.

Choice D rationale

Discouraging visits from the client’s friends can lead to feelings of isolation and loneliness. According to Erikson’s theory, social interactions and relationships are important for the child’s psychosocial development. Encouraging visits from friends can help the child feel connected and supported during their hospitalization.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse is caring for a 2-year-old male toddler in the emergency department. Exhibits Which of the following findings should the nurse identify as an indication that the treatment plan is effective? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is presenting an in-service about the use of postural drainage for infants who have cystic fibrosis. Which of the following positions should the nurse identify as being contraindicated for the infant?

Correct Answer is D

Explanation

A nurse is planning care for a 10-year-old child who will be hospitalized for an extended period of time. Which of the following actions should the nurse include in the plan of care to meet the client’s psychosocial needs according to Erikson?

Correct Answer is C

Explanation

The nurse is caring for a client who has heart failure and a history of asthma. The nurse reviews the provider’s orders and recognizes that clarification is needed for which of the following medications?

Which measure would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis (Croup)?

A child is admitted with a suspected diagnosis of Wilms tumor.The nurse should place a sign with which of the following warnings over the child’s bed?

A nurse is caring for a school-age child in the hospital. Exhibits Which of the following assessment findings should the nurse report to the provider? (Select all that apply)

When the nurse examines a toddler, she suggests to his mother that the activity that could most appropriately foster his developmental task according to Erikson would be to:

A nurse is assessing a 3-year-old child and suspects the child may have a developmental delay. Which of the following actions is a priority for the nurse to take?

The nurse notices that a child is spitting up small amounts of blood in the immediate postoperative period after a tonsillectomy.What would be the best intervention?

A nurse is assessing a 2-year-old child at a well-child visit.The child’s parent expresses concern about the child’s increasing temper tantrums and difficult behaviors. Which of the following statements should the nurse respond with?

A nurse is caring for a 2-year-old male toddler in the emergency department.

Exhibits

Which of the following findings should the nurse identify as an indication that the treatment plan is effective? (Select all that apply.)