A nurse is caring for a child in the emergency department (ED).

Exhibits
For each potential intervention, click to specify if the potential intervention is expected or unexpected for the client. There must be at least 1 selection in every row. There does not need to be a selection in every column.

Have child tilt head back

Insert cotton into nostril

Apply ice to bridge of nose

Apply pressure to tip of nose for at least 10 min

Prepare to administer factor VIII

Prepare to administer topical antifibrinolytic agent

Prepare to administer packed red blood cells

Answer and Explanation

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

Potential Intervention	Expected	Unexpected	Rationale
Have child tilt head back		✅	Tilting the head back increases the risk of blood being swallowed, which can cause nausea or aspiration.
Insert cotton into nostril		✅	Cotton can be ineffective and may dislodge, worsening bleeding. Use gauze or a nasal tampon if needed.
Apply ice to bridge of nose	✅		Cold vasoconstricts blood vessels, helping reduce nasal bleeding.
Apply pressure to tip of nose for at least 10 min	✅		First-line measure for anterior epistaxis. Correct site is the soft part (lower third) of the nose.
Prepare to administer factor VIII	✅		The child has a Factor VIII deficiency (35%), which is diagnostic of Hemophilia A. Factor VIII replacement is the treatment.
Prepare to administer topical antifibrinolytic agent	✅		These agents help stabilize clots and are used for mucosal bleeds in hemophilia.
Prepare to administer packed red blood cells		✅	Not indicated unless there is severe blood loss with signs of anemia or hemodynamic instability, which is not present here.

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Correct Answer is C

Explanation

A. Steatorrhea

This refers to fatty, foul-smelling stools and is associated with malabsorption syndromes (e.g., celiac disease), not UTIs.

B. Jaundice

Jaundice is typically associated with liver or hemolytic conditions. It is not a symptom of a urinary tract infection.

C. Incontinence

In a toilet-trained toddler, new or increased episodes of incontinence may indicate a UTI. Toddlers may have difficulty expressing pain or urinary urgency, so regression in toilet habits is often a key indicator.

D. Rebound tenderness

Rebound tenderness indicates peritoneal irritation, seen in conditions like appendicitis—not in uncomplicated UTIs.

A. Iron deficiency anemia B. Vitamin A toxicity C. Impaired carbohydrate metabolism D. Lactose intolerance

Correct Answer is A

Explanation

A. Iron deficiency anemia

Whole milk is low in iron and can interfere with iron absorption. Excessive milk intake can also displace iron-rich foods from the diet, increasing the risk of iron deficiency anemia.

B. Vitamin A toxicity

Vitamin A toxicity is usually caused by over-supplementation, not milk intake. Milk does contain vitamin A, but not in levels high enough to cause toxicity in this context.

C. Impaired carbohydrate metabolism

There is no link between drinking whole milk and impaired carbohydrate metabolism. This would be more associated with inborn errors of metabolism.

D. Lactose intolerance

Lactose intolerance presents with gastrointestinal symptoms (bloating, diarrhea, etc.) after consuming dairy, not poor appetite. Also, toddlers with lactose intolerance typically avoid milk due to discomfort.

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A nurse is caring for a child in the emergency department (ED). Exhibits For each potential intervention, click to specify if the potential intervention is expected or unexpected for the client. There must be at least 1 selection in every row. There does not need to be a selection in every column.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a toddler who is toilet-trained and has a temperature of 38.5° C (101.3° F). Which of the following findings should the nurse recognize as an indication of a urinary tract infection (UTI)?

Correct Answer is C

Explanation

A nurse is caring for a toddler who drinks 946 mL (32 oz) of whole milk per day and has a poor appetite. The nurse should identify the toddler as being at risk for which of the following conditions?

Correct Answer is A

Explanation

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A nurse is caring for a child in the emergency department (ED).

Exhibits
For each potential intervention, click to specify if the potential intervention is expected or unexpected for the client. There must be at least 1 selection in every row. There does not need to be a selection in every column.