A nurse is planning to obtain a rectal temperature from a toddler. Which of the following actions should the nurse take?

Insert the tip of the thermometer 5 cm (2 in) into the rectum.

Place the child in prone position.

Stabilize the thermometer at the distal end.

Direct the tip of the thermometer toward the spine during insertion.

None

Answer and Explanation

The Correct Answer is B

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Correct Answer is B

Explanation

A. "Administer the medication on an empty stomach." Phenytoin can be taken with or without food. Administering with food can reduce stomach upset.
B. "Encourage the child to brush their teeth after each meal." Phenytoin increases the risk of gingival hyperplasia, so regular brushing helps maintain oral hygiene and prevents complications.
C. "Crush the child's medication to mix with applesauce." Extended-release capsules should not be crushed as this alters their intended release mechanism.
D. "Observe the child for diarrhea." Diarrhea is not a common side effect of phenytoin. Monitoring should focus on side effects like gingival overgrowth, nystagmus, or skin rashes.

A. "Place your baby in a side-lying position when sleeping." B. "Use a drop-side crib until your baby is at least 6 months old." C. "Apply a plastic mattress cover to your baby's bed to protect it." D. “Keep your infant restrained when they are in a highchair."

Correct Answer is D

Explanation

A. "Place your baby in a side-lying position when sleeping." The recommended sleep position for infants is on their back to reduce the risk of sudden infant death syndrome (SIDS).
B. "Use a drop-side crib until your baby is at least 6 months old." Drop-side cribs are not recommended due to the risk of injury or suffocation; they have been banned in many regions.
C. "Apply a plastic mattress cover to your baby's bed to protect it." Plastic mattress covers increase the risk of suffocation and are not recommended.
D. "Keep your infant restrained when they are in a highchair." Proper restraints prevent falls or injuries when the infant is seated in a highchair.

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A nurse is planning to obtain a rectal temperature from a toddler. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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