A nurse is preparing to insert a peripheral intravenous (IV) catheter for a preschooler. Which of the following actions should the nurse take?

Ask the child to hold their breath while the IV catheter is placed.

Explain the procedure to the child in detail.

Apply vapocoolant spray before the IV insertion.

Place the IV catheter on the dominant arm.

Answer and Explanation

The Correct Answer is C

A. "Ask the child to hold their breath while the IV catheter is placed." Holding breath can increase anxiety and is not necessary for IV insertion. Instead, distraction techniques (e.g., deep breathing, counting) are more effective.
B. "Explain the procedure to the child in detail." Preschoolers have limited understanding of medical procedures. Instead, use simple, age-appropriate language and possibly a demonstration with a toy.
C. "Apply vapocoolant spray before the IV insertion." Vapocoolant spray or topical anesthetics (e.g., EMLA cream) help reduce pain and anxiety associated with IV insertion.
D. "Place the IV catheter on the dominant arm." IV placement is typically based on vein accessibility, not dominance. However, placing it on the non-dominant arm may be preferable to avoid interference with activities.

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Correct Answer is B

Explanation

A. Heart rate – No data regarding heart rate is provided in the exhibit, so this is not a relevant option.
B. HbA1c – The child's HbA1c level is 8.5%, which is elevated above the normal range (4% to 5.9%). This indicates poor glycemic control, suggesting the development of cystic fibrosis-related diabetes (CFRD), a common complication of cystic fibrosis. This should be reported to the provider for further evaluation and management.
C. WBC count – The WBC count is 9,600/mm³, which is within the normal range (5,000 to 10,000/mm³), so it does not require reporting.
D. Oxygen saturation – No data regarding oxygen saturation is provided in the exhibit, making this option irrelevant.

A. Pinpoint pupils B. Sunken anterior fontanel C. Hypertonia D. Vomiting

Correct Answer is D

Explanation

A. "Pinpoint pupils." A subdural hematoma typically causes unequal or dilated pupils due to increased intracranial pressure (ICP), rather than pinpoint pupils, which are more commonly associated with opioid toxicity or pontine damage.

B. "Sunken anterior fontanel." A sunken fontanel is a sign of dehydration. In cases of increased ICP, as seen with a subdural hematoma, the anterior fontanel is more likely to be bulging.

C. "Hypertonia." Neurological changes can occur, but hypotonia (decreased muscle tone) is more common in infants with increased ICP rather than hypertonia (increased muscle tone).

D. "Vomiting." Vomiting is a classic sign of increased ICP in infants, which occurs due to the pressure on the brainstem. Other symptoms may include irritability, a bulging fontanel, seizures, and lethargy.

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Body system	Potential Teachings
Gastrointestinal	______
Dental	______
Hematological	_______

A nurse is preparing to insert a peripheral intravenous (IV) catheter for a preschooler. Which of the following actions should the nurse take?

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Naxlex Comprehensive Predictor Exams

A nurse is reviewing the medical record of a school-age child who has cystic fibrosis. Which of the following findings should the nurse report to the provider? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data.)

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Explanation

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Correct Answer is D

Explanation

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