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A nurse is preparing to obtain a blood pressure reading from a school-age child. Which of the following actions should the nurse take?

Record the diastolic value as the first Korotkoff sound (K1).

Release the cuff pressure at a rate of about 5 mm Hg/second.

Position the child's arm at the level of the heart.

Select a cuff with a bladder size that is approximately 20% of the child's upper arm circumference.

Answer and Explanation

The Correct Answer is C

Rationale:

A) The diastolic value is recorded as the disappearance of Korotkoff sounds (K5), not the first sound (K1).

B) The cuff pressure should be released at a rate of 2-3 mm Hg/second, not 5 mm Hg/second.

C) Positioning the child's arm at the level of the heart ensures an accurate blood pressure measurement.

D) The cuff bladder size should be approximately 40% of the child's upper arm circumference, not 20%.

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Correct Answer is B

Explanation

Rationale:

A. Excessive juice does not cause constipation, but it can reduce the appetite for other foods.

B. A 15-month-old toddler needs about 500 milligrams of calcium per day to support bone growth and development. Calcium can be found in dairy products, fortified cereals, and leafy green vegetables.

C. Toddlers need approximately 1,000 to 1,300 calories per day to support their rapid growth and development. Therefore, 1500- 1800 calories per day is too much for a toddler.

D. While toddlers may experience changes in appetite, there is no specific age-related sudden increase at 18 months mentioned in nutritional guidelines.

A. Request that the adolescent sign a consent for treatment form prior to performing STI screening. B. Instruct the adolescent that a guardian must be present to provide consent for STI screening. C. Plan to notify the adolescent's guardian if the STI screening comes back positive. D. Obtain phone consent from the guardian of the adolescent prior to performing STI screening.

Correct Answer is A

Explanation

Rationale:

A) Adolescents have the right to consent to their own medical care for STI screening and treatment in many jurisdictions.

B) Instructing the adolescent that a guardian must be present for consent may discourage them from seeking necessary care due to privacy concerns.

C) Confidentiality is essential in healthcare, and unless there are specific legal or ethical reasons to involve the guardian, the adolescent's privacy should be respected.

D) Obtaining phone consent from the guardian may not be necessary if the adolescent is capable of consenting to their own care.

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A nurse is preparing to obtain a blood pressure reading from a school-age child. Which of the following actions should the nurse take?

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Naxlex Comprehensive Predictor Exams

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