A parent rushes their pre-school age child to the emergency department with an asthma exacerbation.
Which additional finding should alert the nurse that the child is in acute respiratory distress?

Flaring of the nares.

Bilateral bronchial breath sounds.

Diaphragmatic respirations.

Resting respiratory rate of 35 breaths/minute.

Answer and Explanation

The Correct Answer is A

Flaring of the nares is a sign of respiratory distress in children. It indicates that the child is working harder to breathe.
Choice B rationale
Bilateral bronchial breath sounds are normal and do not indicate acute respiratory distress.
Choice C rationale
Diaphragmatic respirations are normal in children and do not indicate acute respiratory distress.
Choice D rationale
A resting respiratory rate of 35 breaths/minute is within the normal range for a preschoolaged child and does not indicate acute respiratory distress.

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Correct Answer is C

Explanation

Choice A rationale

Keeping the skin incision moist by periodically wetting the dressing is not the recommended care for a myelomeningocele surgical repair. The dressing needs to be kept dry to prevent infection and promote healing.

Choice B rationale

Removing the tape rapidly from the edges of the dressing during a change is not advised. This could potentially damage the skin and disrupt the healing process.

Choice C rationale

An intact dressing protects the incision from fecal contamination, which is crucial in preventing infection. This statement indicates an understanding of the procedure.

Choice D rationale

While it’s important to keep the dressing dry to ensure easy removal of sutures, it’s not the primary concern. The main goal is to protect the incision from contamination.

A. Immunocompromised children can be given a live virus vaccine. B. Children with febrile illness should not receive a vaccine. C. Second doses of vaccines can be given to children with prior allergic reactions. D. Breastfed children cannot receive a vaccine until after the introduction of solid foods. E. Breastfed children cannot receive a vaccine until after the introduction of solid foods.

Correct Answer is B

Explanation

Choice A rationale
Immunocompromised children are generally not given live virus vaccines due to the risk of developing the disease the vaccine is meant to prevent.
Choice B rationale
This is the correct statement. If a child has a fever or is ill, vaccination may be postponed.
Choice C rationale
Second doses of vaccines are generally not given to children who have had allergic reactions to the first dose.
Choice D rationale
Breastfeeding does not interfere with the effectiveness of vaccines. In fact, breastfeeding can enhance the response to certain vaccine antigens.

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A parent rushes their pre-school age child to the emergency department with an asthma exacerbation. Which additional finding should alert the nurse that the child is in acute respiratory distress?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is instructing the parents of a child who underwent a surgical repair of a myelomeningocele on how to change an occlusive dressing on the child’s back. Which parental statement indicates understanding of the procedure?

Correct Answer is C

Explanation

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

The nurse is providing information to a parent of a six-month old about vaccinations. Which statement made by the parent should the nurse recognize as understanding the information?

Correct Answer is B

Explanation

A client’s maternal serum alpha-fetoprotein level is elevated at 17 weeks. What condition should the nurse identify as the likely cause of this increase?

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A 3-year-old male was brought into the emergency room this morning with a sudden onset of “fast and noisy breathing”. After reading the history and physical, the nurse suspects the child has dropdown.

A parent rushes their pre-school age child to the emergency department with an asthma exacerbation.
Which additional finding should alert the nurse that the child is in acute respiratory distress?