In the pediatric emergency department, the nurse must prioritize patient care. Which patient should the nurse assess first?

The 1-month-old infant who has developed colic and is crying.

The 14-year-old adolescent whose mother suspects her child is sexually active.

The 2-year-old toddler who was bitten by another child at the day-care center.

The 6-year-old school-aged child who was hit by a car while riding a bicycle.

Answer and Explanation

The Correct Answer is D

Choice A reason: While colic can be distressing, it is not life-threatening and does not require immediate assessment over more critical conditions.
Choice B reason: Suspicions of sexual activity in an adolescent are a concern but do not constitute an emergency that requires immediate assessment.
Choice C reason: A bite from another child, although potentially serious, is less urgent than a trauma case and can be assessed after more critical patients.
Choice D reason: This is the correct choice. A child hit by a car may have life-threatening injuries and requires immediate assessment and intervention.

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Correct Answer is A

Explanation

Choice A reason: This is the correct choice. Thick pulmonary secretions are a hallmark of cystic fibrosis and must be addressed in the care plan.
Choice B reason: While cystic fibrosis can affect various glands, the primary concern is the respiratory system.
Choice C reason: Elevated levels of chloride, not potassium, are found in the sweat of individuals with cystic fibrosis.
Choice D reason: Cystic fibrosis is an autosomal recessive disorder, not dominant. This is important for genetic counseling and understanding the inheritance pattern.

A. Risk for Altered Tissue Perfusion B. Impaired Physical Mobility C. Risk for Altered Nutrition: Less than Body Requirements D. Risk for Fluid Imbalance

Correct Answer is A

Explanation

Choice A reason: A third-degree circumferential burn can compromise blood flow, posing an immediate risk for altered tissue perfusion, which can lead to tissue necrosis and limb loss.

Choice B reason: While impaired physical mobility is a concern, it is not as immediately life-threatening as altered tissue perfusion.

Choice C reason: Nutritional needs are important for healing, but the immediate threat to life from a third-degree burn is the risk for altered tissue perfusion.

Choice D reason: Fluid imbalance is a significant concern due to the potential for burn-induced edema and dehydration; however, the most immediate life-threatening issue is altered tissue perfusion.

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In the pediatric emergency department, the nurse must prioritize patient care. Which patient should the nurse assess first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Betty is a 9-year-old girl diagnosed with cystic fibrosis. Which of the following must you, as the nurse, keep in mind when developing a care plan for the child?

Correct Answer is A

Explanation

What is the highest priority nursing diagnosis for a pediatric client with a third-degree circumferential burn of the right arm?

Correct Answer is A

Explanation

Which nursing intervention will assist a toddler-age client in end-stage renal failure the most?

A client with an arterial ischemic leg ulcer is being discharged from the hospital. Which instruction is most important for the nurse to include in this client's discharge teaching plan?

When planning care for a client newly diagnosed with open-angle glaucoma, the nurse identifies a priority nursing problem of visual sensory-perceptual alterations. This problem is based on which etiology?

What notable sign most likely indicates increased intracranial pressure in an infant?

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