ASSURED PASS
A nurse is assisting with the admission of a toddler who has bacterial meningitis caused by
Haemophilus influenzae type B. Which of the following isolation guidelines should the nurse
plan to initiate?
Droplet precautions
The nurse should plan to initiate droplet precautions for this child, because bacterial meningitis
caused by Haemophilus influenzae type B is transmitted through the air via large-particle
droplets.
A nurse is reinforcing teaching to the guardian of a toddler who is receiving chemotherapy and
has developed stomatitis. Which of the following instructions should the nurse include in the
teaching?
Frequently rinse the mouth with chlorihexidine mouthwash
The nurse should encourage the guardian to rinse the toddler's mouth frequently with
chlorhexidine mouthwash.
A nurse is reinforcing discharge teaching with the guardians of a 6month old infant following a
surgical procedure to repair a hypospadias. Which of the following instructions should the nurse
include?
,Wait 1 week before giving the infant a tub bath
Keep the infants penis as dry as possible until the stent or cather is removed.
The nurse should instruct the guardians to keep the infant's penis as dry as possible until the
stent or catheter is removed. The parent should provide sponge-baths to the child until the
stent or catheter is removed.
A nurse is reviewing the laboratory findings of a school-age child who reports feeling tired and
being easily bruised. Which of the following laboratory values should the nurse report to the
provider?
Platelets 85,000/mm3
This value is below the expected reference range for a school-age child and should be reported
to the provider.
A nurse is contributing to the plan of care for a child who has type 1 diabetes mellitus and is
experiencing an acute illness. Which of the following actions should the nurse include in the
plan of care?
- Encourage an increased fluid intake to flush out ketones and prevent dehydration; this can lead
to DKA
The nurse should encourage an increased fluid intake to flush out ketones and prevent
dehydration. Children who have diabetes mellitus and an acute illness are more likely to
, experience ketonuria and hyperglycemia. Dehydration increases the risk of the child developing
diabetic ketoacidosis.
A nurse is contributing to the plan of care for a child who is in Buck's traction. Which of the
following interventions should the nurse include in the plan?
Maintain the leg in an extended position
-decreases the risk for further injury to the extremity and minimizes the occurrence of muscle
spasms
A nurse in a pediatric clinic is caring for an infant who has heart failure and a prescription for
digoxin. Which of the following statements by the parent indicates desired therapeutic effect of
the medication?
My baby is breathing easier than she used to
-Digoxin(increases cardiac output and decrease venous pressure and pulmonary edema, which
will reduce respiratory demands
A nurse is caring for a group of children in an acute care setting. The nurse should identify that
which of the following children is at risk for impaired elimation?
A child who has hyperglycemia
-A client who has hyperglycemia exhibits manifestations of polyuria, lethargy, confusion, thirst,
nausea, vomiting, abdominal pain, signs of dehydration, rapid respiration, and fruity breath. A
child who has hyperglycemia is at risk for dehydration