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A nurse is planning care for a child who has severe diarrhea. Which of the following
actions is the nurse priority? - correct answer assess fluid balance
A nurse is caring for a toddler who's parent states that the child has a mass in his
abdominal area and his urine is a pink color. Which of the following actions is the
nurse's priority? - correct answer instruct the parent to avoid pressing on the
abdominal area
A nurse is caring for a child who has acute glomerulonephritis. Which of the following
actions is the nurse's priority? - correct answer check the childs weight daily
A nurse is caring for a child who has a suspected diagnosis of bacterial meningitis.
Which of the following is the nurse's priority? - correct answer administer antibiotics
when available
A nurse is collecting data from an adolescent. Which of the following represents the
greatest risk for suicide? - correct answer active psychiatric disorder (mark, mental
problems, patients mind is unstable)
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A nurse is collecting data from an infant who has otitis media (middle ear infection).
The nurse should expect which of the following findings? - correct answer tugging on
the affected ear lobe
A nurse is reinforcing reaching with a parent of a 1 month old infant who is to undergo
the initial surgery to treat hirschsprung's disease (a ganglionic megacolon, part of the
colon isn't connected to the nerves or not functioning, so there will be an increase size
of the colon and stool gets stuck in there). Which of the following statements should
indicate to the nurse that the parent understanding the goal of surgery? - correct
answer "i'm glad that the ostomy is only temporary " (1st there going to cut the
nonfunctioning of the colon, and then apply temporary colostomy, after a couple of
months they will suture it together)
A nurse is caring for an infant who is 1 day postoperative following surgical repair of a
cleft lip. Which of the following actions should the nurse take? - correct answer apply
an antibiotic ointment to the suture site
A nurse is reinforcing discharge instructions with a parent of a child who has cystic
fibrosis. Which of the following statements by the parent indicates an understanding of
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the teaching? - correct answer "i will make sure my child washes her hands before
eating"
A nurse working at a clinic speaks on the telephone with a parent of a 2-monthold
infant. The parent tells the nurse that the infant has projectile vomiting followed by
hunger after meals. Which of the following response by the nurse is appropriate? -
correct answer "bring your infant into the clinic today to be seen"
A nurse is caring for a 4 year old child who is 2 days postoperative following the
insertion of a ventriculoperitoneal shunt. Which of the following findings should the
nurse identify as the priority . (causes icp hydrocephalus) - correct answer lethargy
(high pitched cry, respiratory changes, bradycardia, wide pulse pressure, irritability
A nurse is caring for a child following an open reduction and internal fixation of a
fractured femur and application of a cast. The cast has a window cut in it for viewing of
the incision. Which of the following actions should the nurse take first? - correct
answer perform neurovascular checks of the affected extremity (check for infection,
color, capillary refill, redness)