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Chapter 51
Format: Multiple Choice
Client Needs: Health Promotion and Maintenance
Cognitive Level: Apply
Integrated Process: Nursing Process
Page and Header: 1867, Health History
- The nurse is caring for a 6-year-old girl who was injured in a bicycle accident.
- “Has she been diagnosed with any chronic disorders?”
- “Is your daughter currently taking any medications?”
- “Is she allergic to any medications or drugs?”
- “Tell me how the bicycle accident happened.”
Which question would be most important for the nurse to ask during the health history?
Ans:D
Feedback:
The priority inquiry is to determine the nature of the emergency so that appropriate interventions may be initiated. This will also provide direction for obtaining more in- depth information as time permits. Information about allergic reactions to drugs, medications being taken, and chronic disorders that may affect treatment will be gathered next.
Format: Multiple Choice
Client Needs: Safe and Effective Care Environment: Management of Care
Cognitive Level: Apply
Integrated Process: Nursing Process
Page and Header: 1879, 1884, Laboratory and Diagnostic Testing, Box 51.1
Test Bank for Maternity and Pediatric Nursing 4e Susan Ricci, Theresa Kyle, Susan Carman (All Chapters 1-51, 100% Original Verified, A+ Grade) All Chapters Arranged Reverse: 51-1.This is The only Original Test Bank in the Market for 4th Edition, All other files in the Marker are Fake/Old/Wrong Edition. 1 / 4
- The nurse is caring for a 7-year-old boy experiencing respiratory distress who
- Administering a sedative to help calm the child
- Assisting the child to lie still during the chest radiograph
- Accompanying the child to continue observation
- Informing the child that he might hear a loud banging noise
is scheduled to have a chest radiograph. What would be most important for the nurse to include in the child’s plan of care?
Ans:B
Feedback:
Chest radiographs that disclose alterations in normal anatomy or lung expansion, or evidence of pneumonia, tumor, or foreign body, are commonly performed for respiratory emergencies. Therefore, the nurse would need to assist the child in remaining still during the procedure. A sedative may be ordered for magnetic resonance imaging (MRI). Accompanying the child to continue observation would be necessary if the child was to undergo a computed tomography scan. Telling the child about a loud banging noise would be appropriate if the child was having an MRI.
Format: Multiple Choice
Client Needs: Safe and Effective Care Environment: Management of Care
Cognitive Level: Apply
Integrated Process: Nursing Process
Page and Header: 1866, 1884, Common Medical Treatments, Box 51.1
- A 5-year-old girl is cyanotic, dusky, and anxious when she arrives in the
- Ventilating the child with a bag-valve-mask
- Estimating the child’s weight using a Broselow tape
- Providing therapy using automated external defibrillation
- Using rescue breathing and chest compressions 2 / 4
emergency department. Which action would be most appropriate?
Ans:A
Feedback:
The child is exhibiting signs of ineffective oxygenation and ventilation. Therefore, ventilating the child with a bag-valve-mask and 100% oxygen would be effective and efficient. Estimating the child’s weight with a Broselow tape is typically done by ambulatory care providers. According to the American Heart Association, automated external defibrillators are recommended for use in children who are older than age
- year who have no pulse and have suffered a sudden, witnessed collapse outside
the hospital setting. Rescue breathing and chest compressions are implemented for children who are not breathing and do not have a pulse or when the pulse rate is less than 60 beats per minute.
Format: Multiple Choice
Client Needs: Physiological Integrity: Physiological Adaptation
Cognitive Level: Apply
Integrated Process: Nursing Process
Page and Header: 1886, Shock
- When caring for an 8-year-old boy injured in an automobile accident, the
- Assisting ventilation with a bag-valve-mask (BVM) device
- Treating ventricular fibrillation using a defibrillator
- Managing compensated shock to prevent decompensated shock
- Treating supraventricular tachycardia using cardioversion
nurse demonstrates understanding of the principles of Pediatric Advanced Life Support (PALS) by which action?
Ans:C
Feedback:
The principles of PALS stress evaluating and managing compensated shock with the goal of preventing decompensated shock and thereby preventing cardiopulmonary arrest. Assisting ventilation with a BVM device, treating ventricular fibrillation using a defibrillator, and treating supraventricular tachycardia using cardioversion are interventions that may be used to treat both children and adults. 3 / 4
Format: Multiple Choice
Client Needs: Safe and Effective Care Environment: Management of Care
Cognitive Level: Analyze
Integrated Process: Nursing Process
Page and Header: 1867, Airway Evaluation and Management
- A 9-year-old girl who has fallen from a second-story window is brought to the
- Evaluating pupils for equality and reactivity
- Monitoring oxygen saturation levels
- Asking the child if she knows where she is
- Using the appropriate pain assessment scale
emergency department. Which assessment would be the priority?
Ans:B
Feedback:
Airway is always the priority in any emergency situation. Therefore, monitoring oxygen saturation levels, part of the rapid cardiopulmonary assessment, would be performed before any of the other assessments. Evaluating pupils for equality and reactivity, asking the child if she knows where she is, and using an appropriate pain assessment scale are assessments that would follow the ABCs.
Format: Multiple Choice
Client Needs: Safe and Effective Care Environment: Safety and Infection Control
Cognitive Level: Apply
Integrated Process: Nursing Process
Page and Header: 1877, Physical Examination
- The parents bring their 3-year-old son to the emergency department after he
- / 4
ingested some of his mother’s medicine. Which assessment would be of critical importance for this child?
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