The nurse is giving preop I understand I will be in a body cast and I will show you
instructions to a 14 yr old hoy you taught me to turn
scheduled to correct a
spinal curvature. Which
statement best
demonstrates that learning
has taken place?
To take the vital signs of a 4 Respiratory rate, heart rate, rectal temperature
month old child which
order will give the most
accurate results?
AN otoscope exam of a Ask the child if he has has a cold, runny nose or any ear
child's ear reveals a pain lately
tympanic membrane that is
pearly gray, slightly bulging
and not movable. What
action should the nurse take
next?
Which restraint should be elbow
used for a toddler after a
cleft palate repair?
What preoperative nursing Observe for projectile vomiting
intervention should be
included in the plan of care
for an infant with pyloric
stenosis?
,A six month old returns remove restraints one at a time and provide range of
from surgery with elbow motion exercise
restraints in place. What
nursing intervention should
be included when caring
for any restrained child?
A two year old with Down Congenital Heart Disease
Syndrome is brought to the
clinic for his regular
physical exam. The nurse
knows which problem is
frequently associated with
Down Syndrome?
When assessing a child with inspiration
asthma the nurse should
expect intercostal
retractions during
When planning the care for stresses the suture line
a child who has had a cleft
lip repair, the nurse knows
that crying should be
minimized because it
A client with a productive Administer the first dose of prescribed antibiotic therapy
cough has obtained a
sputum specimen for
culture as instructed. What
action is the best initial
nursing action?
, A client is brought to the deep tendon reflexes
Emergency Department by
ambulance in cardiac arrest
with CPR in progress. The
client is intubated and
receiving 100% O2 per
ambu bag. The nurse
determines the client is
cyanotic, cold, and
diaphoretic. Which
assessment is most
important to obtain?
After a hospitalization for Reorientate client to his room
Syndrome of Inappropriate
Antidiuretic Hormone
(SIADH), a client develops
pontine myselinolysis.
Which intervention should
the nurse implement first?
A male client with heart Has his weight changed in the last several days
failure (HF) calls the clinic
and reports he cannot put
his shoes on because they
are too tight. Which
additional information
should the nurse obtain?
An older adult with a long Apply a high flow venturi mask
hx of COPD is admitted
with progressive shortness
of breath and a persistent
cough. She is anxious and is
complaining of a dry mouth.
Which intervention should
the nurse implement?
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