A nurse is reinforcing teaching with the parents of preschoolers regarding the use of booster

seats in a motor vehicle. Which of the following instructions should the nurse include in the

teaching?

- Secure the child in the booster seat using the motor vehicle’s shoulder-lap seat belt—

booster seats do not have built in straps

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—this position decreases the risk for further

injury to the extremity and minimizes the occurrence of muscle spasms.

A guardian calls the clinic nurse after his child has developed symptoms of varicella and asks

when his child will no longer be contagious. Which of the following responses should the nurse

make?

- Six days after lesions appear if they are crusted—as long as they are crusted over.

A nurse is caring for a toddler who has otitis media and a temperature of 102.4 F. Which of the

following actions should the nurse take first?

- Administer an antipyretic—to decrease the toddler’s body temperature

A nurse is caring for an adolescent who has acne and a new prescription for isotretinoin. For

which of the following adverse effects should the nurse monitor?

- Depression—experience mental status changes, such as suicidal thoughts, aggression,

emotional lability, and depression.

A nurse is contributing to the plan of care for a 10 month old infant who is postoperative

following a cleft palate repair. Which of the following actions should the nurse include in the

plan of care?

- Place the infant in side-lying position—promote healing and prevent injury to the

surgical site.

A nurse is reinforcing teaching about sudden infant death syndrome (SIDS) with the parent of a

1 month old infant. Which of the following statements by the parent indicates an

understanding of the teaching?

- I will allow my baby to have a pacifier while sleeping—decreases the risk for SIDS.

A nurse is collecting data from an infant during a well-child visit. Which of the following sites

should the nurse use when obtaining the infant’s heart rate?