A nurse is creating a plan of care for a school-age child who has heart disease and has developed heart
failure. Which of the following interventions should the nurse include in the plan?
Provide small, frequent meals for the child.
The metabolic rate of a child who has heart failure is high because of poor cardiac function. Therefore,
the nurse should provide small, frequent meals for the child because it helps to conserve energy.
A nurse is teaching the parent of an infant who has a Pavlik harness for the treatment of developmental
dysplasia of the hip. The nurse should identify that which of the following statements by the parent
indicates an understanding of the teaching?
"I will place my infant's diapers under the harness straps."
To prevent soiling of the harness, the parent should apply the infant's diaper under the straps.
A nurse is planning care for a school-age child who is in the oliguric phase of acute kidney injury (AKI)
and has a sodium level of 129 mEq/L. Which of the following interventions should the nurse include in
the plan?
Initiate seizure precautions for the child.
A sodium level of 129 mEq/L indicates hyponatremia and places the child at increased risk for
neurological deficits and seizure activity. The nurse should complete a neurologic assessment and
implement seizure precautions to maintain the child's safety.
A nurse is assessing a school-age child immediately following a perforated appendix repair. Which of the
following findings should the nurse expect?
Absence of peristalsis
The nurse should expect absence of peristalsis immediately following a perforated appendix repair, until
the bowel resumes functioning.
A nurse is preparing an adolescent for a lumbar puncture. Which of the following actions should the nurse
take?
Apply topical analgesic cream to the site 1 hr prior to the procedure.
The nurse should apply a topical analgesic to the lumbar site 1 hr prior to the procedure to decrease the
adolescent's pain while the lumbar needle is inserted.
A nurse is caring for a school-age child who is receiving cefazolin via intermittent IV bolus. The child
suddenly develops diffuse flushing of the skin and angioedema. After discontinuing the medication
infusion, which of the following medications should the nurse administer first?
Epinephrine
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