Peds 254

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Sample questions from Peds 254

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.At change of shift on a pediatric unit, a 6-year-old with a new tracheostomy has an oxygen saturation of 89% and audible secretions; a 10-year-old awaiting discharge is stable, and two other children are sleeping comfortably. Which client should the nurse assess first?

   • A.A child scheduled for a routine dressing change
   • B.A sleeping child whose parent requested an update
   • C.The child with the new tracheostomy and oxygen saturation of 89%
   • D.The child awaiting discharge instructions

   Rationale: The child with the new tracheostomy has hypoxemia and possible airway obstruction, making airway assessment the immediate priority. Discharge teaching, a family update, and a routine dressing change can wait while the nurse addresses an immediate threat to breathing. Prioritize unstable clients using airway, breathing, and circulation.

2. 2.Refer to the client's chart. Which actions should the charge nurse take in response to the change in the client's status? Select all that apply.

   • A.Assign a nurse to remain with the client while help is summoned
   • B.Delegate medication administration to an unlicensed assistive personnel member
   • C.Notify the rapid response team according to facility criteria
   • D.Ensure the client's airway and oxygen equipment are immediately available
   • E.Ask the nursing assistant to assess the client's breath sounds

   Rationale: The notes show worsening work of breathing and the oxygen saturation fell from 95% to 89%, so the client needs immediate assessment, escalation, and airway support. A nursing assistant cannot perform a focused respiratory assessment, and medication administration is not an appropriate delegation to unlicensed personnel. Assigning someone to remain with the client supports continuous observation while help arrives.

3. 3.During rounds on a pediatric oncology unit, a 9-year-old receiving chemotherapy has an absolute neutrophil count of 400/mm3 and a temperature of 38.3 C (100.9 F). Which action should the nurse take first?

   • A.Give an antipyretic and recheck the temperature in 1 hour
   • B.Place the child in a room with another child who has a mild cold
   • C.Obtain a rectal temperature to confirm the reading
   • D.Notify the provider immediately and initiate the febrile neutropenia protocol

   Rationale: Fever with severe neutropenia can signal a life-threatening infection and requires prompt escalation and treatment. An antipyretic could mask fever, exposure to a sick roommate increases infection risk, and rectal temperatures can injure mucosa. Treat fever in a neutropenic client as an urgent finding.

4. 4.In a pediatric clinic, a 3-year-old with a new prescription for an oral antibiotic is ready to leave, and the parent says they cannot read the medication label. Which nursing action best supports safe care?

   • A.Ask the parent to estimate the dose using a household teaspoon
   • B.Use teach-back with a demonstration of measuring the dose using an oral syringe
   • C.Provide written instructions only and ask the parent to call with questions
   • D.Ask an older sibling to explain the medication schedule

   Answer and rationale are in the full material.

5. 5.Refer to the client's chart. Which nursing action is the priority for this 11-year-old?

   • A.Start the prescribed isotonic fluid bolus and reassess perfusion
   • B.Offer oral fluids and repeat the blood pressure in 4 hours
   • C.Administer an antidiarrheal medication before contacting the provider
   • D.Prepare the client for discharge because the temperature is decreasing

   Answer and rationale are in the full material.