The nurse is taking the vital signs of a toddler who is being admitted to the hospital. Which of the following vital signs should the nurse assess first?
A) Temperature
B) Pulse
C) Blood pressure
D) Respirations
D
Feedback:
The nurse should take respirations before taking other vital signs, because it will be difficult to obtain an accurate respiratory rate if a child is crying.
You might also like to view...
The nursing instructor is explaining the best way to assess whether active immunity has developed from the administration of the hepatitis B series. What would the instructor cite as the best assessment method?
A) Serum antibody levels B) Liver not palpable C) Aspartate aminotransferase within normal limits D) Absence of symptoms of hepatitis B infection
Which of the following statements by a parent indicates a need for the nurse to intervene with teaching?
a. "My 5-month-old infant has been drooling, biting, and running a fever for the past few days. I think he's teething." b. "Jennifer's eyes sometimes cross. But I know that this is normal in 1-month-old babies." c. "My neighbor has been giving her baby solids since he was 8 weeks old. I think I'll wait until my baby is about 5 months old." d. "I put my newborn baby on her side when she goes to sleep. I understand this is the best position."
A staff nurse is facing a dilemma between upholding personal care standards and meeting organizational goals. The nurse manager understands that the best way to assist staff members in resolving ethical dilemmas effectively is to ____
a. Avoid applying any pressure to compromise personal values b. Change their work assignment until the dilemma is resolved c. Continually remind staff of consequences related to ignoring organizational goals d. Refer indecisive staff members for additional training
The day after a vaginal delivery, a client develops painful vesicular lesions on the perineum and vulva which are diagnosed as a primary herpes type 2 infection. What care should the newborn receive?
1. Intravenous acyclovir (Zovirax) and contact precautions 2. Cultures of blood and cerebrospinal fluid and serial chest x-rays every 12 hours 3. Parental rooming-in and four intramuscular injections of penicillin 4. Meticulous hand washing and antibiotic eye ointment administration