A 2-year-old child is admitted with vomiting and diarrhea fo…
A 2-year-old child is admitted with vomiting and diarrhea for 2 days. The nurse assesses dry mucous membranes, decreased tears, sunken eyes, and only one wet diaper during the past 10 hours. The child’s heart rate is 132/min. Which nursing action is the priority?
Read DetailsA 2-year-old child with Tetralogy of Fallot suddenly becomes…
A 2-year-old child with Tetralogy of Fallot suddenly becomes cyanotic and begins breathing rapidly while crying. The nurse recognizes that the child is experiencing a hypercyanotic (“tet”) spell. Which nursing action is the priority?
Read DetailsA nurse is caring for a client at 34 weeks’ gestation who pr…
A nurse is caring for a client at 34 weeks’ gestation who presents with sudden-onset severe abdominal pain and dark-red vaginal bleeding. The uterus is firm and tender to palpation. The client reports that she smokes one pack of cigarettes daily and used cocaine recreationally approximately 24 hours ago. Her pregnancy history includes one previous uncomplicated vaginal delivery. She denies abdominal trauma. Her blood pressure is 148/90 mm Hg, and the fetal heart rate demonstrates recurrent late decelerations.Which factor in the client’s history places her at the greatest risk for abruptio placentae?
Read DetailsThe parent of a 5-year-old child tells the nurse, “My child…
The parent of a 5-year-old child tells the nurse, “My child frequently talks to an imaginary friend named Alex and sometimes asks Alex to play.” The parent is concerned that this behavior indicates a psychiatric disorder. Which response by the nurse is most appropriate?
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