Page 588 - Saunders Comprehensive Review For NCLEX-RN

3. Advise the family to visit only during the scheduled visiting
hours.
4. Provide a private room, allowing the child to bring favorite toys
from home.
158. A 16-year-old client is admitted to the hospital for acute appendicitis and an
appendectomy is performed. Which nursing intervention is most
appropriate to facilitate normal growth and development postoperatively?
1. Encourage the client to rest and read.
2. Encourage the parents to room in with the client.
3. Allow the family to bring in the client’s favorite computer games.
4. Allow the client to interact with others in his or her same age
group.
159. Which car safety device should be used for a child who is 8 years old and 4
feet tall?
1. Seat belt
2. Booster seat
3. Rear-facing convertible seat
4. Front-facing convertible seat
160. The nurse assesses the vital signs of a 12-month-old infant with a respiratory
infection and notes that the respiratory rate is 35 breaths per minute. On the
basis of this finding, which action is most appropriate?
1. Administer oxygen.
2. Document the findings.
3. Notify the pediatrician.
4. Reassess the respiratory rate in 15 minutes.
161. The nurse is monitoring a 3-month-old infant for signs of increased
intracranial pressure. On palpation of the fontanels, the nurse notes that the
anterior fontanel is soft and flat. On the basis of this finding, which nursing
action is most appropriate?
1. Increase oral fluids.
2. Document the finding.
3. Notify the pediatrician.
4. Elevate the head of the bed to 90 degrees.
162. The nurse is evaluating the developmental level of a 2-year-old. Which does
the nurse expect to observe in this child?
1. Uses a fork to eat
2. Uses a cup to drink
3. Pours own milk into a cup
4. Uses a knife for cutting food
163. A 2-year-old child is treated in the emergency department for a burn to the
chest and abdomen. The child sustained the burn by grabbing a cup of hot
coffee that was left on the kitchen counter. The nurse reviews safety
principles with the parents before discharge. Which statement by the parents
indicates an understanding of measures to provide safety in the home?
1. “We will be sure not to leave hot liquids unattended.”
2. “I guess our children need to understand what the word hot
means.”
3. “We will be sure that the children stay in their rooms when we

588