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Question 1 of 5

The parent of a 7-month-old reports that the child has been crying and vomiting with a distended belly for the past 4 hours. The infant is now lying quietly in the parent's arms with a pulse of 200/min and respirations of 60/min. Which of the following components of SBAR (situation, background, assessment, recommendation/read back) communication is most important for the nurse to report?

Correct Answer: C

Rationale: The infant's lethargy with tachycardia (200/min) and tachypnea (60/min) are critical, suggesting a serious condition like intussusception or volvulus, requiring urgent reporting. Duration , perceived improvement , and laxative suggestion are less critical.

Question 2 of 5

The nurse is caring for a client who had surgery yesterday. When administering omeprazole, the client asks 'What is that for? I don't take it at home.' Which reply by the nurse is most appropriate?

Correct Answer: B

Rationale: Omeprazole is a proton pump inhibitor used postoperatively to prevent stress ulcers due to surgical stress. It does not affect gastric emptying , prevent infections , or assume GERD without a diagnosis.

Question 3 of 5

The nurse is planning a client care conference with the parents of a 3-year-old with newly diagnosed type 1 diabetes mellitus. What is the priority outcome for the caregivers?

Correct Answer: B

Rationale: The priority outcome for caregivers of a child with type 1 diabetes is knowing how to keep blood sugars stable , as this directly impacts the child's health and prevents complications. Coping , meal planning , and follow-up are important but secondary.

Question 4 of 5

A young adult has been diagnosed with Type 1 diabetes mellitus. The client asks how his condition differs from that of his grandmother who has Type 2 diabetes mellitus. What should the nurse include when replying?

Correct Answer: A

Rationale: Type 1 diabetes involves autoimmune destruction of pancreatic beta cells, causing insulin deficiency; Type 2 involves insulin resistance. Insulin may be used in Type 2, and diet or progression are not defining factors.

Question 5 of 5

The nurse is to administer an iron injection to an adult. How should this be administered?

Correct Answer: D

Rationale: Iron injections are given via Z-track intramuscular in the gluteal muscle to prevent leakage and skin staining, ensuring deep muscle administration.

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