A 7-year-old child with a history of asthma presents to the clinic with shortness of breath and wheezing. The nurse notes that the child's peak flow reading is in the red zone. What should the nurse do first?

Correct Answer: A

Rationale: When a child with asthma presents with shortness of breath and wheezing, and the peak flow reading is in the red zone, indicating severe airflow limitation, the priority intervention is to administer a bronchodilator. Bronchodilators help dilate the airways quickly, improving airflow and assisting with breathing. Reassessing the peak flow reading, notifying the healthcare provider, and providing oxygen therapy may be necessary actions but administering a bronchodilator takes precedence in managing acute asthma exacerbation.

Correct Answer: A

Rationale: In a child with type 1 diabetes presenting with abdominal pain, nausea, vomiting, and a high blood glucose level, the priority is to administer IV fluids to correct dehydration and electrolyte imbalances, which are crucial in managing diabetic ketoacidosis. Administering insulin without addressing fluid deficits can lead to further complications. Monitoring urine output and checking for ketones are important steps but providing IV fluids takes precedence in the initial management of this child's condition.

Correct Answer: B

Rationale: The correct answer is B) Administer antiepileptic medication as prescribed. In a 12-year-old child with a history of epilepsy presenting after a prolonged seizure, the priority intervention is to stop the seizure activity promptly to prevent potential brain damage and further complications. Administering antiepileptic medication as prescribed is crucial in this situation to terminate the seizure and stabilize the child's condition. Option A) Administer oxygen may be important in some cases, but in this scenario, stopping the seizure takes precedence over oxygen administration. Option C) Monitor the child's vital signs is important but not the priority when the child is actively seizing, as immediate intervention to stop the seizure is critical. Option D) Check the child's blood glucose level is also important in evaluating potential triggers for seizures, but it is not the immediate priority when the child is actively seizing. Educationally, understanding the urgent nature of managing seizures in pediatric patients is crucial for pediatric nurses. Timely and appropriate administration of antiepileptic medications can prevent complications and improve outcomes in children with epilepsy. This scenario highlights the significance of prioritizing interventions based on the immediate needs of the patient in an emergency situation.

Correct Answer: A

Rationale: In this scenario, the nurse's priority action should be to obtain a urine sample for toxicology screening. This step is crucial in identifying the substances involved in the relapse, which will guide appropriate treatment strategies. Establishing a therapeutic relationship and discussing treatment options come after obtaining necessary diagnostic information to ensure a comprehensive care plan.

Correct Answer: A

Rationale: The appropriate response for the caregiver is to address the parents' concerns by suggesting scheduling a hearing test and potentially referring the child to a speech therapist if necessary. This proactive approach can help evaluate and support the child's hearing and speech development effectively.