Correct Answer: D

Rationale: The startle reflex should diminish by this age; persistence requires evaluation.

Correct Answer: B

Rationale: In pediatric patients, digoxin administration is guided by the heart rate. If the child's heart rate is below the established threshold, which is typically 90-100 beats per minute in a 4-year-old, the medication should be withheld, and the healthcare provider should be notified for further evaluation and instructions.

Correct Answer: C

Rationale: During a tonic-clonic seizure, the priority action is to turn the child to the side. This helps maintain an open airway and prevents aspiration of secretions or vomitus. It also helps in keeping the airway clear and promotes safety during the seizure episode. Administering oxygen, inserting an oral airway, and starting an IV line are important interventions but should follow the initial step of positioning the child to prevent airway obstruction.

Correct Answer: D

Rationale: For a lumbar puncture in a school-age child, EMLA cream should be applied 2.5 hours before the procedure. EMLA is commonly used to numb the skin, reducing pain and discomfort for the child during the procedure.

Correct Answer: C

Rationale: In a scenario where a 6-month-old infant is unresponsive and not breathing after the airway is open, giving two breaths that make the chest rise is the appropriate action. This helps deliver oxygen to the infant's lungs and can help initiate breathing. Chest compressions are not recommended for infants as the first step in resuscitation. Checking pulses like the femoral or carotid pulse is not the priority when an infant is not breathing, as providing oxygen through breaths is essential.