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A nurse is conducting a well-child assessment on a 24-month-old client during a routine health visit. The parent reports that the child “still looks pot-bellied,” occasionally falls while attempting to run, has had three episodes of otitis media in the past 6 months, and recently began refusing new foods based on texture.Assessment findings include:• Weight: 12.1 kg• Height: 86 cm• Head circumference equals chest circumference• Anterior fontanel closed• Respirations abdominal; HR and RR slightly lower than at 12 months• Walks independently but runs unsteadilyWhich finding would require further evaluation?

A 6-year-old client is scheduled for same-day outpatient tonsillectomy. The parents state they were unable to attend a preadmission tour and appear anxious on the morning of surgery. The child is withdrawn and clings to the parent.Which nursing action best reflects evidence-based care of the child and family in the ambulatory or outpatient setting?

A nurse is counseling the parent of a 20-month-old client who has recently begun refusing assistance with dressing, frequently says “no,” insists on using the same cup at every meal, and has intense temper tantrums when routines are disrupted. The parent reports, “I think my child is becoming manipulative and spoiled.”Which nursing response most accurately interprets the client’s behavior within the framework of psychosocial development?

A 5-year-old child with extensive partial- and full-thickness burns is scheduled for a painful wound debridement procedure in the burn unit. The nurse reviews the pharmacologic plan with the healthcare team. The provider orders IV propofol with supplemental opioid analgesia for procedural sedation.Which explanation best justifies this medication strategy in pediatric burn management?

A pediatric nurse is caring for a 14-year-old client who has been immobilized for several weeks following spinal trauma. During morning rounds, the nurse notes mild lower-extremity edema, decreased exercise tolerance, diminished breath sounds in the lung bases, and complaints of generalized weakness. The nurse anticipates multiple physiologic consequences related to prolonged immobilization and plans interventions to prevent further complications.Which nursing intervention most directly addresses the primary physiologic mechanism responsible for the client’s increased risk of pulmonary embolism associated with prolonged immobilization?

A 9-year-old client is undergoing an emergent open reduction of a femur fracture under general anesthesia with inhaled anesthetics and succinylcholine. Forty minutes into the procedure, the anesthesia provider reports a rapid increase in end-tidal carbon dioxide (ETCO?) despite increasing ventilation. The client’s heart rate rises from 92 to 148 beats/min, jaw rigidity is noted, and the temperature increases from 37.1°C (98.8°F) to 38.9°C (102.0°F) within minutes. Which action by the nurse is most appropriate at this time?

A 3-year-old client (weight 14 kg) is admitted with viral gastroenteritis and fever of 39.5°C (103.1°F). The child has had multiple episodes of diarrhea and mild tachypnea. The provider orders maintenance IV fluids. The nurse calculates the child’s basal maintenance requirement using standard weight-based guidelines and considers necessary adjustments. Which calculation and interpretation by the nurse is most appropriate?

A 4-year-old client is admitted for surgical repair of an umbilical hernia. Before transport to the operating room, the child begins crying and repeatedly asks, “Will my tummy fall out?” The child clutches the abdomen and refuses to let staff approach.Which nursing intervention is most appropriate to minimize this child’s fear of bodily injury?

A 5-year-old client is brought to the emergency department (ED) at 10:30 PM for fever and cough. The child is stable, playful, and in no acute distress. The parent states, “I was afraid the illness would suddenly get worse during the night.” The triage nurse determines that the symptoms are consistent with a mild viral respiratory infection.Which nursing action is most appropriate in managing this emergency admission situation?

A 4-month-old client is brought to the clinic in January with cough, tachypnea, nasal congestion, and decreased oral intake. The infant attends daycare and has a history of bronchopulmonary dysplasia (BPD). The nurse is reviewing factors that increase the risk for severe lower respiratory tract involvement in this client.Which factors contribute to increased susceptibility or severity of respiratory infection in this infant?Select all that apply.