A nurse is caring for a school-age child who has a fracture to the right femur.
Which of the following findings is the nurse's priority?
Capillary refill less than 2 seconds.
Tingling in the right foot.
Respiratory rate 24/min.
2+ right pedal pulse.
The Correct Answer is B
Choice A rationale
Capillary refill less than 2 seconds is a normal finding and suggests adequate perfusion. It is not indicative of a priority concern in this context.
Choice B rationale
Tingling in the right foot can indicate nerve damage or compromised circulation, which is critical to address in a patient with a fracture. This symptom could suggest complications like compartment syndrome, requiring immediate medical attention.
Choice C rationale
Respiratory rate of 24/min is slightly elevated but not directly related to the fracture's immediate complications. It requires monitoring but is not the priority.
Choice D rationale
A 2+ right pedal pulse indicates a normal pulse and adequate circulation in the foot. While important, it does not represent an immediate concern in this context.
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Correct Answer is C
Explanation
Choice A rationale
Watermelon with seeds poses a choking hazard for young children, making it an unsafe food choice. The seeds can easily get stuck in a child’s throat, leading to potential airway obstruction. Additionally, small children might not have the coordination to properly spit out seeds, increasing the risk of accidental swallowing and subsequent choking. Therefore, whole fruits with seeds are generally recommended to be avoided for toddlers.
Choice B rationale
Raw carrots are another choking hazard for young children due to their hard texture. Toddlers might not have developed the necessary chewing skills to safely eat raw vegetables, increasing the risk of choking. Small, hard foods like raw carrots can be difficult to chew and swallow, making them unsafe for children under the age of three. Cooked or finely chopped vegetables are safer alternatives.
Choice C rationale
Mashed potatoes are a safe and appropriate food choice for a 14-month-old child. They are soft, easy to chew, and swallow, reducing the risk of choking. Mashed potatoes can be easily modified to suit the nutritional needs and texture preferences of young children. They can also be fortified with other healthy ingredients like pureed vegetables or proteins to make a balanced meal for toddlers.
Choice D rationale
Popcorn is a known choking hazard for young children and is not recommended for those under the age of four. Popcorn kernels are small, hard, and irregularly shaped, making them difficult for young children to chew and swallow safely. The risk of choking on popcorn is high due to its propensity to lodge in the airway, causing potentially serious complications. .
Correct Answer is B
Explanation
Choice A rationale
Soda and high quantities of juice are high in sugar and lack essential nutrients, making them poor beverage choices for a toddler.
Choice B rationale
Milk provides essential nutrients like calcium and vitamin D, while limiting juice intake reduces sugar consumption, promoting better overall health.
Choice C rationale
Gatorade is designed for athletes to replenish electrolytes and contains high levels of sugar and artificial ingredients, not suitable for toddlers.
Choice D rationale
Red Bull, an energy drink, is highly inappropriate for children due to its high caffeine content and potential harmful health effects.