Level: Advanced
Difficulty: Hard
Subtopic: Child safety
NCLEX: A 6-month-old infant in the pediatric clinic is being evaluated for pediatric injury prevention. The nurse review…
Pediatric nursing Health Promotion and Maintenance Physiological Adaptation
Case Study
A 6-month-old infant in the pediatric clinic is being evaluated for pediatric injury prevention. The nurse reviews this trend: respiratory rate increased from 28/min to 48/min with retractions. Which interpretation and action are most appropriate?
Question
A. Interpret the trend in context, compare it with baseline or benchmarks, and take the safest indicated action.
B. Ignore the trend because one data point can be explained later.
C. Treat a single value without comparing it with baseline, symptoms, or benchmarks.
D. Wait for a critical value or sentinel event before taking any nursing action.
B. Ignore the trend because one data point can be explained later.
C. Treat a single value without comparing it with baseline, symptoms, or benchmarks.
D. Wait for a critical value or sentinel event before taking any nursing action.
Rationale
Correct answer: A. Interpret the trend in context, compare it with baseline or benchmarks, and take the safest indicated action.
Rationale: Trend questions require comparison with baseline, symptoms, risk, and benchmarks. Safe nursing action begins before a preventable event becomes critical.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.
Rationale: Trend questions require comparison with baseline, symptoms, risk, and benchmarks. Safe nursing action begins before a preventable event becomes critical.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.