Difficulty: Medium
Average Score: 84%
Simulated
Passage / Scenario
Nurses' Notes 0915: Received the child awake, alert, and crying. Parent states that child was playing with remote control toy and when the parent heard the child crying, they noticed that a battery was missing from the toy. The parent states that the child was drooling more than usual and witnessed them gagging periodically. 0930: Child is lying on parent's chest with eyes open and requesting 'sippy cup.' Continues to have expiratory wheezing in bilateral upper lobes. Preparing child for diagnostic testing.The nurse should first ___
Correct answer
B
Rationale
The correct answer is B: Keep the child NPO. This is the priority because it ensures the child's safety before any other interventions. Keeping the child NPO helps prevent aspiration during any potential procedures or treatments. Obtaining informed consent (A) is important but not the first step in this situation. Teaching the child's parents (C) can wait until the child's immediate needs are addressed.