Pediatric nursing · practice question
A 6-month-old infant in the pediatric clinic is being evaluated for newly diagnosed congenital heart disease. Assessment data include nasal flaring, grunting, retractions, and SpO2 89%. Using the clinical judgment model, what is the nurse's first step?
Multiple choiceMediumnclex-rn-bsnnclex-validatednclex-2026pediatric-nursing
Answer and explanation
Correct answer
D. Recognize and analyze relevant cues to determine whether the client is stable or deteriorating.
Why
NCSBN clinical judgment begins with recognizing and analyzing cues before taking action or evaluating outcomes.
Test yourself on Pediatric nursing
A free test with instant, explained results. No account needed.
More Pediatric nursing questions
- After nursing care for pediatric injury prevention, the nurse evaluates the client response. Which action best…
- An 8-year-old child in the pediatric unit is being evaluated for dehydration from vomiting and diarrhea. Assessment…
- A 2-year-old toddler in the emergency department is being evaluated for newly diagnosed congenital heart disease.…
- After nursing care for dehydration from vomiting and diarrhea, the nurse evaluates the client response. Which action…
- A 6-month-old infant in the pediatric clinic is being evaluated for family presence during hospitalization. Assessment…
- A 6-month-old infant in the pediatric clinic is being evaluated for dehydration from vomiting and diarrhea. The nurse…