Pediatric nursing · practice question
A 6-month-old infant in the pediatric clinic is being evaluated for routine childhood immunizations. Assessment data include parents report decreased wet diapers and lethargy over 24 hours. Which nursing action should the nurse take first?
Multiple choiceEasynclex-rn-bsnnclex-validatednclex-2026pediatric-nursing
Answer and explanation
Correct answer
D. Perform a focused assessment for immediate risk, then implement the safest intervention per protocol.
Why
First-action questions on the NCLEX require assessment and safety before treatment, documentation alone, or delegation of nursing judgment.
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