A nurse is assessing a 2 1/2 y/o toddler at a well-child visit.
Which of the following findings should the nurse report to
the provider?
a. Height increased by 7.5 cm (3 in) in the past year.
b. Head circumference exceeds chest circumference.
c. Anterior and posterior fontanels are closed.
d. Current weight equals four times the birth weight -
....ANSWER...b. Head circumference exceeds chest
circumference.
A nurse is performing a developmental screening on an 18
m/o. Which of the following should the toddler be able to
perform? (SATA)
a. Build a tower with 6 blocks
b. Throw a ball overhand
c. Walk up and down stairs
d. Stand on one foot for a few sec
e. Use a spoon without rotation - ....ANSWER...b. Throw a
ball overhand
e. Use a spoon without rotation
A nurse is providing teaching about age-appropriate
activities to the guardian of a 2 y/o. Which statement by the
guardian indicates an understanding of the teaching?
a. "I will send my child's fav stuffed animal when napping
away from home will occur."
b. "My child should be able to stand on one foot for a
second."
c. "The soccer team my child will be playing on starts
practicing next week."
d. "I should expect my child to be able to draw circles." -
....ANSWER...a. "I will send my child's fav stuffed animal
when napping away from home will occur."
A nurse is providing anticipatory guidance to the caregivers
of a toddler. Which of the following should the nurse
include? (SATA)
a. Develop food habits that will prevent dental caries.
b. Meeting caloric needs results in an increased appetite.
c. Expression of bedtime fears is common.
d. Expect behaviors associated with negativism and
ritualism.
e. Annual screenings for phenylketonuria are important. -
....ANSWER...a. Develop food habits that will prevent
dental caries.
c. Expression of bedtime fears is common.
d. Expect behaviors associated with negativism and
ritualism.
A Nurse is reviewing lab results of a school age child 1
week postop following an open fracture repair. Which
findings should nurse ID as indication of potential
complication?
a. Erythrocyte sedimentation rate 18 mm/hr
b. WBC count 6,200/mm3
c. C-reactive protein 1.4 mg/LRBC count 4.7 million/mm3 -
....ANSWER...a. Erythrocyte sedimentation rate 18 mm/hr
A Nurse planning care for school age child with tunneled
CVA device. Which interventions should the nurse include
in plan?
a. Use sterile scissors to remove the dressing from the site.
b. Irrigate each lumen weekly with 10 mL of 0.9% sodium
chloride solution when not in use
c. Access the site using a noncoring angled needle
d. Use a semipermeable transparent dressing to cover the
site - ....ANSWER...d. Use a semipermeable transparent
dressing to cover the site
A Nurse is planning care to address nutritional needs for
preschooler with cystic fibrosis. Which interventions should
the nurse include in plans?
a. Administer pancreatic enzymes 2 hr after meals.
b. Discontinue the use of pancreatic enzymes if steatorrhea
develops.
c. Limit fluid intake to 750 mL per day.
d. Increase fat content in the child's diet to 40% of total
calories. - ....ANSWER...d. Increase fat content in the child's
diet to 40% of total calories
A Nurse in ED auscultates lungs of adolescent experiencing
dyspnea. Nurse should ID sound as what?
a. Wheezes
b. Crackles
c. Pleural friction rub
d. Rhonchi - ....ANSWER...a. Wheezes
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