Nokea
During a developmental screening, the nurse finds that a 3-year-old child with cerebral palsy has arrested social and language development. The nurse tells the family:
- A. This is a sign the cerebral palsy is progressing.'
- B. Your child has reached his maximum language abilities.'
- C. I need to refer you for more developmental testing.'
- D. We need to modify your therapy plan.'
Correct Answer: C
Rationale: Arrested development requires further evaluation to determine the cause and appropriate interventions, so referral for additional testing is necessary.
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After teaching the parents of a toddler about commonly aspirated foods, which of the following foods, if identified by the parents as easily aspirated, would indicate the need for additional teaching?
- A. Popcorn.
- B. Raw vegetables.
- C. Round candy.
- D. Crackers.
Correct Answer: D
Rationale: Popcorn, raw vegetables, and round candy are commonly aspirated due to their size, shape, or texture, posing a choking risk. Crackers, while a potential choking hazard, are less commonly associated with aspiration compared to the others, indicating the parents may need further clarification on specific risks.
The nurse is teaching a group of parents about sickle cell anemia. Which statement by a parent indicates a need for further teaching?
- A. Sickle cell anemia is a genetic disorder.'
- B. Crises can be triggered by dehydration.'
- C. The disease only affects African Americans.'
- D. Oxygen therapy may be needed during a crisis.'
Correct Answer: C
Rationale: Sickle cell anemia affects various ethnic groups, not only African Americans. The other statements are accurate, indicating understanding.
The parents of a neonate with hypospadias and chordee wish to have him circumcised. Which of the following explanations should the nurse incorporate into the discussion with the parents concerning the recommendation to delay circumcision?
- A. The associated chordee is difficult to remove during circumcision.
- B. The foreskin is used to repair the deformity surgically.
- C. The meatus can become stenosed, leading to urinary obstruction.
- D. The infant is too small to have a circumcision.
Correct Answer: B
Rationale: The foreskin is needed for surgical repair.
When developing a recreational therapy plan of care for a 3-year-old child hospitalized with pneumonia and cystic fibrosis, which of the following toys would be appropriate?
- A. 100-piece jigsaw puzzle.
- B. Child's favorite doll.
- C. Fuzzy stuffed animal.
- D. Scissors, paper, and paste.
Correct Answer: B
Rationale: A child's favorite doll is appropriate for a 3-year-old, providing comfort and familiarity without posing a risk of irritation or infection, unlike fuzzy stuffed animals which can harbor dust or bacteria.
The nurse is inserting a nasogastric (NG) tube in a child admitted with head trauma. The nurse should explain to the parents that the NG tube will be used to:
- A. Administer medications.
- B. Decompress the stomach.
- C. Obtain gastric specimens for analysis.
- D. Provide adequate nutrition.
Correct Answer: B
Rationale: An NG tube in head trauma decompresses the stomach to prevent aspiration and manage gastric distension.