Nokea
If the admitting nurse documents all of the following parental behaviors, which behavior is most likely to suppress this child's ability to reach the maximum potential for development?
- A. The parent dresses and undresses the teen.
- B. The parent answers all the medical questions.
- C. The parent exaggerates the teen's abilities.
- D. The parent assumes blame for the teen's condition.
Correct Answer: A
Rationale: Over-involvement like dressing the teen hinders independence.
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Which of the following behaviors exhibited by the child demonstrates the most severe reaction to prolonged hospitalization?
- A. Clinging to the parents
- B. Shaking the crib frantically
- C. Thrashing about
- D. Ignoring the parents
Correct Answer: D
Rationale: Ignoring parents indicates severe emotional withdrawal, a significant concern.
Which response by the nurse provides the best explanation of the child's behavior?
- A. Thumb sucking is a primitive form of self-stimulation and security.
- B. Thumb sucking is a regressive behavior with a comforting effect.
- C. Thumb sucking substitutes for the missing fluids due to postoperative restriction of fluids.
- D. Thumb sucking satisfies the child's increased need for a familiar touch.
Correct Answer: B
Rationale: Thumb sucking is a regressive behavior triggered by stress, offering comfort.
Which information given to the teenage mother is most appropriate?
- A. Holding will not result in spoiling the baby.
- B. Grandparents usually spoil babies.
- C. Babies need to be spoiled.
- D. Toddlers are more likely to be spoiled.
Correct Answer: A
Rationale: Reassuring the mother that holding is beneficial promotes bonding and reduces unnecessary worry.
When the client calls the nurse to report the following physical changes, which symptom is considered a serious side effect of clozapine that needs to be reported immediately to the prescribing physician?
- A. Frequent diarrhea
- B. Severe sore throat
- C. Gradual weight loss
- D. Ringing of the ears
Correct Answer: B
Rationale: Severe sore throat may indicate agranulocytosis, a life-threatening side effect of clozapine.
Of the following suggestions, which one would best prevent nursing personnel from becoming injured when providing the adolescent with care?
- A. Apply soft wrist restraints before ambulating the client.
- B. Ask a parent to care for the client.
- C. Explain steps involved in care before touching the client.
- D. Medicate the client immediately before ambulation.
Correct Answer: C
Rationale: Explaining steps reduces fear and potential for aggressive reactions.