The age by which the child can make a tower of 9 cubes and imitates circular stroke is
- A. 24 months
- B. 30 months
- C. 36 months
- D. 42 months
Correct Answer: C
Rationale: This milestone is typically achieved around 36 months.
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A 23 y.o. woman is seen at an outpatient clinic for a routine Pap smear. When questioned, she states she is deciding whether to engage in sexual activity with a man she is just getting to know. She asks how she can tell if he has an STD. Which response by the nurse is best?
- A. "If the man appears clean and has been conscientious about using condoms, he is likely infection free."
- B. "Look carefully for signs of lesions before engaging in sexual activity."
- C. "Be sure to use either a male or female condom to protect against possible transmission of infection."
- D. "An examination by a physician with diagnostic testing is the only way to know if he is infection free."
Correct Answer: D
Rationale: The best response by the nurse is to recommend an examination by a physician with diagnostic testing as the only way to know if the potential partner is infection free. Simply relying on the appearance of cleanliness or condom use may not be sufficient to determine the presence of sexually transmitted infections (STIs) such as HPV, chlamydia, or herpes, which may not have visible symptoms. Encouraging regular testing and open communication about sexual health with partners is crucial in preventing the spread of STIs.
A client who reports increasing difficulty swallowing, weight loss, and fatigue is diagnosed with esophageal cancer. Because this client has difficulty swallowing, the nurse should assign highest priority to:
- A. Helping the client cope with body image
- B. Maintaining a patent airway.
- C. Preventing injury.
- D. Ensuring adequate nutrition.
Correct Answer: B
Rationale: In a client with esophageal cancer who is experiencing difficulty swallowing, maintaining a patent airway is the highest priority. The client is at risk for aspiration due to the compromised ability to swallow, which could lead to respiratory distress, choking, or aspiration pneumonia. Adequate oxygenation is essential for the client's survival and must be addressed as the priority issue. While coping with body image, preventing injury, and ensuring nutrition are important aspects of care, they are secondary to ensuring the client's airway remains open and clear to prevent respiratory complications.
To combat the most common adverse effects of chemotherapy, the nurse would administer an:
- A. Antiemetic
- B. Antibiotic
- C. Antimetabolite
- D. Anticoagulant
Correct Answer: A
Rationale: The most common adverse effects of chemotherapy include nausea and vomiting, which can significantly impact the patient's quality of life. An antiemetic is a medication specifically designed to prevent or alleviate nausea and vomiting. By administering an antiemetic, the nurse can help manage these distressing side effects and improve the patient's overall comfort during chemotherapy treatments. Antibiotics are not typically used to combat the side effects of chemotherapy, and antimetabolites and anticoagulants do not address nausea and vomiting associated with chemotherapy.
A neonate has been diagnosed with caput succedaneum. Which statement is correct about this condition?
- A. It usually resolves in 3-6 weeks
- B. It doesn't cross the cranial suture line
- C. It's a collection of blood between the skull and the periosteum
- D. It involves swelling of tissue over the presenting part of the presenting head
Correct Answer: D
Rationale: Caput succedaneum is a condition characterized by the swelling of tissue over the presenting part of the infant's head during delivery. It is commonly a result of prolonged labor or vacuum extraction. Unlike cephalohematoma, caput succedaneum does cross the cranial suture lines. This condition typically resolves within a few days to a week after birth without intervention. It is important to monitor the infant for any complications or signs of infection during the resolution process.
A client metastatic ovarian cancer is prescribed cisplatin (Platinol). Before administering the first dose, the nurse reviews the client's medication history for drugs that may interact with cisplatin. Which drug may cause significant interactions when given concomitantly with cisplatin?
- A. Erythromycin
- B. A cephalosporin
- C. A tetracycline
- D. An amino glycoside Situation: A client with ovarian cancer is prescribed hydroxyurea (Hydrea), an antimetabolite drug.
Correct Answer: D
Rationale: Amino glycosides, such as gentamicin or amikacin, can interact significantly with cisplatin, leading to increased risk of kidney damage or hearing loss. Both amino glycosides and cisplatin are known to have nephrotoxic and ototoxic effects independently. When combined, the risk of these side effects is potentiated, making it important to monitor renal function and hearing closely when these drugs are co-administered. Therefore, it is crucial to avoid the concomitant use of amino glycosides with cisplatin in order to prevent harmful drug interactions and reduce the risk of adverse effects in the client with metastatic ovarian cancer.