Nokea
The nurse is assessing the growth and development of a 3-year-old child. Which speech and language skills should the nurse identify as normal developmental milestones for this child?
- A. Recognizes most letters and numbers
- B. Uses 1-word sentences
- C. Speaks in simple sentences with four or more words
- D. Uses gestures with 1 to 2-word sentences .
Correct Answer: C
Rationale: Simple sentences with four or more words are expected for a 3-year-old's language development.
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A 1-year-old child with respiratory syncytial virus (RSV) is admitted to the pediatric unit. The child presents with a fever, rhinorrhea, frequent coughing, and sneezing. What additional finding should alert the nurse that the child is in acute respiratory distress?
- A. Diaphragmatic respirations.
- B. A resting respiratory rate of 35 breaths/min.
- C. Bilateral bronchial breath sounds.
- D. Flaring of the nares.
Correct Answer: D
Rationale: Nasal flaring indicates increased breathing effort, a sign of acute respiratory distress in RSV.
A child weighing 18 pounds has been prescribed amoxicillin at a dosage of 25 mg/kg/day. The medication is to be administered orally in two divided doses every 12 hours. The label on the bottle reads, “Amoxicillin for Oral Suspension, USP 400 mg per 5 mL.â€. How many mL should the nurse administer for each dose? (Provide a numerical value only. If rounding is required, round to the nearest tenth.)
- A. 1.3
Correct Answer: A
Rationale: The child's weight is 8.16 kg (18 × 0.45). Total daily dose is 204 mg (8.16 × 25 mg/kg). Each dose is 102 mg (204 ÷ 2). Volume is 1.3 mL (102 ÷ 80 mg/mL, rounded).
During a routine clinic visit, a nurse finds that a 5-year-old girl's systolic blood pressure is above the 90th percentile. What should be the nurse's subsequent action?
- A. Refer the child to the healthcare provider and schedule a blood pressure evaluation in two weeks.
- B. Perform a comprehensive assessment and avoid repeated blood pressure measurements during the examination.
- C. Take the child's blood pressure three times during the visit and record the highest reading.
- D. Measure the blood pressure twice more during the visit and calculate the average of the three readings.
Correct Answer: D
Rationale: Averaging three readings ensures accuracy of elevated blood pressure findings.
A mother brings her 2-month-old to the well-baby clinic. She states that when she kisses her baby, the infant's skin tastes salty. The nurse should prepare the mother for what standard diagnostic test to screen for cystic fibrosis (CF)?
- A. Fecal-fat test.
- B. Sweat-chloride test.
- C. Pulmonary-function test.
- D. Potassium chloride test.
Correct Answer: B
Rationale: The sweat-chloride test is the standard screening for cystic fibrosis due to elevated salt levels in sweat.
The nurse is evaluating a preschool-aged child who is presenting with symptoms of flank pain, dysuria, and a low-grade fever. What additional information should the nurse obtain from the parent to determine if the child might have a urinary tract infection?
- A. Frequency of urination
- B. Any recent changes in diet
- C. Presence of any unusual odors in the urine
- D. Any changes in the color of the urine
Correct Answer: A
Rationale: Increased urination frequency is a common UTI symptom in children, aiding diagnosis.