Nokea
The nurse is interviewing the mother of an infant. The mother reports, "I had a difficult delivery, and my baby was born prematurely." This information should be recorded under which heading?
- A. History
- B. Present illness
- C. Chief complaint
- D. Review of systems
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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Which data should be included in a health history?
- A. Review of systems
- B. Physical assessment
- C. Growth measurements
- D. Record of vital signs
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Which muscle is contraindicated for the administration of immunizations in infants and young children?
- A. Deltoid
- B. Dorsogluteal
- C. Ventrogluteal
- D. Anterolateral thigh
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
At a well-visit, a mother voices concern that her 30-month-old has a smaller vocabulary than other children in his daycare. The nurse should:
- A. Admit the child to the hospital
- B. Assess the child for other age-appropriate development
- C. Suggest that the child is hearing impaired
- D. Explain that the child has a significant developmental delay
Correct Answer: B
Rationale: When a parent expresses concern about a child's development, it is essential to conduct a comprehensive assessment of all areas of development before jumping to conclusions. Choosing option B allows the nurse to evaluate the child for other age-appropriate developmental milestones to determine if there are any delays or concerns. Admitting the child to the hospital (option A) is not necessary at this point and may cause unnecessary stress. Suggesting hearing impairment (option C) without proper evaluation can lead to misdiagnosis. Explaining a significant developmental delay (option D) should only be done after a thorough assessment and diagnosis.
A 12-month-old child presents to the clinic for a well visit after missing several appointments. The child began her immunization schedule but has missed several follow-up appointments and doses of immunizations. What is the most appropriate nursing intervention?
- A. Administer initial immunizations from the beginning of the schedule.
- B. The child cannot receive missed immunizations if the schedule is not followed and will not be vaccinated.
- C. The child should only receive the missed doses of immunizations based on the catch-up schedule.
- D. The child should receive double-strength immunizations at this well visit.
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The nurse is seeing an adolescent and the parents in the clinic for the first time. Which should the nurse do first?
- A. Introduce him- or herself
- B. Make the family comfortable
- C. Give assurance of privacy
- D. Explain the purpose of the interview
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.