Nokea
Which assessment finding is most indicative that the child is developmentally delayed?
- A. The child is being bottle-fed.
- B. The child is not toilet-trained.
- C. The child has no language skills.
- D. The child cannot draw a picture.
Correct Answer: C
Rationale: Lack of language skills at age 2 is a significant indicator of developmental delay.
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What is the most appropriate recommendation for eliminating the 2-year-old's tantrums?
- A. Give the child candy before entering the store.
- B. Ask the child to stop kicking and screaming.
- C. Explain to the child that this behavior is childish.
- D. Remind the child of how a big person acts.
Correct Answer: B
Rationale: Calmly addressing the behavior sets boundaries without reinforcing it.
Which behavior best indicates that an adolescent is at increased risk for suicide?
- A. Disobeying family rules
- B. Arguing with siblings
- C. Letting his grade average drop from a 92 to 88
- D. Becoming depressed over a recent breakup with a girlfriend
Correct Answer: D
Rationale: Depression following a breakup is a significant risk factor for suicide.
Which response by the nurse to the parents is most appropriate at this time?
- A. The physicians here are very well qualified.
- B. This diagnosis is difficult for you to accept.
- C. Why do you feel you need a second opinion?
- D. It's not as bad as it may seem right now.
Correct Answer: B
Rationale: Acknowledging the difficulty of accepting the diagnosis validates the parents' emotions and opens communication without being confrontational.
When the parents ask if their child is psychotic, the nurse who is performing the initial interview is most correct in explaining which of the following as a behavior exhibited by psychotic people?
- A. They have poor response to new situations.
- B. They have difficulty in relationships.
- C. They cannot differentiate reality from unreality.
- D. They feel helpless in resolving problems.
Correct Answer: C
Rationale: Psychosis is characterized by impaired reality testing.
When planning care for an autistic child, which nursing intervention is most appropriate?
- A. Providing interactive play activities
- B. Applying soft restraints while in bed
- C. Using a consistent caregiver
- D. Rocking the child as a calming technique
Correct Answer: C
Rationale: Consistency reduces anxiety in autistic children.