A 6-month-old girl weighs 14.7 lb during a scheduled check-up. Her birth weight was 8 lb. What is the priority nursing intervention?

Discouraging daily fruit juice intake

Increasing the number of breastfeedings

Discussing the child's feeding patterns

Talking about solid food consumption

Answer and Explanation

The Correct Answer is C

A. Discouraging daily fruit juice intakE. While excessive fruit juice intake can contribute to weight gain and dental caries, it's not the priority nursing intervention in this scenario.

B. Increasing the number of breastfeedings: Breastfeeding frequency may be appropriate, but without more information about the child's current feeding patterns and growth trajectory, it's not the priority intervention.

C. Discussing the child's feeding patterns: This is the priority intervention because it allows the nurse to assess the child's current feeding habits, including frequency, duration, and type of feedings, to determine if they are appropriate for the child's growth and development.

D. Talking about solid food consumption: Solid food introduction is typically recommended around 6 months of age, but the priority in this scenario is to assess the current feeding

patterns before discussing solid food introduction.

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Correct Answer is D

Explanation

A. Ignore the temper tantrums. - Ignoring tantrums may work for some children, but it's not a universal solution and can sometimes escalate the behavior. It also doesn't teach the child appropriate ways to cope with their emotions.

B. Tell the child that temper tantrums are not acceptable. - While setting boundaries is important, simply telling the child that tantrums are unacceptable without providing alternative coping

mechanisms may not be effective, especially for a toddler who may not fully understand verbal reasoning.

C. Restrain the child physically. - Physically restraining the child can be harmful and is not recommended as a method for handling temper tantrums. It can lead to increased frustration and potentially cause injury to the child.

D. Distract the child by offering to play a game. - Distracting the child with a game or other engaging activity can help redirect their attention away from the tantrum and towards a more positive outlet for their emotions. This approach can be effective in diffusing the situation and teaching the child healthy coping strategies.

A. Increased intracranial pressure B. Dehydration C. Overhydration D. These are normal findings

Correct Answer is D

Explanation

A. Increased intracranial pressurE. Pulsation and bulging of the fontanel may be signs of

increased intracranial pressure in infants. However, it is important to differentiate between normal fontanel characteristics and abnormal signs of elevated intracranial pressure. In this case, the pulsation and bulging are likely normal responses to crying and changes in intracranial pressure during the newborn period.

B. Dehydration: Dehydration typically presents with sunken fontanels rather than pulsation and bulging. Dehydration is a serious condition that requires prompt assessment and intervention, but it is not indicated by the findings described in the scenario.

C. Overhydration: Overhydration is not typically associated with pulsation and bulging of the fontanel. Overhydration may lead to fluid overload and edema but does not directly affect fontanel characteristics.

D. These are normal findings: Pulsation and brief bulging of the fontanel in response to crying are considered normal findings in newborns. Fontanels allow for the flexibility of the skull bones during childbirth and provide space for brain growth during infancy. Pulsation and bulging may occur temporarily during crying or changes in intracranial pressure and are not necessarily

indicative of pathology.

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A 6-month-old girl weighs 14.7 lb during a scheduled check-up. Her birth weight was 8 lb. What is the priority nursing intervention?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A parent of a toddler asks a nurse at a well-child visit how the child's frequent tempertantrums can best be handled. Which of the following actions should the nurse suggest to the parent?

Correct Answer is D

Explanation

A nurse is assessing the fontanels of a crying newborn and notes that the posterior fontanel pulsates and briefly bulges. What do these findings indicate?

Correct Answer is D

Explanation

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