A nurse assesses 4 children. All of the children are experiencing regression. Which of the following children should the nurse be concerned about?

A 3-year-old child who has experienced gross motor regression for six months.

A 1-year-old child who has been waking frequently during the night crying after moving to a new house one week ago.

A 2-year-old child who has been experiencing regression for two weeks after beginning to attend day care.

A 2-year-old child who has been hospitalized for cellulitis and is having incontinence resulting in diaper use.

Answer and Explanation

The Correct Answer is A

Rationale:

A. A 3-year-old child who has experienced gross motor regression for six months: Persistent loss of previously acquired gross motor skills over an extended period is concerning and may indicate an underlying neurological, muscular, or developmental disorder. This type of regression warrants immediate further evaluation by a healthcare provider.

B. A 1-year-old child who has been waking frequently during the night crying after moving to a new house one week ago: Short-term sleep disturbances related to environmental changes are common in infants and usually resolve as the child adapts. This type of regression is temporary and not immediately concerning.

C. A 2-year-old child who has been experiencing regression for two weeks after beginning to attend day care: Brief behavioral or developmental regression due to adjustment stress is common in toddlers starting day care. This regression is short-lived and resolves with adaptation.

D. A 2-year-old child who has been hospitalized for cellulitis and is having incontinence resulting in diaper use: Regression in toileting during hospitalization is often a stress response and temporary. It usually resolves once the child returns to a familiar environment and is not indicative of a serious underlying condition.

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Correct Answer is C

Explanation

Rationale:

A. "I will only garden when Millie is napping": While supervision during activities is important for toddler safety, gardening during her nap does not directly relate to developmental guidance. Safety strategies should focus on active supervision and safe play rather than timing chores around naps.

B. "I will buy a toy slide since Millie should already know how to climb steps without help": Encouraging physical activity and gross motor skills is important, but expecting a 2-year-old to climb steps independently may be premature. Introducing equipment like slides should be accompanied by supervision and recognition of age-appropriate skill development.

C. "I will limit Millie's milk to 2 cups per day": Limiting milk intake to 16 ounces daily aligns with recommendations for toddlers to prevent excessive calorie intake and ensure adequate iron absorption. This demonstrates understanding of nutritional guidance for a 2-year-old and supports balanced eating habits alongside table foods.

D. "I will give Millie a 5-minute timeout when she is being negative and saying no to everything": While timeouts can be part of behavior management, a 2-year-old’s negative behaviors and assertions of independence are developmentally typical. Using short, consistent discipline strategies is recommended.

A. Heart rate 75/min B. Pulse oximetry 98% on room air C. Blood Pressure 148/88 mm Hg D. Height 154.9 cm (61 inches) E. Weight 44.5 kg (98 lb)

Correct Answer is ["C"]

Explanation

Rationale:

Blood Pressure 148/88 mm Hg: This reading is elevated for a pediatric/adolescent client and indicates stage 2 hypertension based on pediatric BP percentiles. Persistent elevated BP can increase the risk for cardiovascular complications, end-organ damage, and warrants prompt evaluation and intervention.
Heart rate 75/min: This is within normal limits for an adolescent (60–100/min), indicating no acute concern.
Pulse oximetry 98% on room air: Oxygen saturation is within the normal range (95–100%), so no immediate follow-up is needed.
Height 154.9 cm (61 inches): Growth appears consistent with previous measurements; no acute concern is present.
Weight 44.5 kg (98 lb): Weight increase is gradual over time and not outside expected growth patterns, requiring routine monitoring rather than urgent follow-up.

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A nurse assesses 4 children. All of the children are experiencing regression. Which of the following children should the nurse be concerned about?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse determines Millie's parent understood the 2-year-old well child visit teaching when the parent states which of the following?

Correct Answer is C

Explanation

Click to highlight the findings that require immediate follow-up. To deselect a finding, click on the finding again. Select all that apply. Heart rate 75/min Pulse oximetry 98% on room air Blood Pressure 148/88 mm Hg Height 154.9 cm (61 inches) Weight 44.5 kg (98 lb)

Correct Answer is ["C"]

Explanation

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