A nurse is bathing a toddler and notices the child has several bruises. Which of the following actions should the nurse take first?
Notify social services.
Ask the parents what caused the bruises.
Ask the toddler what caused the bruises.
Notify the provider.
The Correct Answer is B
A. Notify social services – Not the first action; the nurse must assess the situation before reporting.
B. Ask the parents what caused the bruises – Correct; gathering information helps differentiate normal bruising from possible abuse.
C. Ask the toddler what caused the bruises – Not the best initial approach, as toddlers may not provide reliable explanations.
D. Notify the provider – Appropriate but should come after assessing the situation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Lightening – Correct; "lightening" occurs when the fetal head descends into the pelvis, reducing pressure on the diaphragm, making it easier to breathe.
B. Decreasing chest diameter – Incorrect; the chest diameter does not decrease; instead, the diaphragm moves upward due to uterine growth.
C. Decreased carbon dioxide production – Incorrect; CO₂ production remains stable during pregnancy.
D. Hyperventilation – Incorrect; while pregnancy increases respiratory effort, the client is experiencing relief, not hyperventilation.
Correct Answer is D
Explanation
A. Fraternal – Incorrect; fraternal twins develop from two separate eggs and sperm and do not share identical genetic material.
B. Dizygotic – Incorrect; dizygotic twins are fraternal twins with different genetic makeup.
C. Trizygotic – Incorrect; trizygotic refers to triplets, not twins.
D. Monozygotic – Correct; monozygotic twins result from one fertilized egg that splits, leading to identical genetic material.
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