A nurse is collecting data from a 4-year-old child during a well-child visit. Which of the following findings should the nurse expect?
Positive Babinski sign.
Birth height has doubled.
Birth weight has doubled.
Presence of permanent teeth.
The Correct Answer is C
Birth weight has doubled.
Choice A reason:
The nurse should not expect a positive Babinski sign in a 4-year-old child during a well-child visit. The Babinski sign is a reflex seen in infants up to about 1 year of age and disappears as the nervous system matures. Its presence in a 4-year-old would be abnormal and may indicate neurological issues.
Choice B reason:
The nurse should not expect birth height to double in a 4-year-old child during a well-child visit. While children do experience significant growth in their early years, it is unlikely that birth height will have doubled by the age of 4. Doubling of birth height would be an atypical finding.
Choice C reason:
The correct choice. The nurse should expect that the child's birth weight has doubled during a well-child visit. From birth to age 4, children typically experience substantial weight gain, and doubling of birth weight is a common milestone in healthy development.
Choice D reason:
The nurse should not expect the presence of permanent teeth in a 4-year-old child during a well-child visit. Permanent teeth typically begin to emerge around 6 years of age and continue to erupt over the following years. The appearance of permanent teeth at age 4 would be premature and unusual.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason:
Hep B is given at birth, 2 months, and 6 months of age not at 11 years old.
Choice B reason:
Measles, mumps, rubella (MMR) The rationale for not choosing Measles, mumps, rubella (MMR) is the same as for choice A. If the child has already received the required doses of the MMR vaccine, giving extra doses is not necessary and may not provide any additional benefit.
Choice C reason:
This vaccine is recommended for children at age 11-12 years to boost immunity against tetanus, diphtheria, and pertussis. This is a one-time dose, and it's important to ensure that children receive it on schedule.
Choice D reason:
Pneumococcal (PCV) The rationale for not choosing Pneumococcal (PCV) is that this vaccine is typically given in infancy and early childhood as part of the routine immunization schedule.
Since the child is 11 years old and up to date with current recommendations, they are unlikely to require another dose of PCV at this stage.
Correct Answer is D
Explanation
Choice A reason:
Take this medication every day for regular bowel movements. Rationale: This choice is incorrect. Docusate sodium is a stool softener used to prevent constipation, but it should not be taken daily for regular bowel movements. Overuse of stool softeners can lead to dependence and may disrupt the natural bowel function.
Choice B reason:
Take the medication with mineral oil. Rationale: This choice is incorrect. Docusate sodium should not be taken with mineral oil. When taken together, they can form a mixture that is difficult for the body to absorb, leading to potential adverse effects.
Choice C reason:
Decrease dietary fiber intake while taking this medication. Rationale: This choice is incorrect. It is not advisable to decrease dietary fiber intake while taking docusate sodium. Fiber is essential for promoting regular bowel movements and overall gastrointestinal health.
Combining the medication with a high-fiber diet can enhance its effectiveness.
Choice D reason:
Take the medication with a full glass of water. Rationale: This choice is correct. The nurse should instruct the client to take docusate sodium with a full glass of water. The water helps to soften the stool and allows the medication to work effectively in preventing constipation.
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