A nurse is collecting data from a 9-year-old child during a well-child visit. Which of the following findings should the nurse expect?

Expresses conflict over independence and control

Demonstrates self-centered thinking

Displays emotional detachment from parents

Grasps concept of cause-and-effect

Answer and Explanation

The Correct Answer is D

A. Expressing conflict over independence and control is incorrect. This behavior is more characteristic of adolescents, who struggle with autonomy as they develop their identity. Nine-year-old children are still largely influenced by parents and rules.

B. Demonstrating self-centered thinking is incorrect. Egocentric thinking is typical in preschool-aged children, while school-aged children develop the ability to see other perspectives and think more logically.

C. Displaying emotional detachment from parents is incorrect. While school-aged children begin to form peer relationships, they typically maintain strong emotional connections with their parents rather than detaching from them.

D. Grasping the concept of cause-and-effect is correct. At this stage, children develop logical thinking and an understanding of consequences, allowing them to recognize how actions lead to specific outcomes.

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Correct Answer is D

Explanation

A. "Check the client's skin every 4 hr" is incorrect. Skin checks should be performed more frequently for clients who are immobilized, ideally every 2 hours, to detect early signs of pressure damage and prevent the development of pressure ulcers.

B. "Place a donut-shaped cushion under the client" is incorrect. Donut-shaped cushions can increase pressure on the surrounding tissue, leading to ischemia and an increased risk of pressure ulcers. They are not recommended for ulcer prevention.

C. "Turn the client every/hr" is incorrect. The client should be repositioned regularly, but turning the client every hour is not a standard practice. The typical guideline is every 2 hours for clients at risk of pressure ulcers.

D. "Place the client in a 30° lateral position" is correct. The 30° lateral position helps to reduce pressure on bony prominences, such as the sacrum and heels, and is effective in preventing pressure ulcers. This position minimizes pressure on the skin while promoting circulation.

A. Nausea and vomiting B. Altered mental status C. Dysrhythmias D. Hypothermia

Correct Answer is B

Explanation

A. Nausea and vomiting: Nausea and vomiting can be present with hypernatremia (high sodium levels), but they are not the most prominent or specific symptom. The client may experience these symptoms, but they are usually accompanied by other signs.

B. Altered mental status: This is a common manifestation of hypernatremia. The elevated sodium level causes an osmotic imbalance, leading to water shifting out of cells, which results in neurological symptoms, including confusion, lethargy, or seizures.

C. Dysrhythmias: Dysrhythmias can occur with electrolyte imbalances, including hypernatremia, but the primary symptoms related to sodium levels are more often neurological in nature, such as confusion or altered mental status, rather than dysrhythmias specifically.

D. Hypothermia: Hypernatremia typically causes an increase in body temperature, not hypothermia. Elevated sodium levels cause dehydration, which could contribute to increased body temperature rather than cooling.

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A nurse is collecting data from a 9-year-old child during a well-child visit. Which of the following findings should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assisting with developing a plan of care for a client who is immobilized. Which of the following interventions should the nurse recommend to reduce the development of pressure ulcers?

Correct Answer is D

Explanation

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Correct Answer is B

Explanation

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