A nurse is collecting data on an 18-month-old toddler at a wellness visit in the health care provider's office. During the appointment, the nurse asks the parent about developmental milestones. The parent states that the toddler has not said their first word yet. Which of the following actions by the nurse is accurate?

Complete a screening test for autism spectrum disorder (ASD).

Ask the parent about recent immunizations

Educate the parent that toddlers do not typically say their first word until 18-20 months of age.

Ask the parent if the toddler has a history of hospitalizations or surgeries.

Answer and Explanation

The Correct Answer is A

A. Complete a screening test for autism spectrum disorder (ASD). By 18 months, most toddlers have said their first word, and a lack of speech development can be an early sign of ASD or other developmental delays. The M-CHAT (Modified Checklist for Autism in Toddlers) is a common screening tool used at this age to assess for autism. Early identification allows for timely interventions.

B. Ask the parent about recent immunizations. While immunization history is important for overall health, there is no connection between vaccines and delayed speech development. This question does not directly address the developmental concern at hand.

C. Educate the parent that toddlers do not typically say their first word until 18-20 months of age. This is incorrect. Most toddlers say their first word around 12 months, and by 18 months, they typically have a vocabulary of several words. A lack of speech at this age warrants further assessment.

D. Ask the parent if the toddler has a history of hospitalizations or surgeries. While medical history is important, hospitalizations or surgeries are not the most common causes of delayed speech. Developmental screening is the most appropriate next step in evaluating speech delays.

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Correct Answer is B

Explanation

A. Mood changes. While mood changes can occur due to various health conditions, they are not a direct indicator of a bleeding disorder. Bleeding disorders typically present with physical symptoms like easy bruising or joint swelling.

B. Swollen knees. Joint swelling (hemarthrosis) is a key sign of bleeding disorders such as hemophilia. In children with a bleeding disorder, even minor trauma can cause bleeding into the joints, leading to pain, stiffness, and swelling, particularly in weight-bearing joints like the knees and ankles.

C. Frequent falls. While frequent falls may result in bruising, they are not a direct indicator of a bleeding disorder. However, children with a bleeding disorder may bruise excessively or experience prolonged bleeding after minor falls.

D. Dental caries. Dental caries (tooth decay) is not a symptom of a bleeding disorder but rather results from poor oral hygiene, dietary factors, or bacterial infection. Bleeding disorders may cause prolonged bleeding after dental procedures, but they do not directly cause cavities.

A. Today's lesions B. Discomfort level C. History and physical D. Body temperature E. Appearance of skin

Correct Answer is {"A":{"answers":"A,B"},"B":{"answers":"A"},"C":{"answers":"A,B"},"D":{"answers":"A"},"E":{"answers":"B"}}

Explanation

Eczema (Atopic Dermatitis)

Discomfort level: Pain 3/10 (more likely due to itching than infection)
History of mosquito bites and prolonged scratching
No fever (Temperature 37°C/98.6°F)
Multiple scabs and lesions from scratching

Cellulitis

Redness, warmth, and swelling on the left lower leg
History of skin breakdown (scratching increases infection risk)
Lesions present (Possible infection due to prolonged scratching)

Rationale:

Eczema (Atopic Dermatitis):

Eczema is a chronic inflammatory skin condition that causes itching, dryness, and irritation, often triggered by allergens or skin trauma. The child’s history of mosquito bites and excessive scratching aligns with eczema, as scratching worsens skin irritation and can lead to scabbed lesions. The absence of fever and a mild pain level (3/10) suggest this is primarily an inflammatory response rather than an infection.

Cellulitis:

Cellulitis is a bacterial skin infection that develops when bacteria enter through a break in the skin, often causing redness, warmth, swelling, and pain. The redness, warmth, and swelling on the left lower leg indicate possible early cellulitis, likely caused by bacteria introduced through scratching. However, the absence of fever and only mild pain suggest it may not be a severe infection yet.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is collecting data while caring for a school-age child. Which of the following findings may indicate an undiagnosed bleeding disorder?

Correct Answer is B

Explanation

A nurse is caring for a 10-year-old client in a pediatric clinic. Exhibits For each potential provider's prescription, click to specify if the assessment findings are consistent with Eczema or Cellulitis. Each finding may support more than 1 disease process.

Correct Answer is {"A":{"answers":"A,B"},"B":{"answers":"A"},"C":{"answers":"A,B"},"D":{"answers":"A"},"E":{"answers":"B"}}

Explanation

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