A nurse is making a home visit to a 5-year-old child who has cerebral palsy and uses a wheelchair. Which of the following observations made by the nurse indicates that the family needs support and resources to cope with the child's condition?
A grandparent is assisting the child in performing ADLs.
The child is playing a game with their siblings.
The parent is withdrawn and rarely interacts with the child.
The step-parent is helping the child prepare to transition into school.
The Correct Answer is C
Rationale:
A) Involvement of a grandparent in assisting with activities of daily living (ADLs) indicates family support.
B) The child engaging in play with siblings suggests social interaction and family involvement.
C) A withdrawn parent may indicate emotional distress or difficulty coping with the child's condition, necessitating support and resources.
D) The step-parent's involvement in preparing the child for school transition indicates family support and engagement in the child's development.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A) While empathetic, this response does not provide information or reassurance about the child's bedwetting in the hospital setting.
B) Regression, including bedwetting, is a common response to stress or disruption in routine, such as hospitalization, and is often temporary.
C) Dismissing the parent's concern may increase their anxiety and is not appropriate.
D) While it's important to consider potential medical implications, the nurse should first address the parent's concerns and offer reassurance about the temporary nature of the bedwetting.
Correct Answer is C
Explanation
Rationale:
A) Inability to hold a bottle is typically achieved by 4-6 months, so it might indicate a developmental delay.
B) Palmar grasp is a primitive reflex typically seen in newborns, and it should be replaced by more voluntary grasping patterns by 8 months.
C) Sitting unsupported is a milestone typically achieved by 6-8 months, indicating expected growth and development at 8 months.
D) Forcing the tongue outward when touched might indicate tongue thrust reflex, which should typically disappear around 4-6 months.
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