During a 2-year-old well-child visit, a toddler's parent tells the nurse that this son, who is the youngest of five, rarely talks spontaneously. Which intervention should the nurse implement?

Suggest that the parent read aloud to the child at bedtime.

Discuss with the parent the need for a hearing screening.

Recommend that the parent enroll the child in preschool.

Encourage parent to tell the child to ask for what he wants.

Answer and Explanation

The Correct Answer is B

A. Suggest that the parent read aloud to the child at bedtime. Reading aloud to the child is a beneficial practice that can enhance language development, vocabulary, and communication skills. It provides the child with exposure to language in a meaningful context and can stimulate spontaneous speech.

B. Discuss with the parent the need for a hearing screening. A hearing screening is a prudent intervention as hearing issues can significantly impact speech development. Ensuring the child has normal hearing is a critical first step in addressing delayed speech. Once hearing issues are ruled out, reading aloud and other strategies can be more effectively implemented.

C. Recommend that the parent enroll the child in preschool. Enrolling the child in preschool can provide a language-rich environment and opportunities for social interaction, which can stimulate speech and language development. However, this may not be the first step without ruling out other issues like hearing problems.

D. Encourage the parent to tell the child to ask for what he wants. Encouraging the child to use words to express needs is helpful for language development. It promotes verbal communication and helps the child learn to articulate desires and needs. This strategy, combined with other interventions, can be effective.

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Correct Answer is B

Explanation

A. Inspect for pedal edema. While pedal edema can be a sign of preeclampsia, obtaining blood pressure is a more immediate and crucial assessment.

B. Obtain a blood pressure. This is the correct next step, as rapid weight gain and nausea/vomiting can be symptoms of preeclampsia, which is often accompanied by hypertension.

C. Listen to foetal heart rate. This is important but secondary to assessing the mother's condition, especially when preeclampsia is suspected.

D. Ask for a 24-hour diet recall. This might be relevant for nutritional assessment but is not the priority when preeclampsia is suspected.

A. Obtain a dietary consultation for nutrition teaching. B. Instruct the client in the need to use iodized salt. C. Request diagnostic laboratory testing for the client. D. Schedule a follow-up appointment in one month.

Correct Answer is C

Explanation

A. Obtain a dietary consultation for nutrition teaching: Diet might play a role in some thyroid conditions, but a referral for dietary consultation wouldn't be the first step.

B. Instruct the client in the need to use iodized salt: Iodine deficiency can cause goiter (enlarged thyroid gland), but most table salt in developed countries is iodized.

C. Request diagnostic laboratory testing for the client: This is the most appropriate next step. Blood tests can help determine the cause of the enlarged thyroid gland.

D. Schedule a follow-up appointment in one month: A follow-up might be needed, but further workup is essential to determine the cause of the finding.

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During a 2-year-old well-child visit, a toddler's parent tells the nurse that this son, who is the youngest of five, rarely talks spontaneously. Which intervention should the nurse implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client who is 32 weeks gestation arrives at the clinic reporting nausea and vomiting for the past 24 hours. The nurse reviews the record and observes there has been a rapid weight gain over six weeks. Which action should the nurse implement next?

Correct Answer is B

Explanation

When performing a physical assessment, palpation reveals to the clinic nurse that a client has an enlarged thyroid gland. What action should the nurse take in response to this finding?

Correct Answer is C

Explanation

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