The nurse finds that an infant has stronger pulses in the upper extremities than in the lower extremities. Which assessment will the nurse perform next on this infant?

Pedal pulses.

Blood pressure of the four extremities.

Lower extremity reflexes.

Hemoglobin and hematocrit values.

Answer and Explanation

The Correct Answer is B

Choice A reason: Assessing pedal pulses is important, but it does not provide complete information about the circulatory status of the infant.
Choice B reason: This is the correct choice. Discrepancies in pulse strength between the upper and lower extremities may indicate a cardiovascular problem such as coarctation of the aorta, which can be further evaluated by comparing blood pressures in all four extremities.
Choice C reason: Lower extremity reflexes are not directly related to the strength of pulses.
Choice D reason: Hemoglobin and hematocrit values are important but would not be the next step in assessing the significance of the difference in pulse strength.

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Correct Answer is C

Explanation

Choice A reason: Feeding the toddler is important, but it does not specifically address the development of autonomy or decision-making skills.

Choice B reason: Dressing the toddler is a necessary task, but it does not encourage the child's active participation or independence.

Choice C reason: Offering the toddler a choice of clothing allows the child to make decisions, fostering a sense of control and independence, which is developmentally appropriate and empowering for the toddler.

Choice D reason: Asking the toddler if he would like to take his medicine is a good practice to involve the child in their care, but it is not as impactful on development as offering choices that promote autonomy.

A. Apply a warm, moist pack to the feet. B. Call the healthcare provider to report the edema. C. Elevate the legs on pillows. D. Encourage movement of the toes.

Correct Answer is C

Explanation

Choice A reason: Applying a warm, moist pack is not the most appropriate action as it may increase swelling and does not address the underlying cause of the edema.

Choice B reason: While it is important to report significant changes to the healthcare provider, mild edema post-surgery can be expected and managed with elevation.

Choice C reason: Elevating the legs on pillows can help reduce edema by promoting venous return and decreasing swelling.

Choice D reason: Encouraging movement of the toes is beneficial for circulation and preventing stiffness, but it is not the primary intervention for edema. Elevation is more effective in this scenario.

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The nurse finds that an infant has stronger pulses in the upper extremities than in the lower extremities. Which assessment will the nurse perform next on this infant?

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