The nurse is caring for a 4-year-old with cerebral palsy on an inpatient unit who is struggling to eat with regular utensils. What intervention will the nurse include in the plan of care?

Call the provider to request an enteral tube.

Provide large, padded utensils.

Have the parents feed the child.

Refer the patient to the nutritionist.

Answer and Explanation

The Correct Answer is B

Choice A reason: Requesting an enteral tube is not necessary unless the child is unable to eat orally at all. The goal is to support the child's ability to eat independently, if possible.

Choice B reason: Providing large, padded utensils can help a child with cerebral palsy improve their ability to eat independently. Adaptive utensils are designed to accommodate the motor challenges that children with cerebral palsy may face, making it easier for them to grasp and use the utensils.

Choice C reason: While having the parents feed the child can be a short-term solution, it does not promote independence. The focus should be on finding ways to support the child's ability to eat on their own.

Choice D reason: Referring the patient to a nutritionist can be helpful for overall dietary management, but it does not directly address the immediate issue of the child's difficulty with using regular utensils. Adaptive utensils are a more direct solution to this problem.

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Correct Answer is C

Explanation

Choice A reason: A red blood cell count of 4.5 million/cu mm is within the normal range for pregnant women. It does not indicate an immediate concern that needs to be reported to the healthcare provider. Normal red blood cell counts help ensure adequate oxygen transport in the body.

Choice B reason: A haematocrit level of 37% is also within the normal range for pregnant women. Haematocrit measures the proportion of red blood cells in the blood, and this level does not indicate an immediate concern. It is important for maintaining proper oxygen delivery and overall blood volume.

Choice C reason: Platelets 85,000/mm3 is significantly below the normal range (150,000-450,000/mm3). Low platelet counts (thrombocytopenia) can lead to increased risk of bleeding and can be a sign of conditions like preeclampsia, HELLP syndrome, or other blood disorders. This is a critical finding that needs to be immediately reported to the healthcare provider for further evaluation and management to prevent potential complications.

Choice D reason: Haemoglobin level of 14 g/dL is within the normal range for pregnant women and indicates good oxygen-carrying capacity of the blood. It does not represent an immediate concern that would require urgent reporting to the healthcare provider. Maintaining proper haemoglobin levels is crucial for overall health and well-being.

A. Human Papillomavirus B. Pneumococcal C. Measles D. Rubella

Correct Answer is A

Explanation

Choice A reason: The Human Papillomavirus (HPV) vaccine is typically recommended for preteens at age 11 or 12 to protect against HPV infections that can lead to certain types of cancer later in life. This vaccine is given as a series of shots, and starting the series at 11 years old is ideal for maximizing its effectiveness before any potential exposure to the virus.

Choice B reason: The Pneumococcal vaccine is generally recommended for infants, young children, and older adults, particularly those with certain health conditions. It protects against pneumococcal disease, including infections in the lungs, blood, and brain. While it is crucial for vulnerable populations, it is not typically administered to healthy 11-year-old children.

Choice C reason: The Measles vaccine is part of the MMR (Measles, Mumps, Rubella) vaccine, which is usually administered in two doses—the first dose at 12-15 months of age and the second dose at 4-6 years of age. By the time a child reaches 11 years old, they would have already received both doses of the MMR vaccine, assuming they followed the standard vaccination schedule.

Choice D reason: The Rubella vaccine is also included in the MMR vaccine, which is given in two doses during early childhood. Since the second dose is typically administered by the age of 6, an 11-year-old child would not require another dose of the Rubella vaccine if they followed the standard vaccination schedule.

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The nurse is caring for a 4-year-old with cerebral palsy on an inpatient unit who is struggling to eat with regular utensils. What intervention will the nurse include in the plan of care?

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