The nurse is doing a routine assessment on a 19-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as:
An abnormal finding-indicates the need for developmental assessment.
A normal finding.
An abnormal finding-indicates the need for immediate referral to a practitioner
A questionable finding-the infant should be rechecked in 1 month.
The Correct Answer is B
A. An abnormal finding-indicates the need for developmental assessment.
This is not accurate. The closure of the anterior fontanel within the expected age range does not indicate an abnormal finding or the need for additional developmental assessment.
B. A normal finding.
This is the correct interpretation. The anterior fontanel normally closes between 12 to 18 months, and closure by 19 months is within the expected developmental range.
C. An abnormal finding-indicates the need for immediate referral to a practitioner.
This is not necessary based on the information provided. The closure of the anterior fontanel within the expected timeframe is a normal finding.
D. A questionable finding-the infant should be rechecked in 1 month.
There's no need for rechecking in 1 month. The closure of the anterior fontanel at 19 months is considered normal.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Autonomy.
The ethical/moral principle represented in this situation is autonomy. Autonomy refers to the respect for an individual's right to make their own decisions and choices about their own life and well-being. In this case, the parent expressing second thoughts about the child's surgery reflects a reconsideration of the decision, and the nurse's action of calling the surgeon respects the parent's autonomy by seeking further discussion and clarification.
B. Fidelity
Fidelity refers to the principle of faithfulness, loyalty, and keeping promises. While it is important in the healthcare context, the scenario does not involve a breach of fidelity.
C. Equality
Equality relates to the fair and just treatment of individuals. In this scenario, the primary focus is on the parent's autonomy and the reconsideration of the elective surgery, rather than issues of equality.
D. Justice
Justice involves the fair distribution of benefits and burdens in society. The scenario does not directly relate to justice but is more aligned with the principle of autonomy as the parent reconsiders the decision about the child's surgery.
Correct Answer is ["46"]
Explanation
To provide adequate hydration for a toddler with dehydration, the nurse needs to calculate the daily fluid requirements based on the child's weight and then divide it by 24 hours to get the hourly rate.
For a 12 kg toddler, the daily fluid requirement is 1000 ml for the first 10 kg plus 50 ml for each additional kg, which equals 1100 ml.
Therefore, the hourly rate is 1100 ml / 24 hours, which is about 46 ml.
The nurse would set the pump at 46 ml per hour.
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