When measuring a 6-month-old baby in the hospital for seizures, the nurse obtains a head circumference that is up 1 cm from the last measurement one week ago. The nurse re-measures and gets the same number What is the best next step?
Assume you made a mistake and report out the same head circumference as the before
Take Vital Signs
Report to the MD/NP/PA in charge of the patient the head circumference that you obtained as well as the patient's current status. Expect that they will also re-measure
Move your measuring tape to above the mid-forehead, so that your number matches the findings from the week before.
The Correct Answer is C
A. Assume you made a mistake and report out the same head circumference as before.
Incorrect Explanation: Assuming a mistake without taking proper action might not be the best approach.
Explanation: While it's good to consider the possibility of human error, healthcare professionals should prioritize accurate measurements and follow appropriate protocols when discrepancies arise.
B. Take Vital Signs.
Incorrect Explanation: Taking vital signs might not directly address the concern about the head circumference measurement.
Explanation: Vital signs (like heart rate, respiratory rate, blood pressure) are important indicators of a patient's overall health, but they may not directly address the issue of the head circumference measurement discrepancy.
C. Report to the MD/NP/PA in charge of the patient the head circumference that you obtained as well as the patient's current status. Expect that they will also re-measure.
Correct Explanation: This is the best next step.
Explanation: When there's a discrepancy in a critical measurement like head circumference, it's important to communicate this to the responsible healthcare provider (MD/NP/PA). They need to be aware of any changes in the patient's condition and measurements, and they will likely want to re-measure or reassess the situation themselves to ensure accuracy.
D. Move your measuring tape to above the mid-forehead, so that your number matches the findings from the week before.
Incorrect Explanation: Fudging measurements to match previous data is not a professional or ethical approach.
Explanation: Altering measurements to match previous values, especially without proper indication, is not a responsible practice in healthcare. It's essential to ensure accurate and honest documentation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Apply cool sterile soaks to the child's head.
Explanation: Applying cool sterile soaks to the child's head would not directly address periorbital edema. Nephrotic syndrome is a kidney disorder that results in proteinuria (loss of protein in urine), leading to fluid accumulation and edema. Cooling the head would not have a significant impact on reducing periorbital edema caused by nephrotic syndrome.
B. Apply warm compresses.
Explanation: Correct Choice. Applying warm compresses can help increase blood circulation and promote the reabsorption of excess fluid causing periorbital edema. Warmth can dilate blood vessels and improve the movement of fluids, potentially alleviating the edema.
C. Encourage the child to eat low protein foods.
Explanation: While dietary modifications might be part of managing nephrotic syndrome, specifically encouraging low protein foods may not directly address periorbital edema. The primary treatment for nephrotic syndrome involves medications to control proteinuria and manage fluid balance.
D. Elevate the head of the bed.
Explanation: Elevating the head of the bed is more commonly used to manage conditions like heart failure or obstructive sleep apnea. It might have some impact on overall fluid distribution, but it's not the most effective measure for reducing periorbital edema caused by nephrotic syndrome.

Correct Answer is A
Explanation
A. Inattention, Hyperactivity, Impulsivity
Explanation: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity. These symptoms can significantly impact an individual's ability to function in various areas of their life, such as school, work, and social interactions.
The other options are not accurate descriptions of ADHD:
B. "Can never be well treated" is not correct. ADHD can be effectively managed and treated through a combination of strategies, which may include behavioral interventions, psychoeducation, counseling, and in some cases, medication.
C. "Inability to learn" is not a defining characteristic of ADHD. While individuals with ADHD might face challenges in learning due to their symptoms, they are certainly capable of learning and can benefit from tailored strategies to support their learning process.
D. "Excess tiredness, impulsivity, and hyperactivity" describes a combination of symptoms, but ADHD is specifically characterized by inattention, hyperactivity, and impulsivity. Tiredness, while not a primary symptom of ADHD, can be a secondary effect of difficulties in focusing and maintaining attention.
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