Which cue in the clinic visit note does the pediatric nurse identify as the greatest concern?
The parent states Millie is very active, runs, dances, and mimics her parents.
Millie eats table foods but is a picky eater.
Millie sleeps in a toddler bed and shares the bedroom with her 4-year-old sister.
The parent describes their house as older and currently having some renovations done.
They keep medications and cleaning products in a high, locked cabinet in the bathroom.
The Correct Answer is D
Rationale:
- House is older and currently undergoing renovations: Older homes commonly contain lead-based paint, and renovation activities can release hazardous lead dust into the home. A 2-year-old child is at the highest risk for hand-to-mouth ingestion and neurological vulnerability. Lead poisoning can occur even without visible symptoms and can cause irreversible cognitive, behavioral, and developmental impairment.
- Millie is very active and mimics her parents: High activity levels, pretend play, and imitation are expected developmental behaviors for a 2-year-old. These cues do not indicate a safety risk or developmental abnormality and instead reflect age-appropriate gross motor and social development.
- Millie is a picky eater who eats table foods: Picky eating is common at age 2 due to toddler autonomy, slower growth rate, and fluctuating appetite. While nutritional counseling is appropriate, it does not pose an immediate health danger compared to environmental toxin exposure.
- Millie sleeps in a toddler bed and shares a room with her 4-year-old sister: Both room-sharing and sleeping in a toddler bed are typical and safe arrangements for a child of this age when the sleep environment is childproofed. There is no direct safety hazard associated with siblings sharing a room.
- Medications and cleaning products stored in a high, locked cabinet: This storage method reflects appropriate household safety precautions that reduce the risk of accidental ingestion. Although poison control safety is important, the parent’s method shows good preventive practice.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. Elevated systolic blood pressure in the upper extremities and elevated systolic blood pressure in the lower extremities: Uniformly elevated blood pressure in both upper and lower extremities does not indicate coarctation of the aorta. This pattern may suggest systemic hypertension but not a localized obstruction of the aorta.
B. Elevated systolic blood pressure in the upper extremities and low systolic blood pressure in the lower extremities: This is characteristic of coarctation of the aorta, where narrowing of the aortic arch causes obstruction to blood flow to the lower extremities. The upper extremities receive blood before the narrowing, resulting in higher pressures compared with the legs.
C. Low systolic blood pressure in the upper extremities and low systolic blood pressure in the lower extremities: Low pressures in all extremities suggest generalized hypotension or poor cardiac output rather than a localized structural defect like coarctation of the aorta.
D. Low systolic blood pressure in the upper extremities and elevated systolic blood pressure in the lower extremities: This pattern is not consistent with coarctation of the aorta. Elevated lower extremity pressure with low upper extremity pressure may indicate other rare circulatory anomalies but is not typical for this condition.
Correct Answer is A
Explanation
Rationale:
A. A 3-year-old child who has experienced gross motor regression for six months: Persistent loss of previously acquired gross motor skills over an extended period is concerning and may indicate an underlying neurological, muscular, or developmental disorder. This type of regression warrants immediate further evaluation by a healthcare provider.
B. A 1-year-old child who has been waking frequently during the night crying after moving to a new house one week ago: Short-term sleep disturbances related to environmental changes are common in infants and usually resolve as the child adapts. This type of regression is temporary and not immediately concerning.
C. A 2-year-old child who has been experiencing regression for two weeks after beginning to attend day care: Brief behavioral or developmental regression due to adjustment stress is common in toddlers starting day care. This regression is short-lived and resolves with adaptation.
D. A 2-year-old child who has been hospitalized for cellulitis and is having incontinence resulting in diaper use: Regression in toileting during hospitalization is often a stress response and temporary. It usually resolves once the child returns to a familiar environment and is not indicative of a serious underlying condition.
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