A nurse is assessing a 24-month-old toddler. Which of the following findings should the nurse report to the provider?
Eats a large amount of food one day then very little the next
Holds his breath when having a temper tantrum
Sleeps 11 to 12 hr per day
Has a vocabulary of 30 words
The Correct Answer is B
A. Eating a large amount of food one day and very little the next is a normal eating pattern for toddlers. They may have days when they eat more and days when they eat less.
B. This finding should be reported to the provider. Breath-holding spells during temper tantrums can be concerning and may require further evaluation.
C. Toddlers typically need about 11-14 hours of sleep per day, so sleeping 11 to 12 hours is within the normal range.
D. A vocabulary of 30 words is considered normal for a 24-month-old toddler.
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Related Questions
Correct Answer is B
Explanation
A. Rhinorrhea (runny nose) is a common symptom of respiratory syncytial virus (RSV) and may not require immediate reporting unless it is severe or associated with other concerning symptoms.
B. Correct. Tachypnea (rapid breathing) in an infant with RSV can be a sign of
respiratory distress and may require immediate intervention or further evaluation by the provider.
C. Pharyngitis (sore throat) is a possible symptom of RSV, but it may not be as immediately concerning as tachypnea.
D. Coughing is a common symptom of RSV and may not require immediate reporting unless it is severe or associated with other concerning symptoms.
Correct Answer is B
Explanation
A.While an elevated cholesterol level is a concern in diabetes, it is not the priority in this case. The elevated HbA1c level indicates a more pressing issue that requires immediate attention.
B. The correct answer is B. HbA1c 11.5%. HbA1c is a measure of the average blood glucose level over the past 2 to 3 months. A high HbA1c indicates poor glycemic control and increased risk of complications from diabetes. The nurse's priority is to address the factors that are contributing to the high HbA1c and provide education and support to improve the adolescent's self-management.
C. Glycosuria, while important to monitor, is a common finding in uncontrolled diabetes.
It indicates elevated blood glucose levels and may require adjustments in the treatment plan. However, it is not as critical as addressing the elevated HbA1c level.
D. A preprandial blood glucose level of 124 mg/dL is within a reasonable range for an adolescent with diabetes. It is important to monitor blood glucose levels, but the elevated HbA1c level takes precedence in this situation.
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