A nurse is assessing a toddler at a well-child visit. At what point in the physical examination should the nurse examine the child's tympanic membrane?
At the beginning
Before examining the head and neck
At the end
Before auscultating the chest
The Correct Answer is C
A. It’s usually best to build trust and rapport first with non-invasive assessments. Starting with a potentially uncomfortable procedure like looking in the ears may cause distress and make the rest of the exam more difficult.
B. Examining the tympanic membrane before the head and neck might still be too early in the assessment and could cause the child to become uncooperative for subsequent steps. If the child becomes upset, it could complicate the rest of the physical exam, making it harder to complete.
C. Performing the ear examination at the end allows the nurse to build trust and rapport throughout the visit. The child is less likely to become distressed too early in the exam, which helps maintain cooperation for as long as possible. If the child does become upset, it is at the end of the visit, and the more critical assessments have already been completed.
D. If the ear exam causes distress, it may make the child uncooperative for important assessments like auscultating the heart and lungs.
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Related Questions
Correct Answer is B
Explanation
At the age of 3, children typically start to develop better balance and coordination. They may be able to stand on one foot for a short period of time, although their ability to maintain balance may vary.
Walking backward heel to toe, skipping, and hopping on one foot are typically achieved around the age of 4-5 years.
As for vocabulary, a 3-year-old child may have a vocabulary of approximately 300-500 words, although the exact number can vary. A vocabulary of 1500 words is more commonly seen in older children.
Correct Answer is B
Explanation
Crying is a common behavioral response to pain in infants, and it serves as an important indicator of discomfort. Infants may cry more intensely, have a high-pitched cry, or exhibit inconsolable crying when they are in pain. It is important for the nurse to assess the infant's pain level and provide appropriate interventions to alleviate the discomfort.
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