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A nurse is making a home visit to a 5-year-old child who has cerebral palsy and uses a wheelchair. Which of the following observations made by the nurse indicates that the family needs support and resources to cope with the child's condition?

A grandparent is assisting the child in performing ADLs.

The child is playing a game with their siblings.

The parent is withdrawn and rarely interacts with the child.

The step-parent is helping the child prepare to transition into school.

Answer and Explanation

The Correct Answer is C

Rationale:

A) Involvement of a grandparent in assisting with activities of daily living (ADLs) indicates family support.

B) The child engaging in play with siblings suggests social interaction and family involvement.

C) A withdrawn parent may indicate emotional distress or difficulty coping with the child's condition, necessitating support and resources.

D) The step-parent's involvement in preparing the child for school transition indicates family support and engagement in the child's development.

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Correct Answer is D

Explanation

Rationale:

A) Hyperactivity is not typically associated with a postictal state after a seizure.

Instead, the child may appear lethargic or drowsy.

B) Nystagmus, or rapid, involuntary eye movements, is not typically seen in the postictal state following a seizure.

C) Apnea, or cessation of breathing, may occur during the seizure itself but is not typically a postictal finding.

D) Amnesia, or memory loss, is a common postictal finding after a seizure, particularly in complex partial seizures or psychomotor seizures.

A. Record the diastolic value as the first Korotkoff sound (K1). B. Release the cuff pressure at a rate of about 5 mm Hg/second. C. Position the child's arm at the level of the heart. D. Select a cuff with a bladder size that is approximately 20% of the child's upper arm circumference.

Correct Answer is C

Explanation

Rationale:

A) The diastolic value is recorded as the disappearance of Korotkoff sounds (K5), not the first sound (K1).

B) The cuff pressure should be released at a rate of 2-3 mm Hg/second, not 5 mm Hg/second.

C) Positioning the child's arm at the level of the heart ensures an accurate blood pressure measurement.

D) The cuff bladder size should be approximately 40% of the child's upper arm circumference, not 20%.

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A nurse is making a home visit to a 5-year-old child who has cerebral palsy and uses a wheelchair. Which of the following observations made by the nurse indicates that the family needs support and resources to cope with the child's condition?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is collecting data from a child who recently experienced a psychomotor seizure.Which of the following findings should the nurse expect?"

Correct Answer is D

Explanation

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Correct Answer is C

Explanation

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