A nurse is performing a developmental assessment on a 4-year-old client. What assessment finding would warrant further investigation?

The client has urinary and bowel continence.

The client is unable to tie their shoes.

The client introduces their "friend" who is not visible to the nurse.

The client speaks in 2-3 word sentences.

Answer and Explanation

The Correct Answer is D

A. Urinary and bowel continence is expected by age 4, so this does not warrant further investigation.

B. Tying shoes is a skill typically developed later, around 5-6 years of age, so not being able to do so at age 4 is not concerning.

C. Having an imaginary friend is common in children around this age and is not a cause for concern.

D. Speaking in 2-3 word sentences is typical for a younger child, around 2 years of age. By age 4, a child should be able to speak in more complex sentences, so this finding warrants further investigation.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is D

Explanation

A. Bronchiolitis usually presents with wheezing and difficulty breathing, not drooling or inability to cough.

B. Asthma typically presents with wheezing, shortness of breath, and coughing, but not with drooling or an inability to cough.

C. Nasopharyngitis, or the common cold, usually causes symptoms like runny nose, cough, and sore throat, but not drooling or agitation.

D. Bacterial epiglottitis is a life-threatening condition characterized by drooling, agitation, inability to cough, and potential airway obstruction. The child often appears anxious and sits leaning forward in a "tripod" position.

A. Offer a pacifier with sucrose for pain relief. B. Maintain elbow restraints in the postoperative period. C. Place infant in trendelenburg position in the immediate postoperative period. D. Provide an ice collar for pain.

Correct Answer is B

Explanation

A. Offering a pacifier is contraindicated after cleft lip and palate repair as it can disrupt the surgical site and interfere with healing.

B. Maintaining elbow restraints prevents the infant from touching or putting objects in their mouth, which could disrupt the surgical site and compromise healing.

C. The Trendelenburg position is not recommended as it can increase pressure on the surgical site and compromise breathing.

D. An ice collar may be used for pain relief in older children or adults but is not typically used in infants, and it may not be feasible in this population.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse is performing a developmental assessment on a 4-year-old client. What assessment finding would warrant further investigation?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A 4-year-old client presents to the emergency department with drooling, agitation, and inability to cough. The nurse should recognize these findings are associated with which diagnosis?

Correct Answer is D

Explanation

A nurse is caring for an infant in the post-anesthesia care unit following cleft lip and palate repair. What is an appropriate action for the nurse to take?

Correct Answer is B

Explanation

A nurse is providing teaching to a parent of a preschooler who has eczema. What instruction should the nurse include in the discharge teaching?

A nurse has developed a plan of care for a family whose 7-year-old has been experiencing enuresis. Which of the following statements by the parents indicates that further teaching is needed?

A 17-year-old well-female has come to the clinic to get a rubella immunization that is required by the college she plans to attend. Before administering this immunization, the client should have which screening or test?

A clinic nurse is caring for a 4-year-old client with acute diarrhea and mild dehydration who is afebrile, active, and alert. The nurse is providing instructions to the parent. Which statement by the parent indicates understanding?

The nurse is caring for a pediatric client admitted with nephrotic syndrome. What assessment finding would likely be noted in a client with this diagnosis?

A nurse is admitting a pediatric client to the unit who has leukemia. Which client should the nurse place in the same room with this child?

A nurse is caring for a 3-year-old child who has had 160 mL of urine output over the past 8 hour period. The child weighs 33 lb. After calculating the client's urinary output, which action is appropriate?