A school nurse is using Weber's test to check a child's hearing acuity. Which of the following actions should the nurse take?

Hold a vibrating tuning fork 1 to 2 cm (0.4 to 0.8 in) from the child's ears.

Place a vibrating tuning fork on the top of the child's head.

Whisper a statement to the child from 0.6 m (2 feet) away.

Apply a pair of headphones securely over the child's ears

Answer and Explanation

The Correct Answer is B

A. Hold a vibrating tuning fork 1 to 2 cm (0.4 to 0.8 in) from the child's ears – This describes the Rinne test, not the Weber test.

B. Place a vibrating tuning fork on the top of the child's head – Correct. The Weber test assesses hearing loss by placing a tuning fork on the midline of the skull to determine if sound is heard equally in both ears.

C. Whisper a statement to the child from 0.6 m (2 feet) away – This describes the whisper test, not the Weber test.

D. Apply a pair of headphones securely over the child's ears – Not part of the Weber test; this is used for audiometry testing.

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Correct Answer is D

Explanation

A. It is expected for a 24-month-old to have some difficulty with coordination when throwing a ball.

B. Using both feet on each step when going upstairs is developmentally appropriate at this age.

C. Running with a wide stance is common in toddlers as they develop balance and coordination.

D. This is the correct answer. By 24 months, a toddler should begin using pronouns such as "I" or "me" instead of referring to themselves by name, indicating a possible language delay.

A. Place the client on an air mattress. B. Rewrap the bandage every 8 hr in a circular pattern. C. Turn the client every 4 hr while in bed. D. Instruct the client to use an overbed trapeze to move around in bed.

Correct Answer is D

Explanation

A. Place the client on an air mattress – While air mattresses help prevent pressure ulcers, they do not directly address mobility needs in the immediate postoperative period.

B. Rewrap the bandage every 8 hr in a circular pattern – The bandage should be reapplied more frequently (every 4–6 hr) using a figure-eight pattern to prevent restriction of circulation.

C. Turn the client every 4 hr while in bed – Clients should be turned at least every 2 hr to prevent pressure ulcers and improve circulation.

D. Instruct the client to use an overbed trapeze to move around in bed – This is the best intervention because it allows the client to reposition independently, reducing the risk of skin breakdown and enhancing mobility.

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A school nurse is using Weber's test to check a child's hearing acuity. Which of the following actions should the nurse take?

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