The nurse is assessing an infant and needs to determine length. ...

[captainjonesify]

The nurse is assessing an infant and needs to determine length. Which procedure is appropriate for the nurse to use to measure length?
 
  1. Get assistance to measure the child from head to toe in prone position.
  2. Wait until the child is sleeping and hold the child upright in front of a tape measure attempting for the best accuracy possible.
  3. Place the child in a supine position and measure from the crown of the head to the heel while holding the legs straight.
  4. Have the mother to assist the child in standing in front of a tape measure.

Question 2

The nurse is obtaining tricep skinfold measurements on a client. Which locations would the nurse correctly use for this assessment?
 
  1. Midpoint of the arm between the scapula and the elbow.
  2. Two inches and centered below the scapula.
  3. One inch around the umbilicus.
  4. Lateral aspect of thigh.

[trampas]

Answer to Question 1

Correct Answer: 3
Recumbent length is obtained on persons who cannot stand freely for height measurements. The length is measured using a device, and by having the person lie flat in the supine position and measuring from the crown of the head to the heel with toes pointed upward and knees straight. It is incorrect to hold a client in a standing position to obtain a height measurement, either with the client awake or asleep. The nurse may enlist help from others to measure, but the measurement is from head to heel, not head to toe, and not in prone position.

Answer to Question 2

Correct Answer: 1
Tricep skinfold measurements are done at the midpoint of the arm, equidistant from the uppermost posterior edge of the acromion process of the scapula and the olecranon process of the elbow. The remaining answers are not tricep skinfolds.