The community-health nurse visits the child-care center. Which ...

[vinney12]

The community-health nurse visits the child-care center. Which finding indicates the need for staff education?
 
  1. A group of 2-year-olds are eating a snack of Cheerios.
  2. Several 4-year-olds are outside playing on a slide.
  3. An 18-month-old is pushing a toy truck.
  4. A 2-month-old is sleeping in a crib on his stomach.

Question 2

The nurse is preparing to complete a health surveillance appointment with a school-age client and parents. Which observations would necessitate the need for further assessment by the nurse?
 
  1. Client who does not make eye contact
  2. Client with visible bruises in various stages of healing
  3. Client holding a video game talking with parent
  4. Client playing a card game with sibling
  5. Client who appears red in the face while walking to exam room

[nanny]

Answer to Question 1

Correct Answer: 4
Rationale: To decrease the incidence of sudden infant death syndrome (SIDS), infants should be placed on their backs to sleep. All of the other examples are developmentally appropriate activities for the specified age group.

Answer to Question 2

Correct Answer: 1,2,5
Rationale: Nursing assessment begins with the first encounter with the client and the family. The nurse would want to further explore a client who does not make eye contact, who has bruises in various stages of healing, and a client who appears red in the face while walking to the exam room. All of these items may be clues to emotional issues, physical violence, and health related issues, such as hypertension. A client who is holding a video game and talking to the parent and a client who is playing a card game with a sibling are not observations that are abnormal for the school-age client.