Which is the priority nursing action when performing a physical ...

[ts19998]

Which is the priority nursing action when performing a physical assessment on a toddler?
 
  1. Leaving intrusive procedures such as eye and ear examinations until the end
  2. Explaining each part of the examination to the child before performing it
  3. Performing the assessment from head to toe
  4. Asking the mother to tell the child not to be afraid

Question 2

The nurse is educating the parents of a 2-month-old infant when to contact the healthcare provider. Which statements by the parents indicate the need for further instruction? Select all that apply.
 
  1. We will contact the doctor if our baby does not have a bowel movement each day.
  2. We will contact the doctor if our baby is vomiting.
  3. We will contact the doctor if our baby has a temperature greater than 99F.
  4. We will contact the doctor if our baby does finish each bottle.
  5. We will contact the doctor if our baby develops a skin rash.

[fwbard]

Answer to Question 1

1
Explanation:
1. Intrusive procedures such as examinations of the eyes, ears, throat, and genitals should be done last to decrease the anxiety of the child during the initial phases of the examination, which include heart and lungs.
2. A toddler is too young to understand the medical terminology.
3. Intrusive procedures such as examinations of the eyes, ears, throat, and genitals should be done last to decrease the anxiety of the child during the initial phases of the examination, which include heart and lungs.
4. Asking the mother to tell the child not to be afraid is an inappropriate response.

Answer to Question 2

1, 3, 4
Explanation:
1. Each infant will develop a pattern for bowel movements; some infants will have several each day, while others may have a bowel movement once every couple of days. This parental statement indicates the need for further education.
2. Infants are prone to dehydration; therefore, it is appropriate for the parents to contact the healthcare provider for vomiting.
3. Parents are instructed to contact the healthcare provider for a temperature greater than or equal to 99.3F. This parental statement indicates the need for further education.
4. Failure to eat is a reason to contact the healthcare provider; however, failure to finish each bottle is not a reason to contract the healthcare provider. This parental statement indicates the need for further education.
5. A skin rash is a reason to contact the healthcare provider. This statement indicates appropriate understanding of the information presented.