The nurse is assessing a 12-month-old boy with an ...

[hbsimmons88]

The nurse is assessing a 12-month-old boy with an English-speaking father and a Spanish-speaking mother. The boy does not say mama or dada yet. Which of the following is the priority intervention?
 
  A) Performing a developmental evaluation of the child
  B) Encouraging the parents to speak English to the child
  C) Asking the mother if the child uses Spanish words
  D) Referring the child to a developmental specialist

Question 2

A school-age child was instructed on transfer techniques after having spinal surgery. For which outcome should the nurse assess when making a home visit to this patient?
 
  A) Patient transfers from bed to a chair unassisted.
  B) Patient stands up and walks to a chair with parental assistance.
  C) Patient transfers from the bed to a chair with one person assisting.
  D) Patient unable to move from the bed to a chair without assistance.

[scottmt]

Answer to Question 1

C
Feedback:
Infants in bilingual families may use some words from each language. Therefore, the priority intervention in this situation would be to ask the mother if the child uses Spanish words. There is not enough evidence to warrant performing a developmental evaluation or referring the child to a developmental specialist. Encouraging the parents to speak English to the child is unnecessary if the child is progressing with Spanish first.

Answer to Question 2

A
Feedback:
An outcome is the focus or goal of the instruction. For the child being instructed on transfer techniques after spinal surgery, the nurse should assess for the child's ability to perform the transfer as instructed, or the patient is able to transfer from the bed to a chair unassisted. The patient standing up and walking is evidence that instruction was not effective. The need to have one or more people assisting with the transfer indicates that instruction was not effective and the outcome was not met.

[hbsimmons88]

TYSM

[shewald78]

Gracias!