during a routine health assessment the nurse notes that an 8 month old infant has a significant head lag which is the most appropriate action
Logo

Nursing Elites

ATI RN

ATI Nursing Care of Children

1. During a routine health assessment, the nurse notes that an 8-month-old infant has a significant head lag. Which is the most appropriate action?

Correct answer: C

Rationale: Significant head lag at 8 months is concerning and warrants further evaluation, as it may indicate developmental delays or neurological issues.

2. Which reflex, present at birth, is elicited by stroking the sole of the infant's foot, resulting in the fanning of the toes?

Correct answer: A

Rationale: The Babinski reflex is the correct answer. This reflex is characterized by the fanning out of the toes when the sole of the foot is stroked. It is a normal reflex in infants and is typically present at birth, disappearing by around 12 months of age. The Moro reflex, which involves the infant's response to a sudden loss of support or a loud noise, is not related to the fanning of toes. Sucking and rooting reflexes are related to feeding behaviors and are not elicited by stroking the sole of the foot.

3. Children may believe that they are responsible for their parents' divorce and interpret the separation as punishment. At which age is this most likely to occur?

Correct answer: C

Rationale: At around 8 years old, children may feel they are responsible for their parents' divorce and view it as a punishment, which can impact their emotional well-being.

4. Identification and treatment of cryptorchid testes should be done by age 2 years. What is an important consideration?

Correct answer: B

Rationale: Early treatment of cryptorchidism is essential to preserve fertility and prevent complications such as testicular cancer. Surgery is usually well-tolerated, and sexual reassignment is not typically related to this condition.

5. What major complication is associated with a child with chronic renal failure?

Correct answer: C

Rationale: Water and sodium retention is a major complication in chronic renal failure, leading to hypertension and edema. Hypokalemia and metabolic alkalosis are less common, and while BUN levels rise, retention rather than excretion is problematic in chronic renal failure.

Similar Questions

Which statement best describes colic?
What clinical manifestation(s) should the nurse expect to see as shock progresses in a child and becomes decompensated shock?
The school nurse is teaching a group of adolescents about avoiding contaminated water during a mission trip. What should the nurse include in the teaching?
A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. What nursing goal is appropriate for this child?
What amount of fluid loss occurs with moderate dehydration?

Access More Features

ATI RN Basic
$69.99/ 30 days

  • 5,000 Questions with answers
  • All ATI courses Coverage
  • 30 days access

ATI RN Premium
$149.99/ 90 days

  • 5,000 Questions with answers
  • All ATI courses Coverage
  • 30 days access

Other Courses