1. A mother brings her 8 mo. old baby boy to clinic because he has been vomiting and had diarrhea for last 3days.
Which assessment is most important for nurse to make?
a. Assess infant abdomen for tenderness
b. Determine if the infant was exposed to a virus
c. Measure the infant’s pulse
d. Evaluate the infant’s cry
2. While obtaining the vital signs of a 10-year-old who had a tonsillectomy this morning, the nurse observesthe
child swallowing every 2-3 minutes. Which assessment should the nurse implement?
a. Inspect the posterior oropharynx
b. Assess for teeth clenching or grinding
c. Touch the tonsillar pillars to stimulate the gag reflex
d. Ask the child to speak to evaluate change in voice tone
3. The parents of a 3-year old boy who has Duchenne muscular dystrophy ask, “How can our son have this
disease? We are wondering if we should have any more children.” What information should the nurse provide
to parents?
a. This is an inherited X-linked recessive disorder, which primarily affects male children in thefamily
b. The striated muscle groups of males can be impacted by a lack of the protein dystrophin in their
mothers
c. The male infant had a viral infection that went unnoticed and untreated so muscle damage was
incurred
d. Birth trauma with a breech vaginal birth causes damage to the spinal cord, thus weakening the
muscles
4. A 2-week-old female infant is hospitalized for the surgical repair of an umbilical hernia. After returning tothe
postoperative neonatal unit, her RR and HR have increased during the last hour. Which intervention should the
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