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1. What is the significance of a negative Ortolani test result in a 3-month-old
infant?
Signs of lymphedema
Presence of hip dislocation
Indication of developmental delay
No evidence of hip dysplasia
2. If a nurse assesses a 2-year-old boy and finds that one testicle is located in
the inguinal canal, what should be the nurse's next step in management?
Perform a manual reduction of the testicle.
Document the findings and schedule a follow-up in one year.
Refer for further evaluation by a pediatric urologist.
Advise the parents to monitor the condition at home.
3. When assessing a pt, the nurse documents the aptitude of the left femoral
pulse as "0". What would the nurse except the amplitude to be of the left
dorsalis pedis pulse?
0
4+
2+
1+
,4. Describe the significance of the Moro reflex in infant development and what
its persistence beyond 4 months may indicate.
The Moro reflex is a reflex that helps infants sit up; its absence
indicates strong muscle development.
The Moro reflex is a grasp reflex that helps infants hold onto objects;
its absence indicates developmental delays.
The Moro reflex is a startle reflex that indicates normal neurological
development; persistence beyond 4 months may suggest
neurological issues.
The Moro reflex is a response to touch that helps infants feed; its
persistence indicates healthy feeding behavior.
5. Which lobe of the brain is primarily associated with personality changes and
comprehension?
Temporal lobe
Parietal lobe
Frontal lobe
Occipital lobe
6. The nurse is unable to palpate the dorsalis pedis pulse on an older adult
client. What would be most appropriate for the nurse to do next?
Ask another nurse to assess the pulse.
Use Doppler ultrasonography to locate the pulse.
Document absence of dorsalis pedis pulse.
Auscultate the anatomic area with a stethoscope.
,7. In a clinical scenario, if a 70-year-old patient reports feeling only one sharp
prick after multiple pin pricks, what nursing intervention should be prioritized
to further assess sensory function?
Increase the frequency of pin prick tests.
Conduct a comprehensive neurological assessment.
Administer pain relief medication.
Refer the patient for imaging studies.
8. Describe how breastfeeding supports both infant and maternal health.
Breastfeeding has no significant health benefits for either party.
Breastfeeding only benefits the infant by preventing obesity.
Breastfeeding is primarily a method for maternal weight loss.
Breastfeeding supports infant health by providing essential
nutrients and antibodies, while also promoting maternal bonding
and recovery.
9. In a scenario where a nurse identifies impetigo in a child, what would be the
most appropriate nursing intervention to prevent the spread of this
condition?
Educate the caregiver on proper hygiene and the importance of
keeping the affected areas clean and covered.
Suggest the caregiver to use over-the-counter antifungal creams.
Advise the caregiver to apply topical steroids to reduce inflammation.
Recommend that the child avoid all physical activity until the lesions
heal.
, 10. A 65-year-old patient remarks that she just cannot believe that her breasts
sag so much. She states it must be from a lack of exercise. What explanation
should the nurse offer her? After menopause:
The glandular and fat tissue atrophies, causing breast size and
elasticity to diminish, resulting in breasts that sag.
A diet that is high in protein will help maintain muscle mass, which
keeps the breasts from sagging.
Sagging is usually due to decreased muscle mass within the breast.
Only women with large breasts experience sagging.
11. A nurse is giving a teaching to a 21-year-old patient who is getting ready for
her first pap smear. What would be important to include?
You will need a pap smear every 5 years
Schedule the test during your period
Nothing should be inserted into the vagina for 2-3 days before
There should be no bleeding after; bleeding can indicate a
complication
12. In a clinical scenario, if a patient presents with a supernumerary nipple and
reports discomfort in the area, what should be the nurse's immediate action?
Conduct a thorough assessment of the area and document
findings.
Ignore the complaint as it is a benign condition.
Provide reassurance without further evaluation.
Refer the patient to a specialist without assessment.