CHAPTER 19

The nurse is assessing a 13-month-old. The nurse notes which reflexes as normal for this age group?

The infant's toes fan when the lateral surface of the sole is stroked

The nurse suspects a foreign body in a young child's nose. Which finding is most likely to cause the nurse to suspect this?

There is a foul-smelling odor coming from the child's nose.

The school nurse is performing a hearing screening for an adolescent. The primary focus of a history and examination for this age group would be:

1.) Explore exposure to loud noises, including music 2.) Perform the whisper test 3.) Perform screening tests for hearing loss 4.) Ask about previous antibiotic use

The nurse is assessing a newborn and notices the child has a cleft palate. What risks are associated with this finding? Select all that apply:

1.) Speech impairments 2.) Hearing impairment 3.) Failure to thrive 4.)Premature birth

The nurse is performing an eye exam on a child. The nurse knows that the child will have the visual acuity of an adult at which age?

6 years

The nurse is assessing a 1-year-old and suspects respiratory distress. Which finding indicates this?

Observation of sternal and supraclavicular retractions with breathing

The nurse suspects an infant has fetal alcohol syndrome. Which assessment finding is consistent for an infant with fetal alcohol syndrome?

Thin upper lip

The mother of a child tells the nurse that she is concerned that her child may be having trouble hearing. Which statement made by a parent suggests a possible hearing impairment in the child?

"My 4-month-old baby does not respond to loud noise."

The nurse suspects that a child has sensory impairment. At what age can the child undergo sensory neurologic testing?

Kindergarten age

The nurse notes that a 2-year-old child has a cough that sounds like a "bark." What other findings should the nurse anticipate?

Labored breathing and fever