A nurse notes that a 2-year-old child has multiple bruises over his body at different stages of healing. What is the most appropriate action for the nurse at this time?
a. Obtain further data now to rule out abuse.
b. Remind parents that toddlers are clumsy and may fall, causing bruising.
c. Determine if this toddler has a coagulation disorder.
d. Recommend further observation at future visits.
ANS: A
You might also like to view...
A nursing manager is assessing a nursing home over concerns regarding institutional mistreatment of older patients. Which situation would warrant further concern over this issue?
1. A client refuses to take her morning shower. 2. A client screams at a patient care technician. 3. A client denies taking his morning medication. 4. A client curses out another nursing home patient.
A school-aged child appears to be very brave about having blood drawn, but when the blood is actually being, drawn he begins to cry and pulls away. Which response would best demonstrate an understanding of his needs?
A) "It's okay to cry; I know having your blood tested hurts." B) "I know it hurts, but if you hold still, it will soon be over." C) "Big boys don't cry. Let me see how brave you can be." D) "I will have to hold you down if you can't behave."
The nurse is using a Doppler for obtaining the fetal heart tone of a client who is at 28 weeks gestation and obtains a rate of 98 bpm. Which is the nurse's next action for this client?
A. Take the client's pulse while monitoring the fetal heart rate. B. Massage the client's abdomen and retake the fetal heart tone. C. Distract the client and retake the fetal heart tone. D. Request the healthcare provider (HCP) assess the client for possible fetal compromise.
One of the effects of histamine on the vasculature is:
A. vasoconstriction of the blood vessels and vasodilation of the capillaries. B. vasodilation of the blood vessels and the capillaries. C. vasoconstriction of the blood vessels and the capillaries. D. vasodilation of the blood vessels and vasoconstriction of the capillaries.