A nurse is assessing a 3-year-old child and suspects the child may have a developmental delay. Which of the following actions is a priority for the nurse to take?
Refer the child to social work for early intervention.
Educate the parents on the developmental delays their child is diagnosed with.
Provide the parents with pamphlets for support groups for children with developmental delays.
Discuss the assessment findings with the primary care provider.
The Correct Answer is D
Choice A rationale
Referring the child to social work for early intervention is important, but it is not the immediate priority. The nurse should first discuss the assessment findings with the primary care provider to confirm the diagnosis and plan the next steps.
Choice B rationale
Educating the parents on the developmental delays their child is diagnosed with is essential, but it should come after a confirmed diagnosis and a comprehensive plan is in place. The primary care provider should be involved in this process.
Choice C rationale
Providing the parents with pamphlets for support groups is supportive but not the immediate priority. The nurse should first ensure that the primary care provider is aware of the assessment findings to confirm the diagnosis and plan appropriate interventions.
Choice D rationale
Discussing the assessment findings with the primary care provider is the priority action. This ensures that the child receives a thorough evaluation and appropriate interventions are planned based on a confirmed diagnosis.
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Correct Answer is D
Explanation
Choice A rationale
A storybook about a child who has diabetes can be helpful in educating the child about their condition and normalizing their experience. However, it may not be as effective in addressing the immediate distress caused by an insulin injection. Therapeutic play that directly involves the injection experience can be more beneficial in helping the child cope with their fear and anxiety.
Choice B rationale
A period of play in the playroom can provide a distraction and help the child relax. However, it does not specifically address the child’s distress related to the insulin injection. Therapeutic play that involves role-playing the injection process can be more effective in helping the child understand and cope with the procedure.
Choice C rationale
A video game can serve as a distraction and help the child relax. However, it does not directly address the child’s fear and anxiety related to the insulin injection. Therapeutic play that involves role-playing the injection process can be more effective in helping the child understand and cope with the procedure.
Choice D rationale
Using a needleless syringe and a doll allows the child to engage in therapeutic play that simulates the experience of receiving an insulin injection. This type of play helps the child understand the procedure, reduces fear and anxiety, and provides a sense of control over the situation. It is a direct and effective way to help the child cope with the distress caused by the injection.
Correct Answer is D
Explanation
Choice A rationale
A positive Babinski reflex is normal in infants up to 2 years old and indicates normal neurological development.
Choice B rationale
A negative Doll’s eye reflex is concerning as it may indicate a neurological problem. However, it is not as critical as a positive Moro reflex in a 9-month-old.
Choice C rationale
A negative Crawl reflex may indicate developmental delays, but it is not as critical as a positive Moro reflex in a 9-month-old.
Choice D rationale
A positive Moro reflex is abnormal in a 9-month-old and may indicate neurological issues. This reflex typically disappears by 2 months of age.