how should a nurse assess pain in a nonverbal child
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HESI LPN

HESI PN Nutrition Practice Exam

1. How should pain be assessed in a nonverbal child?

Correct answer: B

Rationale: Observing the nonverbal child's facial expressions and body movements is crucial in assessing pain. Nonverbal children may not be able to communicate their discomfort verbally, making it essential to rely on physical cues. Asking parents about the child's usual behavior (choice A) may provide some insight but observing the child directly is more direct and reliable. Measuring blood pressure (choice C) is not typically a direct method for assessing pain in nonverbal children. Using a pain rating scale designed for older children (choice D) is also inappropriate for nonverbal children who cannot participate in such self-reporting tools.

2. In what position should infants be placed to sleep to reduce the risk of sudden infant death syndrome (SIDS)?

Correct answer: D

Rationale: The American Academy of Pediatrics recommends placing infants on their backs (supine) to sleep to reduce the risk of sudden infant death syndrome (SIDS). This position has been shown to decrease the likelihood of SIDS occurrence. Placing infants on their right or left side (choices A and B) or prone (choice C) can increase the risk of SIDS as it may obstruct the infant's airway or lead to overheating, which are known risk factors for SIDS.

3. How many vitamins are known to be required in the diet of human beings?

Correct answer: D

Rationale: The correct answer is D: 13. There are 13 essential vitamins required in the diet of human beings, including vitamins A, C, D, E, K, and the B vitamins. Choice A (5), Choice B (8), and Choice C (10) are incorrect because they do not represent the total number of essential vitamins needed by human beings.

4. Parents of a 6-month-old child, diagnosed with iron deficiency anemia, ask why it was not diagnosed earlier. What should the nurse say?

Correct answer: B

Rationale: The correct answer is B: 'Maternal stores of iron are depleted at about 6 months.' Iron deficiency anemia becomes apparent around 6 months of age when the infant's iron stores, primarily received from the mother during pregnancy, are depleted. This timing coincides with the introduction of solid foods, which may lack sufficient iron. Choices A, C, and D are incorrect because they do not address the specific reason why iron deficiency anemia is typically diagnosed around 6 months of age.

5. What is a common sign of a respiratory infection in infants?

Correct answer: B

Rationale: Rapid breathing is a common sign of a respiratory infection in infants. When infants have a respiratory infection, their breathing may become rapid as their body tries to get more oxygen. This symptom is often seen alongside cough and fever. Increased appetite (Choice A) is not typically associated with respiratory infections but can be seen in other conditions. Decreased urine output (Choice C) is more indicative of dehydration or kidney issues rather than a respiratory infection. Lethargy (Choice D) can be a symptom of various illnesses but is not as specific to respiratory infections as rapid breathing.

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