The Nurse Has Just Started Assessing a Young Child Who

question 37

Multiple Choice

The nurse has just started assessing a young child who is febrile and appears very ill.There is hyperextension of the child's head (opisthotonos) with pain on flexion.The most appropriate action is to:

• A) refer for immediate medical evaluation.
• B) continue the assessment to determine the cause of neck pain.
• C) ask the parent when the child's neck was injured.
• D) record "head lag" on the assessment record and continue the assessment of the child.

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Definitions:

Goal Specificity

The degree to which objectives are clearly defined, unambiguous, and measurable, making it easier to focus efforts and evaluate progress.

Performance Review

A formal assessment in which the job performance of an employee is documented and evaluated, often leading to feedback or development plans.

Goal Acceptance

The degree to which individuals or groups agree upon and commit to achieving a set goal or target.

Time Management

The process of organizing and planning how to divide one's time between specific activities to maximize efficiency and productivity.