Level: Foundational
Difficulty: Easy
Subtopic: School-age development
NCLEX: An 8-year-old child at a school health screening is being evaluated for developmental expectations for school-age…
Psychology / lifespan development Health Promotion and Maintenance
Case Study
An 8-year-old child at a school health screening is being evaluated for developmental expectations for school-age development. Assessment data include the child has new headaches before school and asks to stay home. Which finding requires the nurse to intervene immediately?
Question
A. A stable, long-standing finding that matches the expected care plan.
B. The new finding that the child has new headaches before school and asks to stay home.
C. A comfort request with unchanged vital signs and no new symptoms.
D. Routine data unchanged from the prior assessment.
B. The new finding that the child has new headaches before school and asks to stay home.
C. A comfort request with unchanged vital signs and no new symptoms.
D. Routine data unchanged from the prior assessment.
Rationale
Correct answer: B. The new finding that the child has new headaches before school and asks to stay home.
Rationale: Follow-up items test whether the nurse recognizes cues that are new, acute, or inconsistent with stability and need prompt nursing action.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.
Rationale: Follow-up items test whether the nurse recognizes cues that are new, acute, or inconsistent with stability and need prompt nursing action.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.