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 assessment approach should the nurse use first?
Question
A. Begin invasive procedures before any focused assessment.
B. Use only the chart from admission without current data.
C. Defer assessment until all medications are administered.
D. Screen for instability, then perform a focused assessment related to the presenting concern.
B. Use only the chart from admission without current data.
C. Defer assessment until all medications are administered.
D. Screen for instability, then perform a focused assessment related to the presenting concern.
Rationale
Correct answer: D. Screen for instability, then perform a focused assessment related to the presenting concern.
Rationale: Assessment begins with stability screening and focused data collection before invasive or delayed actions.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.
Rationale: Assessment begins with stability screening and focused data collection before invasive or delayed actions.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.