A nurse is assessing a 10-month-old infant. Which of the following findings should the nurse report to the provider?
infant cannot build a tower of three or four cubes
The infant does not sit steadily without support
The infant is unable to imitate animal sounds
The infant cannot turn pages in a book
The Correct Answer is B
At 10 months of age, most infants should be able to sit steadily without support. If the infant is unable to sit without support or shows difficulty maintaining balance while sitting, it may indicate a developmental delay or potential motor coordination issues. It is important to report this finding to the healthcare provider for further evaluation and appropriate intervention if necessary.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. It’s usually best to build trust and rapport first with non-invasive assessments. Starting with a potentially uncomfortable procedure like looking in the ears may cause distress and make the rest of the exam more difficult.
B.Examining the tympanic membrane before the head and neck might still be too early in the assessment and could cause the child to become uncooperative for subsequent steps. If the child becomes upset, it could complicate the rest of the physical exam, making it harder to complete.
C.Performing the ear examination at the end allows the nurse to build trust and rapport throughout the visit. The child is less likely to become distressed too early in the exam, which helps maintain cooperation for as long as possible.If the child does become upset, it is at the end of the visit, and the more critical assessments have already been completed.
D.If the ear exam causes distress, it may make the child uncooperative for important assessments like auscultating the heart and lungs.
Correct Answer is B
Explanation
Furrowing of the brow is often associated with discomfort or distress in infants. Other signs of pain in infants can include crying, irritability, increased heart rate, increased respiratory rate, and changes in sleep and feeding patterns. The eyes wide open, decreased muscle tone, and dry hands and feet are not specific indicators of pain and may have other explanations or may be within normal variations for an infant.
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