Exhibits

A nurse is collecting data from a 6-month-old infant during a well-child visit. Which of the following findings should the nurse report to the provider? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data)

Gross motor skills

Temperature

weight

Feeding habits

Answer and Explanation

The Correct Answer is C

A. Gross motor skills: Rolling from abdomen to back, playing with feet, smiling responsively, and turning toward sounds are expected developmental milestones at 6 months of age. These findings indicate appropriate gross motor, social, and sensory development.

B. Temperature: A temperature of 37.4° C (99.3° F) is within the normal range for an infant. This finding does not suggest infection or illness and does not require provider notification.

C. Weight: At 6 months of age, an infant is expected to have approximately doubled their birth weight. This infant weighed 3.6 kg at birth and currently weighs 5.9 kg, which suggests inadequate weight gain and should be reported for further evaluation.

D. Feeding habits: Breastfeeding combined with small amounts of cereal and fruit three times daily is appropriate for a 6-month-old infant. There is no indication from the feeding history alone that intake is inappropriate.

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Correct Answer is C

Explanation

A. Documenting suspicions in the client's medical record: While accurate documentation of objective findings is important, simply recording suspicions without following mandated reporting procedures does not fulfill the nurse’s legal responsibility. Documentation supports care but is not the primary legal action.

B. Notifying the caregiver of the findings: Informing the caregiver may be inappropriate and could place the client at further risk, especially if the caregiver is the suspected abuser. Legal obligations prioritize protecting the client over notifying the caregiver.

C. Reporting findings to social services: Nurses are mandated reporters of suspected elder abuse or neglect. Reporting objective findings of malnutrition and unexplained bruising to social services ensures that the client’s safety is addressed and fulfills the nurse’s legal responsibility.

D. Including findings during hand-off report: Communicating relevant findings during hand-off is part of good nursing practice, but it does not meet the legal requirement to report suspected abuse to appropriate authorities.

A. A B. B C. C

Correct Answer is B

Explanation

A. This image shows Heberden's and Bouchard's nodes, which are bony enlargements of the finger joints typically associated with Osteoarthritis.

B. This image clearly shows the loss of the normal angle between the nail and the nail bed (Lovibond angle). The fingertips appear enlarged and "drumstick-like," and the nails have a distinct downward, convex curvature.

C. This image displays Ulnar Drift (the fingers slanting toward the pinky side) and joint swelling, which are classic manifestations of Rheumatoid Arthritis. It also shows age-related lentigines (liver spots) on the skin.

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Exhibits A nurse is collecting data from a 6-month-old infant during a well-child visit. Which of the following findings should the nurse report to the provider? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is B

Explanation

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Exhibits

A nurse is collecting data from a 6-month-old infant during a well-child visit. Which of the following findings should the nurse report to the provider? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data)