A nurse is collecting data from an 18-month-old toddler. Which of the following findings should the nurse report to the provider?
Speaks four words
Builds a tower of three blocks
Has temper tantrums
Jumps in place with both feet
The Correct Answer is A
Choice A reason:
At 18 months, a toddler should typically be saying more than four words. This finding may
indicate a potential delay in speech development, and it should be reported to the provider for further evaluation.
Choice B reason:
Building a tower of three blocks is an appropriate developmental milestone for an 18-month-old and does not warrant reporting.
Choice C reason:
Temper tantrums are a normal behavior for toddlers, as they are still developing emotional regulation skills. This finding does not require reporting unless it is severe or causing harm to the child.
Choice D reason:
Jumping in place with both feet is an appropriate developmental milestone for an 18-month-old and does not warrant reporting.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason:
Avoiding discussing the child's diagnosis with the sibling may create unnecessary secrecy and could hinder the sibling's understanding and coping.
Choice B reason:
Designating one parent to stay at home with the sibling may not be necessary, as both parents can still provide support and care for both children.
Choice C reason:
Avoiding having the sibling visit the child in the facility may isolate them and prevent opportunities for bonding and support.
Choice D reason:
This statement is correct. Encouraging phone calls between the siblings allows them to maintain communication, express their feelings, and support each other during the separation caused by hospitalization.
Correct Answer is B
Explanation
Choice A reason:
Increased urinary output is not typically associated with heart failure. In fact, heart failure often leads to decreased urine output due to decreased cardiac output.
Choice B reason:
Tachycardia (rapid heart rate) is a common manifestation of heart failure in infants. The heart compensates for decreased cardiac output by beating faster.
Choice C reason:
Bounding peripheral pulses are not typically associated with heart failure. In fact, weak peripheral pulses may be a sign of decreased cardiac output.
Choice D reason:
Increased blood pressure is not typically associated with heart failure in infants. Instead, infants with heart failure may have low or normal blood pressure.
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