A nurse is observing a newborn’s reactions to different stimuli.

The nurse touches the corner of the newborn’s mouth with a finger and sees that the newborn turns her head toward that side and starts to suck.

The nurse recognizes this as:

A nurse is assessing a newborn’s reflexes as part of a neurologic examination.

The nurse strokes the outer edge of the sole of the newborn’s foot from heel to toe and observes that the newborn’s toes fan upward and out.

The nurse documents this as a positive response for which of the following reflexes?

A nurse is caring for a 2-month-old infant who has a positive Moro reflex.

Which of the following actions should the nurse take to elicit this reflex? (Select all that apply.)

A nurse is observing a newborn’s reactions to different stimuli.

The nurse touches the corner of the newborn’s mouth with a finger and sees that the newborn turns her head toward that side and starts to suck.

The nurse recognizes this as:

A nurse is performing a routine assessment on a newborn.

The nurse strokes the cheek of the newborn and notes that the newborn turns toward that side and opens his mouth.

The nurse documents this finding as which of the following?

A nurse is performing a routine assessment on a newborn.

The nurse gently drops the head of the newborn while supporting the body and observes symmetric abduction and extension of the arms followed by flexion and adduction of the arms.

This finding indicates a positive response for which of the following reflexes?

A nurse is evaluating an infant’s neuromuscular development by testing different reflexes.

The nurse strokes the outer edge of the sole of the infant’s foot up toward the toes and observes that the infant’s toes fan upward and out.

The nurse documents this as:

A nurse is performing a neurological assessment on a 4-month-old infant.

The nurse gently drops the infant’s head backward while supporting the body.

The nurse expects to see which of the following responses as part of a normal reflex?

A nurse is evaluating a client who has a suspected stroke.

The nurse asks the client to stick out his tongue and observes that it deviates to the left side.

Which of the following cranial nerves is most likely affected?

A nurse is observing an infant who is lying on his back.

The nurse notices that when the infant’s head is turned to the right, his right arm and leg extend, while his left arm and leg flex.

The nurse recognizes this as which of the following reflexes?

A nurse is performing a neurological examination on a client who has a history of multiple sclerosis.

The nurse notices that the client has difficulty walking and maintaining balance.

Which of the following tests should the nurse use to assess the client’s coordination?