A nurse is teaching a group of parents about expected development of gross motor skills during infancy. The nurse should teach that the following developmental tasks are expected to occur in what order? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Sits steadily unsupported

Changes from prone to sitting

Rolls from back to abdomen

Rolls from back to side

Answer and Explanation

The Correct Answer is D,C,A,B

D. Rolling from back to side is the earliest movement and reflects initial development of trunk rotation and muscle control. This typically occurs around 4 months of age. C. Rolling from back to abdomen requires greater coordination and strength than rolling to the side and usually occurs around 5 to 6 months as infants gain better control of their core muscles. A. Sitting steadily unsupported develops once the infant has strong trunk control and balance, typically around 6 to 8 months. This skill indicates improved postural stability. B. Changing from prone to sitting is the most advanced skill listed. It requires coordinated use of the arms, core, and balance, and typically occurs later around 8 to 10 months as mobility becomes more purposeful.

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Free Nursing Study Resources

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A"}}

Explanation

Rationale:

• Measure the infant's weight daily: Daily weight monitoring is standard for postoperative infants to assess hydration status and overall recovery. Accurate weight helps guide fluid replacement and nutrition management.

• Initiate short breastfeeding sessions 12 hr postoperatively: Postoperative feedings usually begin relatively quickly (often 4-6 hours post-op) with small amounts of clear fluids or breast milk/formula, gradually increasing. 12 hours is an expected time frame to begin re-feeding/breastfeeding sessions.

• Place the infant in prone position after feeding: Infants are placed on their backs (supine) to reduce the risk of sudden infant death syndrome (SIDS). Prone positioning after feeding is not recommended in postoperative care unless specifically ordered for surgical reasons.

• Fold the infant's diaper below the incision site: Keeping the diaper below the surgical site prevents irritation, friction, or pressure on the incision, promoting healing and preventing infection. This is a standard nursing intervention after abdominal surgery in infants.

A. Administer a continuous infusion of calcium gluconate B. Place the client in the semi-Fowler's position. C. Ensure bright lighting in the room. D. Initiate seizure precautions.

Correct Answer is D

Explanation

Rationale:

A. Administer a continuous infusion of calcium gluconate: Calcium gluconate is not used for the management of preeclampsia or seizure prophylaxis. Magnesium sulfate is the medication of choice to prevent eclamptic seizures in clients with severe preeclampsia.

B. Place the client in the semi-Fowler's position: Semi-Fowler’s position does not optimize uteroplacental perfusion. Left lateral positioning is preferred to enhance blood flow to the uterus and improve maternal and fetal oxygenation.

C. Ensure bright lighting in the room: Bright lighting can increase stimulation and anxiety, which is not beneficial for a client at risk for seizures. A calm, low-stimulation environment is preferable to minimize seizure triggers.

D. Initiate seizure precautions: Clients with preeclampsia with severe features are at high risk for eclampsia, making seizure precautions essential. These include placing the bed in a low position, padding side rails, having oxygen and suction available, and monitoring closely for neurologic changes.

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Naxlex Comprehensive Predictor Exams

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A"}}

Explanation

A nurse is planning care for a client who is at 36 weeks of gestation and has preeclampsia with severe features. Which of the following actions should the nurse plan to implement?

Correct Answer is D

Explanation

A nurse case manager is caring for a population of clients in the community. Which of the following demonstrates the role of a liaison?

A nurse observes a client who is at 37 weeks of gestation and has preeclampsia with severe features having a seizure. Which of the following actions following the seizure should the nurse take first?

A nurse is preparing to discharge a client who has a new diagnosis of COPD and will require home oxygen. Which of the following members of the health care team should the nurse consult?

The nurse reviews the entries in the medical record. Exhibits The nurse is preparing the client for a blood transfusion. Which of the following actions should the nurse take? Select all that apply.

A charge nurse delegates to an assistive personnel (AP) the task of ambulating a client. At the end of the shift, the nurse discovers the client has not been ambulated. Which of the following actions should the nurse take first?

A nurse is caring for a 2-year-old toddler. Which of the following food choices should the nurse recommend to promote independence in eating?

A nurse is caring for a client who tells the nurse that he feels he is being discharged from the facility too soon. Which of the following statements by the nurse demonstrates client advocacy?