Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client’s progress.

A) Check the client's pulse rate: While it is important to assess vital signs, the priority in this scenario is ensuring that the client’s airway is open and that they can breathe adequately. A pulse rate check can be performed after addressing the immediate respiratory needs.

B) Administer oxygen to the client: Administering oxygen is important for clients who are cyanotic and showing signs of respiratory distress. However, oxygen will not be effective if the airway is obstructed. The first priority is to ensure that the airway is open and clear, as this is the most immediate need for breathing.

C) Establish a patent airway for the client: The most immediate priority is to ensure that the client has a patent airway. Cyanosis and a decreased respiratory rate with shallow respirations indicate that the client is likely unable to get enough oxygen, possibly due to an obstruction or inadequate airway. Once the airway is secured, other interventions such as administering oxygen can follow.

D) Place a pulse oximeter on the client's finger: While measuring oxygen saturation is important, the priority action is to ensure that the client’s airway is open first. If the client is cyanotic and showing signs of respiratory distress, the nurse must address the airway immediately before assessing the pulse oximeter reading, as it may not provide accurate data without a patent airway.

A) Rolls from back to abdomen: Rolling from back to abdomen is a typical developmental milestone for a 4-month-old infant. By this age, infants usually have increased muscle strength and coordination, allowing them to start rolling over. This movement helps build their core strength, which is important for later developmental milestones like sitting up and crawling.

B) Moves objects to mouth: It is common for a 4-month-old to move objects to their mouth as they begin exploring the world around them. This action is a key part of sensory development and helps infants develop their hand-to-mouth coordination. Additionally, this behavior assists in teething and the development of oral motor skills.

C) Anterior fontanel closed: The anterior fontanel normally closes between 12 to 18 months of age. If it is closed at 4 months, it may suggest abnormal cranial growth, such as craniosynostosis, where the sutures of the skull close too early. This could lead to increased pressure on the brain, which can cause developmental delays or other complications, so the provider should be notified for further assessment.

D) Posterior fontanel closed: The posterior fontanel typically closes by 2 to 3 months of age. If it is closed by 4 months, it is completely normal and indicates proper cranial development. The closing of the posterior fontanel helps ensure the skull's bones are fusing together as expected, and it does not raise any concerns at this stage.