The nurse is assessing a 4-month-old boy during a scheduled visit. Which findings might suggest a developmental problem?
The child does not vocally respond to voices.
The child never squeals or yells.
The child does not babble.
The child does not say dada or mama.
The Correct Answer is C
A. The child does not vocally respond to voices: While vocal responsiveness is an important aspect of development, it may vary among infants and is not necessarily indicative of a developmental problem at 4 months.
B. The child never squeals or yells: Squealing and yelling are vocalizations that infants may or may not exhibit at this age, and their absence alone may not necessarily indicate a developmental problem.
C. The child does not babblE. Babbling, which typically begins around 4 to 6 months of age, involves the repetition of consonant-vowel combinations (e.g., "bababa"). The absence of babbling by 4 months may suggest a delay in language development and could be a potential sign of a developmental problem.
D. The child does not say dada or mamA. Infants may begin to associate "dada" or "mama" with specific caregivers, but this typically occurs later, closer to 6 to 9 months of age. The absence of this behavior at 4 months may not necessarily indicate a developmental problem.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Do nothing: this is a normal condition for toddlers: Lordosis, also known as swayback, is a common and typically normal finding in toddlers as they develop and their posture adjusts. It is characterized by an exaggerated curvature of the lumbar spine. In most cases, lordosis resolves on its own as the child grows and their musculoskeletal system matures. Therefore, no
intervention is usually necessary.
B. Notify the primary care healthcare provider about the condition: Lordosis alone is not
typically considered a concerning finding in toddlers unless it is severe or accompanied by other
symptoms. It is not necessary to notify the primary care provider unless there are additional concerning signs or symptoms.
C. Refer the toddler to a physical therapist: Referring the toddler to a physical therapist for lordosis alone is not warranted unless there are other significant musculoskeletal issues or developmental concerns.
D. Explain that the child will need a back bracE. Lordosis in toddlers does not typically require the use of a back brace. It is usually a benign and self-limiting condition that resolves with time as the child's musculoskeletal system matures.
Correct Answer is D
Explanation
A. “This is a vasomotor response caused by cooling or warming": While vasomotor responses can cause changes in skin color due to temperature changes, acrocyanosis specifically refers to blue discoloration of the hands and feet due to reduced peripheral circulation, not necessarily due to temperature changes.
B. “This is normal her circulatory system will take a few days to adjust”: While it's true that newborns may have transient circulatory changes as their circulatory system adapts after birth, acrocyanosis specifically refers to a benign condition characterized by persistent blue discoloration of the extremities unrelated to circulatory adjustments.
C. "Let's watch her carefully to make sure she does not have a circulatory problem": While it's important to monitor infants for any signs of circulatory problems, acrocyanosis is typically a
benign and self-limiting condition that does not require intervention unless accompanied by other concerning symptoms.
D. "Your daughter has acrocyanosis; this is causing her blue hands and feet.”: This response provides an accurate explanation for the blue discoloration of the infant's hands and feet. Acrocyanosis is a common and benign condition in newborns characterized by blue discoloration of the extremities due to peripheral vasoconstriction, which gradually resolves over the first few days to weeks of life.
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