The nurse is examining a 10-month-old boy who was born 10 weeks early. Which finding is cause for concern?

The child exhibits plantar grasp reflex.

The child has doubled his birth weight.

No primary teeth have erupted yet.

The child's head circumference is 49.53 cm.

Answer and Explanation

The Correct Answer is C

A. The child exhibits plantar grasp reflex: The presence of the plantar grasp reflex at 10 months

is appropriate and not cause for concern. This reflex typically diminishes by around 9 months but can persist slightly longer in premature infants.

B. The child has doubled his birth weight: Doubling birth weight by around 6 months is a normal developmental milestone, and achieving this by 10 months is appropriate, indicating healthy growth.

C. No primary teeth have erupted yet: The absence of primary teeth by 10 months, especially in a preterm infant, may indicate a delay in dental development and should prompt further evaluation by a healthcare provider.

D. The child's head circumference is 49.53 cm: The head circumference of 49.53 cm falls within the typical range for a 10-month-old infant and is not inherently concerning.

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Correct Answer is A

Explanation

A. 87 lb is a reasonable weight for a 10-year-old boy who was 80 lb the previous year, considering the average weight gain is about 10 pounds a year at this age.

B. 81 lb would be a below-average weight gain for a year for a child of this age. C. 89 lb would be an above-average weight gain for a year for a child of this age.

D. 85 lb is within the range but slightly below the average expected weight gain for a year for a child of this age.

A. Speak to the child using mature language and appeal to his or her desire for self-care. B. Include the child in all parts of the examination: speak to the caregiver before and after the examination. C. Keep up a running dialogue with the caregiver, explaining each step as you do it. D. Address the child by name; speak to the caregiver and do the most invasive parts last.

Correct Answer is A

Explanation

A. Speak to the child using mature language and appeal to his or her desire for self-care. - School-age children are typically more independent and responsive to mature communication. Acknowledging their desire for self-care fosters cooperation during the examination process.

B. Include the child in all parts of the examination: speak to the caregiver before and after the examination. - While involving the child in the examination process is important, school-age children may prefer direct communication rather than primarily interacting with caregivers.

C. Keep up a running dialogue with the caregiver, explaining each step as you do it. - While

involving caregivers in the examination process is important, maintaining a dialogue primarily with them may not fully engage the child during the assessment.

D. Address the child by name; speak to the caregiver and do the most invasive parts last. - While considering the child's comfort and addressing them directly is essential, school-age children

may respond better to direct communication rather than deferring to caregivers for discussion

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The nurse is examining a 10-month-old boy who was born 10 weeks early. Which finding is cause for concern?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is performing a physical assessment of a 10-year-old boy. The nurse notes that during last year's check-up, the child weighed 80 lb. According to average growth for this age group, what would be his expected current weight?

Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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