A nurse is assessing a 15-month-old toddler. Which of the following findings should the nurse report to the provider?
The toddler cannot jump with both feet.
The toddler cannot build a tower of six to seven cubes
The toddler cannot stand upright without support
The toddler cannot turn a doorknob
The Correct Answer is C
By 15 months of age, toddlers typically develop the ability to stand and maintain balance without support. This milestone is an important indicator of gross motor development. Not being able to stand upright without support at this age may suggest a delay or impairment in motor skills, and further evaluation may be needed to determine the underlying cause.
The other findings mentioned—difficulty jumping with both feet, inability to build a tower of six to seven cubes, and inability to turn a doorknob—are within the expected range of development for a 15-month-old toddler. While some children may already demonstrate these skills, others may acquire them later in their developmental journey. It is important to consider individual variations in development, but the inability to stand without support should be further assessed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. It’s usually best to build trust and rapport first with non-invasive assessments. Starting with a potentially uncomfortable procedure like looking in the ears may cause distress and make the rest of the exam more difficult.
B.Examining the tympanic membrane before the head and neck might still be too early in the assessment and could cause the child to become uncooperative for subsequent steps. If the child becomes upset, it could complicate the rest of the physical exam, making it harder to complete.
C.Performing the ear examination at the end allows the nurse to build trust and rapport throughout the visit. The child is less likely to become distressed too early in the exam, which helps maintain cooperation for as long as possible.If the child does become upset, it is at the end of the visit, and the more critical assessments have already been completed.
D.If the ear exam causes distress, it may make the child uncooperative for important assessments like auscultating the heart and lungs.
Correct Answer is B
Explanation
Crying is a common behavioral response to pain in infants, and it serves as an important indicator of discomfort. Infants may cry more intensely, have a high-pitched cry, or exhibit inconsolable crying when they are in pain. It is important for the nurse to assess the infant's pain level and provide appropriate interventions to alleviate the discomfort.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today