A nurse is assessing a 4-month-old infant at a well-child visit. Which of the following findings should the nurse expect?

The infant exhibits a fear of strangers.

The infant understands the word "no".

The infant has an absent grasp reflex.

The infant rolls from their back to their abdomen.

Answer and Explanation

The Correct Answer is C

A. "The infant exhibits a fear of strangers." Stranger anxiety typically develops around 6 to 9 months of age.
B. "The infant understands the word 'no'." Understanding simple words like "no" begins closer to 9 months to 1 year of age.
C. "The infant has an absent grasp reflex." The grasp reflex begins to disappear by 3 months of age, with voluntary grasping developing by 4 to 5 months.
D. "The infant rolls from their back to their abdomen." Rolling from back to abdomen usually occurs around 5 to 6 months.

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Correct Answer is C

Explanation

A. Warm extremities: Typically, in heart failure, extremities can feel cold due to poor circulation and reduced cardiac output.
B. Frequent headaches: Headaches are not a typical sign of heart failure in children. Although they can occur in some cases due to increased intracranial pressure, they are not characteristic of heart failure.
C. Distended neck veins: Distended neck veins are a hallmark sign of right-sided heart failure. It occurs when the heart is unable to efficiently pump blood, leading to congestion and fluid retention, which can cause blood to back up into the veins, resulting in visible distention.
D. Weight loss: Weight gain due to fluid retention is more common in heart failure. Weight loss may occur in more advanced or chronic cases due to decreased appetite and fluid shifts, but weight gain is the expected finding in early stages.

Correct Answer is ["12.5"]

Explanation

Dose required per day = 50mg/kg/day × 40 kg = 2000 mg/day

Dose per administration = 2000mg4 doses= 500 mg/dose

Volume to administer:

200mg5ml=40mg/ml

500mg40mg/ml=12.5ml/dose

Correct answer =12.5mL/dose

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A nurse is assessing a 4-month-old infant at a well-child visit. Which of the following findings should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a child who has heart failure. Which of the following clinical manifestations should the nurse expect?

Correct Answer is C

Explanation

Correct Answer is ["12.5"]

Explanation

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