A nurse is assessing a 4-month-old infant during a well-baby visit. For which of the following findings should the nurse notify the provider?
No head lag when pulled to a sitting position
Doll's eye reflex intact
Presence of tears when crying
Positive Babinski reflex
The Correct Answer is B
A. No head lag when pulled to a sitting position is a normal finding at 4 months of age.
B. They should not have doll's eye reflex intact, which means that their eyes move in the opposite direction of their head when turned. This reflex normally disappears by 3 months of age and its persistence may indicate brain damage.
C. The presence of tears when crying is a normal finding at 4 months of age.
D. They should also have positive Babinski reflex, which means that their toes fan out when their sole is stroked. This reflex normally disappears by 12 months of age.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"E"}
Explanation
A. While acute glomerulonephritis can occur following certain infections such as streptococcal infections, it is less commonly associated with fever and lethargy compared to pyelonephritis.
B. Pyelonephritis is a bacterial infection of the kidneys commonly associated with fever and lethargy, especially in young children. The fever and lethargy reported by the parent, along with the urine sample obtained, suggest a concern for pyelonephritis.
C. Polycystic kidney disease typically presents later in life and is not typically associated with acute febrile illness in a 1-year-old toddler.
D. Renal scarring can occur as a complication of untreated or recurrent urinary tract infections (UTIs), particularly pyelonephritis. The presence of fever and lethargy in the child, along with the history of decreased appetite, raises concerns for a urinary tract infection that could lead to renal scarring if left untreated.
E. Nephrotic syndrome typically presents with edema, proteinuria, hypoalbuminemia, and hyperlipidemia, rather than the symptoms described in the scenario.
Correct Answer is A
Explanation
A. This finding is consistent with both acute laryngotracheobronchitis and pneumonia, as both conditions can cause discomfort and distress in children.
B. Fever can be present in both acute laryngotracheobronchitis and pneumonia as they are both infections of the respiratory tract. It is a non-specific symptom that can occur with various respiratory illnesses.
C. This finding is more consistent with acute laryngotracheobronchitis than pneumonia, as acute laryngotracheobronchitis is characterized by a barking, non-productive cough that worsens at night or with agitation, while pneumonia causes a productive cough that may be accompanied by chest pain or difficulty breathing.
D. This finding is more consistent with acute laryngotracheobronchitis than pneumonia, as acute laryngotracheobronchitis causes inflammation and narrowing of the upper airway, leading to a high-pitched sound during inhalation, while pneumonia affects the lower airway and does not usually cause stridor.
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