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

Answer and Explanation

The Correct Answer is B

A.   No head lag when pulled to a sitting position is a normal finding at 4 months of age and does not require notification of the provider.
B.   The Doll's eye reflex (also known as oculocephalic reflex) should be absent by 4 months of age. Its persistence could indicate neurological abnormalities and warrants further evaluation by the provider.
C.   Presence of tears when crying is a normal physiological response and does not require notification of the provider.
D.   Positive Babinski reflex is normal in infants under 2 years old and typically disappears by 12 to 24 months of age. It does not require immediate notification of the provider.

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Correct Answer is B

Explanation

A. Unopened bottles of formula are not typically a source of healthcare-associated infection.
B. Bedside computer keyboards can harbor various pathogens and are commonly touched by multiple individuals without thorough cleaning, making them a common source of healthcare-associated infections.
C. Disposable diapers, if properly disposed of and not reused, are not typically a source of healthcare-associated infection.
D. Protective plastic gowns, if used appropriately, are not typically a source of healthcare-associated infection.

A. Oral electrolyte solution B. Applesauce C. White grape juice D. Chicken soup

Correct Answer is A

Explanation

A. Oral electrolyte solution helps to prevent dehydration and maintain electrolyte balance in infants with acute diarrhea.
B. Applesauce may worsen diarrhea due to its high fiber content and should be avoided initially.
C. White grape juice may worsen diarrhea due to its high sugar content and lack of electrolytes.
D. Chicken soup may not provide the necessary electrolytes and may contain ingredients that are difficult for an infant with acute diarrhea to digest.

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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?

Nursing Test Bank

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