A nurse is assessing a 4-year old preschooler. Which of the following findings should indicate to the nurse a need to refer the child for a possible developmental delay? (Select all that apply.)
The child occasionally reverses letters when writing.
The child is unable to follow simple two-step instructions.
The child occasionally stutters when excited or nervous.
The child has a vocabulary of fewer than 50 words
The child has difficulty sharing toys with peers
Correct Answer : B,D
A. Occasional letter reversal is common at this age and not a concern for developmental delay.
B. At 4 years old, a child should be able to follow simple two-step instructions. Difficulty doing so may indicate a developmental delay.
C. Occasional stuttering when excited or nervous is common and does not indicate a developmental delay.
D. A vocabulary of fewer than 50 words is concerning, as children at this age typically have a much larger vocabulary.
E. Difficulty sharing toys is developmentally normal for a 4-year-old and does not necessarily indicate a delay.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D"]
Explanation
A. Staying dry for extended periods and waking up dry are clear indicators that the child may be ready for potty training.
B. Encouraging the child to sit on the potty, even without using it, helps familiarize them with the process, which is beneficial for readiness.
C. Discipline for accidents can create anxiety and resistance toward potty training; it is important to approach the process positively.
D. Waiting for signs of interest and the ability to follow simple instructions respects the child's developmental readiness, making the transition smoother.
E. Starting potty training too early can lead to frustration for both the child and parents; readiness should be based on the child’s cues rather than age alone.
Correct Answer is D
Explanation
A. Using medical jargon would likely confuse and scare the child.
B. Keeping medical equipment visible might increase anxiety, as young children can become fearful of unfamiliar objects.
C. Separating the child from their parent during the examination can increase fear and resistance, so it is better to keep the parent nearby for reassurance.
D. Allowing the child to role-play with medical equipment helps reduce anxiety, makes the experience more familiar, and increases cooperation during the assessment.
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