A nurse is assessing a one-month-old infant.
Which of the following findings should the nurse report to the provider?

Inability to sit without support.

Inability to raise head when in prone position.

Inability to bring an object to mouth.

Inability to pick up an object with fingers.

Answer and Explanation

Correct Answer : B,C,D

Choice A rationale

At one month of age, infants are not expected to sit without support. Therefore, an inability to do so would not be a cause for concern at this age.

Choice B rationale

By one month, infants should be able to briefly raise their head when placed in a prone (on their stomach) position. If an infant is unable to do this, it could indicate a potential developmental delay or muscle weakness.

Choice C rationale

At one month, infants typically have not yet developed the coordination to bring an object to their mouth. Therefore, an inability to do so at this age would not be a cause for concern.

Choice D rationale

By one month, infants are not expected to have the fine motor skills necessary to pick up an object with their fingers. Therefore, an inability to do so would not be a cause for concern at this age.

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Correct Answer is D

Explanation

Choice A rationale

Rocking the baby to sleep and then laying the baby in the crib might not alleviate the baby’s shortness of breath and irritability. While rocking can be soothing, it does not address the underlying issue of respiratory difficulty.

Choice B rationale

Taking the baby from the mother and laying the baby in the crib might not be the best advice. Separation from the mother might increase the baby’s distress and does not address the baby’s respiratory difficulty.

Choice C rationale

Feeding the baby and then laying the baby down might not be the best advice. Feeding can be difficult for a baby who is tachypneic and might increase the risk of aspiration.

Choice D rationale

Advising swaddling the baby and placing the baby on its back at a 30-degree angle in the crib is the best advice. This position can help to decrease work of breathing and increase comfort, which might help the baby to rest better.

A. Keeping the parents close by, so the infant can see them. B. Expecting the infant’s cooperation during the physical assessment. C. Auscultating heart, lung, and bowel sounds first. D. Smiling and using a gentle voice when talking to the infant. E. Starting the assessment at the infant’s head, beginning with the ears and eyes.

Correct Answer is ["A","C","D","E"]

Explanation

Choice A rationale

Keeping the parents close by during a physical assessment can help to soothe and comfort the infant. The presence of a familiar face can reduce anxiety and fear, making the examination process smoother.

Choice B rationale

Expecting an infant’s cooperation during a physical assessment is not realistic. Infants are not capable of understanding the purpose of the examination and may become distressed or uncooperative.

Choice C rationale

Auscultating heart, lung, and bowel sounds first is a recommended technique when performing a physical assessment on an infant. These assessments are non-invasive and can be done quickly and quietly, which can help to keep the infant calm and relaxed.

Choice D rationale

Using a gentle voice and smiling when talking to the infant can help to create a soothing and comforting environment. This can help to reduce the infant’s anxiety and make the examination process smoother.

Choice E rationale

Starting the assessment at the infant’s head, beginning with the ears and eyes, is a recommended technique. This allows the nurse to observe the infant’s facial expressions and reactions, which can provide valuable information about the infant’s overall health and well- being.

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A nurse is assessing a one-month-old infant.Which of the following findings should the nurse report to the provider?

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Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

When performing a physical assessment on an infant, the nurse understands that which of the following techniques will aid in the ability to complete the examination? (Select all that apply)

Correct Answer is ["A","C","D","E"]

Explanation

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A nurse is assessing a one-month-old infant.
Which of the following findings should the nurse report to the provider?