A nurse is caring for a toddler in a pediatric clinic.

Exhibits

Click to highlight the findings that require immediate follow-up. To deselect a finding click on the finding again.

Screenings

13-month visit

Gross Motor: Can stand up and walk independently, attempts to scoot upstairs on hands and knees

Fine motor: Picks at cereal out of a snack cup with two fingers. Transfers food from one hand to the other and feeds self with small bites in a fist. Uses one finger to repetitively spin a wheel on a toy truck.

Nutrition: Drinks from a cup when parent holds it but does not pick up the cup or try to hold it. Likes fruit like blueberries and peaches, but spits out vegetables.

Language: No attempt to communicate verbally. Makes repetitive noises that change pitch but do not seem to be associated with trying to communicate. Behavioral: Parent picks up toddler and gives them a hug and a kiss on the cheek. Toddler does not respond or cuddle them back. Does not respond when asked to point to a body part or show the nurse the toy they are playing with.

Uses one finger to repetitively spin a wheel on a toy truck

Drinks from a cup when parent holds it but does not pick up the cup or try to hold it. Likes fruit like blueberries and peaches, but spits out vegetables

No attempt to communicate verbally

Makes repetitive noises that change pitch but do not seem to be associated with trying to communicate

Parent picks up toddler and gives them a hug and a kiss on the cheek. Toddler does not respond or cuddle them back

Does not respond when asked to point to a body part or show the nurse the toy they are playing with

Answer and Explanation

The Correct Answer is ["A","B","C","D","E","F"]

Language Delay: "No attempt to communicate verbally. Makes repetitive noises that change pitch but do not seem to be associated with trying to communicate." By 12–13 months, toddlers typically say 1–2 words, attempt to mimic sounds, and use gestures (e.g., pointing, waving) to communicate. The lack of verbal communication and repetitive vocalizations without meaning raise concerns about delayed expressive language development, which is an early sign of ASD or speech delay

Lack of Social Reciprocity: "Parent picks up toddler and gives them a hug and a kiss on the cheek. Toddler does not respond or cuddle them back." By this age, toddlers typically enjoy physical affection, seek comfort, and show attachment to caregivers. A lack of reciprocal affection or engagement may indicate social communication deficits, which are hallmark features of ASD.

Nutrition: Likes fruit like blueberries and peaches, but spits out vegetables." Food preferences at this age are common, and rejecting vegetables alone is not necessarily concerning. However, extreme food selectivity (avoiding entire food groups, refusing textures) can be a sign of sensory processing issues, which are more common in ASD.

Fine Motor: "Drinks from a cup when parent holds it but does not pick up the cup or try to hold it." By 12–13 months, toddlers typically attempt to hold and drink from a cup independently.Delayed self-feeding skills may indicate fine motor delays or lack of interest in independent eating, which can be seen in neurodevelopmental disorders like ASD.

Lack of Joint Attention: "Does not respond when asked to point to a body part or show the nurse the toy they are playing with." At 12–13 months, toddlers should be able to follow simple commands and engage in joint attention (e.g., pointing to objects, responding to names). Failure to follow basic commands or lack of engagement with others is a red flag for delayed receptive language development or social communication deficits.Lack of joint attention is one of the earliest indicators of ASD and warrants immediate follow-up.

"Uses one finger to repetitively spin a wheel on a toy truck". This behavior is another important red flag for autism spectrum disorder (ASD) and requires immediate follow-up. This child’s repetitive spinning of a wheel using one finger suggests fixated, repetitive behaviors, which are hallmark features of ASD.

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Correct Answer is B

Explanation

A. Cough, edema, and increased work of breathing. While these symptoms can indicate worsening heart failure, cough and edema are less prominent signs in infants compared to respiratory distress and feeding difficulties.

B. Tachypnea and diaphoresis with feeding, poor weight gain, and irritability. This is correct. Infants with worsening heart failure often struggle with feeding due to increased energy demands and difficulty breathing. Tachypnea (rapid breathing) and diaphoresis (excessive sweating) during feeding are classic early signs. Poor weight gain results from inadequate caloric intake, and irritability may be due to fatigue and hypoxia.

C. Abdominal pain, poor appetite, and cough. Abdominal pain is difficult to assess in infants, and poor appetite alone is not a definitive sign of heart failure. Cough may occur but is not a primary indicator of worsening heart failure in infants.

D. Bradycardia, rapid weight gain, and irritability. Bradycardia is not a common sign of worsening heart failure in infants; tachycardia (fast heart rate) is more typical. Rapid weight gain could suggest fluid retention but is not as reliable a sign as feeding difficulties and respiratory distress.

A. "The life expectancy for an individual who has this disorder is 25 years of age.” B. "This disorder is most common in individuals of Northern European descent.” C. "Heart failure will occur at some point during the progression of CF.” D. “This disorder occurs when the mother has a mutation of the 7th chromosome.”

Correct Answer is B

Explanation

A. "The life expectancy for an individual who has this disorder is 25 years of age." Advances in treatment, including improved respiratory therapies and medications like CFTR modulators, have significantly increased life expectancy. Many individuals with cystic fibrosis (CF) now live into their 40s or beyond, depending on disease severity and access to medical care.

B. "This disorder is most common in individuals of Northern European descent." CF is most prevalent in individuals of Northern European ancestry, affecting about 1 in 2,500 to 3,500 newborns in this population. It is much less common in individuals of African, Asian, or Hispanic descent.

C. "Heart failure will occur at some point during the progression of CF." CF primarily affects the lungs and digestive system due to thick mucus production, but heart failure is not a direct consequence of the disease. However, cor pulmonale (right-sided heart failure) can develop secondary to chronic lung disease and pulmonary hypertension in severe cases.

D. "This disorder occurs when the mother has a mutation of the 7th chromosome." CF is an autosomal recessive disorder, meaning a child must inherit mutated CFTR genes from both parents (not just the mother). The mutation affects the CFTR gene located on chromosome 7, leading to defective chloride transport and thick mucus production.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing care for an infant who has heart failure and is being discharged from the hospital. When reinforcing discharge education, which of the following clinical manifestations should the nurse ensure caregivers are able to identify as signs of worsening heart failure?

Correct Answer is B

Explanation

A nurse is reinforcing teaching to a newly hired nurse about cystic fibrosis. Which of the following statements should the nurse make?

Correct Answer is B

Explanation

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