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 C

Explanation

A. "Cognitive abilities in children with Down syndrome cannot be improved, so focusing on physical health is the only priority." While children with Down syndrome do experience cognitive impairments, early intervention programs such as speech, occupational, and physical therapy can enhance cognitive, motor, and social development, improving their overall functioning.

B. "Infants who have Down syndrome typically have significantly higher IQ scores compared to typically developing infants." Children with Down syndrome generally have mild to moderate intellectual disability, and their IQ scores tend to be lower than typically developing peers, not higher.

C. "Early intervention programs can mitigate cognitive impairments in infants who have Down syndrome." This is correct. Early stimulation, structured learning environments, and specialized therapies can help optimize the child's cognitive potential and improve adaptive skills.

D. "Cognitive abilities of infants who have Down syndrome are typically within the average range during the first year of life." Although some developmental milestones may appear similar in early infancy, delays in cognitive and motor development often become noticeable within the first year, distinguishing children with Down syndrome from their typically developing peers.

A. "Adolescents may feel responsible for the illness." B. "Adolescents may feel frustrated for being dependent on others." C. "Children 3 to 5 years old are too young to understand the difference between life and death." D. "Children around 5 or 6 years old may try to be brave and shield loved ones from distress."

Correct Answer is B

Explanation

A. "Adolescents may feel responsible for the illness." While younger children may engage in magical thinking and believe they caused their illness, adolescents typically have a more developed understanding of disease processes and are less likely to blame themselves.

B. "Adolescents may feel frustrated for being dependent on others." Adolescents value independence and autonomy, so a terminal illness that forces them to rely on caregivers can lead to frustration, anger, and emotional distress. This struggle with dependency is a common psychosocial challenge in adolescent patients.

C. "Children 3 to 5 years old are too young to understand the difference between life and death." Preschool-aged children may not fully grasp the permanence of death, but they do have some awareness of it. They often see death as temporary or reversible, influenced by their limited cognitive development and exposure to media or stories.

D. "Children around 5 or 6 years old may try to be brave and shield loved ones from distress." While school-aged children may begin to understand the finality of death, the tendency to "be brave" and protect loved ones is more common in older children and adolescents, who have a stronger sense of emotional responsibility.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching to the parents of a 2-month-old infant who has Down Syndrome. Which of the following statements addressing cognitive ability should the nurse reinforce?

Correct Answer is C

Explanation

A hospice nurse is reinforcing teaching to a parent about how age affects how their child experiences a terminal illness. Which of the following statements should the nurse include?

Correct Answer is B

Explanation

A nurse is reinforcing education to the parent of a 5-year-old client who has manifestations consistent with autism spectrum disorder (ASD). Which of the following statements should the nurse reinforce about the screening process for ASD?

A nurse is reinforcing teaching to a newly hired nurse about the management of care for the terminal illness of a child. Which of the following statements by the newly hired nurse indicates an understanding of the teaching?

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