A nurse is collecting data from a 15-month-old toddler.
Which of the following findings should the nurse expect?
Turns two pages in a book at a time.
Throws a ball overhead without falling.
Drinks independently from a cup.
Refers to themselves by their first name.
The Correct Answer is C
Choice A rationale
Turning two pages at a time reflects fine motor control development seen in younger toddlers. At 15 months, most toddlers refine coordination, progressing to turning single pages. Double-page turning is less precise, often due to immature grasp and pinch abilities. Fine motor milestones evolve with age, allowing toddlers to handle books more adeptly. This finding contrasts expected skills of a 15-month-old toddler, who typically exhibits improved single-page manipulation.
Choice B rationale
Throwing a ball overhead without falling signifies advanced gross motor skills uncommon at 15 months. Toddlers this age generally develop basic motor coordination like walking and controlled ball rolling rather than overhead throwing. Overhead throwing requires integrated balance and muscle strength, milestones reached closer to 18-24 months. A 15-month-old’s motor development includes walking without assistance and simple gross motor activities like kicking.
Choice C rationale
Drinking independently from a cup indicates motor and cognitive skills typical of a 15-month-old toddler. At this age, toddlers develop hand-eye coordination and the ability to grasp and tilt cups correctly. Fine motor milestones include learning to feed themselves and achieve independence in activities like drinking. Drinking independently reflects self-sufficiency and developmental progress expected in toddlers at 15 months.
Choice D rationale
Referring to themselves by their first name reflects cognitive and language skills progressing beyond 15 months. Toddlers this age typically use single words or gestures to communicate needs. Self-identification with their name becomes evident later, around 18-24 months, as language skills improve. A 15-month-old toddler may recognize their name but is unlikely to articulate it spontaneously.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","D"]
Explanation
Choice A rationale
A sunken anterior fontanel suggests reduced intracranial pressure from dehydration. Loss of extracellular fluid volume diminishes intracranial compensation mechanisms, making this a critical dehydration indicator.
Choice B rationale
An increased pulse rate compensates for reduced circulating volume due to dehydration. Tachycardia signals sympathetic nervous system activation to maintain cardiac output.
Choice C rationale
Dry mucous membranes result from reduced salivary gland activity caused by extracellular fluid depletion. Lack of moisture directly indicates dehydration severity.
Choice D rationale
Irritability in children occurs from electrolyte imbalance and reduced perfusion during dehydration. CNS irritability often signals hypovolemia effects on neural function.
Correct Answer is A
Explanation
Choice A rationale
Rhinorrhea is a common manifestation of respiratory syncytial virus (RSV), as the virus causes inflammation of the upper respiratory mucosa leading to excessive nasal secretions. This inflammation and increased mucus production are the body's defensive response to eliminate the virus. The condition is most prevalent during early stages of infection and is often accompanied by other symptoms like cough and fever. The absence of other options makes rhinorrhea a characteristic feature in RSV.
Choice B rationale
Vesicles on the trunk are typically associated with varicella-zoster virus (chickenpox), not RSV. Vesicles form as the virus infects epithelial cells, leading to fluid-filled lesions that eventually crust over. This clinical presentation is entirely unrelated to the respiratory symptoms caused by RSV, which targets the respiratory epithelial cells rather than the skin.
Choice C rationale
Barrel chest develops as a chronic adaptation in diseases like emphysema and cystic fibrosis, where prolonged air trapping occurs. RSV predominantly affects younger children acutely, resulting in symptoms like rhinorrhea, cough, and wheezing without long-term anatomical alterations like barrel chest.
Choice D rationale
Clubbing of the fingers arises in chronic conditions like congenital heart disease or cystic fibrosis due to prolonged hypoxia and tissue growth factors affecting the nails. RSV is an acute respiratory virus, unlikely to lead to chronic hypoxia causing clubbing.
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