A nurse is collecting data from a 9-month-old infant.
Which of the following findings requires a nursing intervention?
Positive Moro reflex.
Negative Doll's eye reflex.
Positive Babinski reflex.
Negative Crawl reflex.
The Correct Answer is A
The correct answer is a. Positive Moro reflex.
Choice A reason:
Positive Moro reflex: This reflex should disappear by 6 months of age. Its presence at 9 months indicates potential neurological issues.
Choice B reason:
Negative Doll’s eye reflex: This reflex, indicating brainstem function, should be positive in infants. A negative result suggests severe brainstem dysfunction
Choice C reason:
Positive Babinski reflex: This reflex is normal up to 2 years of age. It indicates normal neurological development in infants.
Choice D reason:
Negative Crawl reflex: Crawling typically develops between 6-10 months. A negative crawl reflex at 9 months could indicate developmental delays
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Allowing the child to choose an article or two of clothing that she can wear with the brace can help her feel more confident and in control of her appearance.
This can help her feel better about wearing the brace and improve her overall attitude toward the treatment.
Choice B is not the best answer because it focuses on the long-term benefits of the treatment without addressing the child’s immediate concerns and emotions.
Choice C is not the best answer because it suggests that the child should be left alone to deal with her emotions, which may not be helpful in this situation.
Choice D is not the best answer because it suggests comparing the child’s situation to others who are sicker, which may not be helpful or appropriate.
Correct Answer is B
Explanation
The priority intervention for a newly-admitted client who has acute osteomyelitis is antibiotic therapy.
Choice A is incorrect because antipyretic therapy is not the priority intervention.
Choice C is incorrect because optimal nutrition and hydration are not the priority intervention.
Choice D is incorrect because surgical debridement of necrotic tissue is not the priority intervention.
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