A nurse is reviewing the health records of several 4-month-old infants who were seen in the pediatric office today. Which infant behavior will require referral for further evaluation of growth and development?
Unable to support head
Cannot sit without assistance
Rolls from prone to supine position
Reaches for nearby objects
The Correct Answer is A
Choice A reason: By 4 months, infants should be able to support their head steadily. Persistent head lag or inability to hold the head upright may indicate neuromuscular delay or hypotonia. This warrants further evaluation to rule out developmental concerns.
Choice B reason: Sitting without assistance is not expected at 4 months. Most infants still require support and are developing trunk control. This behavior is within normal limits and does not require referral.
Choice C reason: Rolling from prone to supine is an appropriate milestone for 4-month-olds. It reflects developing gross motor skills and is a positive sign of neuromuscular development.
Choice D reason: Reaching for nearby objects is a normal fine motor milestone at 4 months. It demonstrates visual-motor coordination and curiosity. This behavior is expected and does not indicate concern.
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Naxlex Comprehensive Predictor Exams
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Correct Answer is D
Explanation
Choice A reason: Pretend play, such as stirring an empty bowl and verbalizing imaginative content, reflects symbolic thought and is more aligned with the preoperational stage, which begins around age 2. This behavior suggests emerging cognitive abilities beyond the sensorimotor stage.
Choice B reason: Offering a toy to comfort a crying adult demonstrates empathy and theory of mind, which are more advanced cognitive functions. These behaviors typically emerge in the preoperational stage and beyond.
Choice C reason: Insisting on routine behaviors like sitting in the same chair reflects ritualism and egocentrism, common in the preoperational stage. It does not directly reflect sensorimotor exploration or cause-effect learning.
Choice D reason: Stacking blocks and clapping when they fall demonstrates cause-and-effect understanding, sensory exploration, and motor coordination—all hallmarks of the sensorimotor stage. This stage emphasizes learning through physical interaction with the environment and immediate feedback.
Correct Answer is B
Explanation
Choice A reason: Building a tower of four cubes is typically achieved around 18 months of age. At 11 months, fine motor skills are still developing, and stacking multiple cubes is beyond the expected milestone.
Choice B reason: Sitting independently is a milestone usually achieved between 6 and 9 months. By 11 months, most infants can sit without support and maintain balance while playing. This is a foundational gross motor skill and expected at this age.
Choice C reason: Walking independently usually occurs between 12 and 15 months. Some infants may begin cruising or taking steps with support at 11 months, but full independent walking is not expected yet.
Choice D reason: Turning a doorknob requires refined fine motor coordination and strength, typically seen in toddlers closer to 2 years old. It is not an expected milestone for an 11-month-old.
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