The nurse is assessing an 18-month-old patient at a well-child visit. What findings would suggest a developmental delay?

Says two-word sentences.

Uses pincer grasp to eat Cheerio’s.

Removes shoes and socks.

Prefers to use the right hand.

Answer and Explanation

The Correct Answer is D

Choice A reason: Saying two-word sentences is an expected developmental milestone for an 18-month-old child. At this age, children should begin combining two words to form simple sentences, such as "more juice" or "mama go." This indicates normal language development.

Choice B reason: Using a pincer grasp to eat Cheerio’s is a typical fine motor skill for an 18-month-old child. The ability to pick up small objects between the thumb and forefinger demonstrates proper development of fine motor skills and hand-eye coordination.

Choice C reason: Removing shoes and socks is a common developmental milestone for an 18-month-old child. This task shows growing independence and the ability to perform basic self-care activities, which is a sign of normal development.

Choice D reason: Preferring to use the right hand may suggest a developmental delay because children typically do not show a strong hand preference (left or right) until around the age of 2 to 3 years. Early hand dominance can be a sign of an underlying issue, such as asymmetry in muscle strength or neurological development. It is important to assess further if a child shows a strong preference for one hand at this early age.

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Correct Answer is B

Explanation

Choice A reason: While nausea, tiredness, and sleepiness are common during the first trimester of pregnancy, they are typically not signs of an immediate emergency. This patient does not exhibit any alarming symptoms that would require immediate hospital referral.

Choice B reason: Blurred vision and seeing spots during pregnancy can be symptoms of preeclampsia, a potentially dangerous condition characterized by high blood pressure. Preeclampsia can pose serious health risks to both the mother and the baby and requires immediate medical attention.

Choice C reason: Frequent urination is a common symptom in the later stages of pregnancy due to the pressure the growing baby exerts on the bladder. This symptom alone does not indicate an immediate need for hospital evaluation.

Choice D reason: Having 4 to 5 contractions in an hour at 37 weeks of pregnancy can be a sign of early labor. However, unless the contractions are persistent and intensifying, this may not necessitate an immediate hospital referral. The nurse would likely advise the patient to monitor the contractions and come in if they continue or become stronger.

A. Colouring book B. large building blocks C. Hanging crib toys D. Modelling clay

Correct Answer is B

Explanation

Choice A reason: A colouring book may not be the best choice for a 12-month-old as it requires fine motor skills that are still developing at this age. Additionally, crayons can pose a choking hazard.

Choice B reason: Large building blocks are appropriate for a 12-month-old toddler. They promote gross motor skills, hand-eye coordination, and cognitive development. These blocks are easy to grasp and safe for young children.

Choice C reason: Hanging crib toys are more suitable for younger infants who are not yet mobile. A 12-month-old is likely more interested in interactive and manipulative toys that they can hold and manipulate.

Choice D reason: Modelling clay is not recommended for a 12-month-old due to the potential choking hazard and the fact that the child may try to put it in their mouth.

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The nurse is assessing an 18-month-old patient at a well-child visit. What findings would suggest a developmental delay?

Nursing Test Bank

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