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: Cheese sauce may be high in fat and sodium, but noodles with cheese sauce are generally safe for an 11-month-old infant to consume in moderation. The primary concern for infants' diet is ensuring that foods are safe to swallow and do not pose a choking hazard, which noodles do not.

Choice B reason: Honey is not recommended for children under one year old due to the risk of botulism, a serious illness caused by a toxin produced by the bacterium Clostridium botulinum. Infants have underdeveloped immune systems that cannot fight off the toxin, making honey a potentially dangerous food choice for them.

Choice C reason: Cooked broccoli is generally a safe and nutritious food for an 11-month-old infant. It's a good source of vitamins, minerals, and fibre. However, it should be soft enough for the infant to chew and swallow without risk of choking.

Choice D reason: Cut-up cherry tomatoes are appropriate for an 11-month-old infant as long as they are cut into small, manageable pieces to prevent choking. Cherry tomatoes provide essential nutrients like vitamins A and C and can be a healthy addition to an infant's diet.

A. Identify the patient's nutritional needs. B. Provide a structured environment. C. Request a mental health consult. D. Plan a therapeutic diet with the patient.

Correct Answer is C

Explanation

Choice A reason: Identifying the patient's nutritional needs is important, but given the significant weight loss and the patient's distorted body image, it is crucial to first address the underlying psychological issues.

Choice B reason: Providing a structured environment can be beneficial for patients with eating disorders, but it is not the most immediate priority in this case. The primary concern is the patient's mental health and distorted body image.

Choice C reason: Requesting a mental health consult is the priority intervention. The patient's significant weight loss, low body weight, and belief that they are fat suggest the possibility of an eating disorder, such as anorexia nervosa. A mental health professional can provide a comprehensive evaluation and appropriate psychological support and intervention.

Choice D reason: Planning a therapeutic diet is important for the long-term management of the patient's nutritional status, but it should follow after addressing the immediate mental health concerns. Proper treatment of an eating disorder requires a multidisciplinary approach, including psychological, nutritional, and medical interventions.

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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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Explanation

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