A nurse is collecting data from a 6-month-old infant in the well child clinic.
Which of the following findings should the nurse expect?
Infant's birth weight is tripled.
Lateral incisors are present.
Posterior fontanel is closed.
Infant sits well without support.
The Correct Answer is C
Choice A rationale
The infant's birth weight typically doubles by 4-6 months and triples by 1 year of age. If an infant's weight has tripled at 6 months, it may indicate overnutrition or an underlying health condition.
Choice B rationale
Lateral incisors usually appear between 9 to 13 months. At 6 months, the central incisors are more likely to be emerging.
Choice C rationale
The posterior fontanel typically closes by 2 to 3 months of age. Therefore, by 6 months, it is expected to be closed.
Choice D rationale
Infants usually sit without support around 8 months. At 6 months, they may sit with support or briefly without support but not consistently.
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Correct Answer is C
Explanation
Choice A rationale
Performing ROM exercises can cause stress on the infant's developing bones and muscles and is not the priority for spina bifida.
Choice B rationale
Feeding through an NG tube is not necessary unless the infant has feeding difficulties related to spina bifida.
Choice C rationale
Placing the infant in a prone position prevents pressure on the lesion, reducing the risk of injury and infection.
Choice D rationale
Covering the lesion with a dry cloth can cause the area to dry out and is not recommended; sterile, moist dressings are preferred.
Correct Answer is A
Explanation
Choice A rationale
It's normal for an 8-month-old child to exhibit separation anxiety when their parents leave. This stage of development typically begins around 6 to 8 months of age and can peak around 14 to 18 months. It is a sign that the child has developed a strong attachment to their parents and understands the concept of object permanence—that objects and people continue to exist even when they are not visible.
Choice B rationale
While rest is important for an infant, this statement does not address the underlying issue of separation anxiety. It implies that the child's crying is due to fatigue, which can be misleading to the parents.
Choice C rationale
An overstimulating environment can cause distress in infants, but in this case, the crying is more directly related to separation anxiety. It's essential to differentiate between the two causes so that parents can respond appropriately.
Choice D rationale
Notifying a provider is unnecessary for typical separation anxiety. This response could unnecessarily alarm the parents and does not educate them on the normalcy of this developmental phase.