Which observation is expected when the nurse is assessing the gestational age of a neonate born at term?
No creases on the plantar surface of the foot.
Abundant lanugo covering most of the body.
Flexed position at rest.
Pinna of the ear that remains folded.
The Correct Answer is C
Choice A rationale
The absence of creases on the plantar surface is typical of a preterm infant, not a term infant. Term infants usually have some creases.
Choice B rationale
Abundant lanugo is more common in preterm infants, while term infants may have some but not extensive lanugo.
Choice C rationale
A flexed position at rest is expected in a term neonate, as it indicates good muscle tone and neuromuscular development.
Choice D rationale
The pinna of the ear remaining folded is more indicative of a preterm infant, as term infants typically have fully formed and firmer ear cartilage.
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Correct Answer is C
Explanation
Choice A rationale
Encouraging play exercises in the evening can lead to overstimulation, which can make it harder for the toddler to fall asleep. Physical activity should generally be done earlier in the day to help with sleep later on.
Choice B rationale
Turning off the room light can create a dark environment conducive to sleep, but it doesn’t address the need for a calming routine, which is essential for young children’s sleep. Some children also feel safer with a nightlight.
Choice C rationale
Providing bedtime rituals can help signal to the toddler that it is time to wind down and sleep. Consistent rituals, such as reading a story or singing a lullaby, provide a sense of security and comfort.
Choice D rationale
Explaining the source of the toddler’s fears may be beyond the cognitive ability of a toddler and does not directly promote sleep. It’s better to provide comfort and reassurance through routine.
Correct Answer is B
Explanation
Choice A rationale
A pincer grasp, using the thumb and index finger to pick up small objects, typically develops around 9 to 12 months of age, not at 4 months.
Choice B rationale
The posterior fontanel typically closes by the age of 2 to 3 months, so a 4-month-old infant would be expected to have a closed posterior fontanel. This finding is consistent with normal development.
Choice C rationale
Lateral incisors, the teeth on either side of the front teeth, typically erupt around 9 to 13 months of age, not at 4 months.
Choice D rationale
Sitting steadily without support generally occurs closer to 6 to 8 months of age, so it would not be expected in a 4-month-old infant.