A mother is worried that her 3-month-old child is not holding her own head up. Which action by the nurse is most appropriate?

A.
Explain that sturdy head control occurs around 6 months.
B.
Document the findings and alert the health-care provider.
C.
Reassure the mother that her baby is completely normal.
D.
Teach the mother that head control is evident at 9 months.


ANS: A
Sturdy head control occurs around 6 months of age. The findings should be documented, but there is no need to alert the health-care provider because this is a normal finding for a 3-month-old. Simply reassuring the mother does not give her the information she needs.

Nursing

You might also like to view...

A student nurse asks an instructor how best to develop nursing outcomes for clients. Which response by the instructor most accurately answers the student's question?

1. "You can use NIC, a standardized reference for nursing outcomes." 2. "Look at your client's problems and set a realistic, achievable goal." 3. "With client collaboration, outcomes should be based on client problems." 4. "Copy your standard outcomes from a nursing care plan textbook."

Nursing

A patient who has been seen responding to auditory hallucinations earlier in the morning approaches the nurse and shakes his fist, saying, "Back off, bitch!" and then goes into the day room

Which intervention would be most important to undertake before the nurse follows the patient into the day room? a. Contact the patient's physician to obtain an order for seclusion. b. Review the patient's history for clues about his risk of violence. c. Assure that adequate staff are available and nearby for backup. d. Check for orders for PRN medication and prepare a sedative.

Nursing

The nurse is planning to provide a client with an injection. Which of the following should the nurse keep in mind when providing the injection?

a. Intradermal injections should be given at a 30° angle. b. Subcutaneous injections may be given in the upper arm and thigh areas. c. Intramuscular injections should be given at a 60° angle. d. Intramuscular injections may be given to the infant in the dorsogluteal and deltoid muscles.

Nursing

The nurse is caring for an 8-year-old girl who requires medication that is only available in an enteric tablet form. The nurse is teaching the mother how to help the girl swallow the medication

Which of the following statements indicates a need for further teaching? A) "I can encourage her to place it on the back of her tongue.". B) "I can pinch her nose to make it easier to swallow.". C) "We cannot crush this type of pill as it will affect the delivery of the medication.". D) "We can place the tablet in a spoonful of applesauce.".

Nursing