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    Ati Rn Paediatrics 2023 Proctored Exam

    A nurse is assessing a 5-month-old infant. Which of the following findings should the nurse report to the provider?

    Explanation & Rationale

    A. Unable to roll from back to abdomen. Incorrect. Many infants do not roll over until closer to 6 months old, so this is not a concerning finding at 5 months.B. Absent grasp reflex. Incorrect. The grasp reflex typically disappears around 4 to 6 months of age, so its absence is normal at this stage.C. Unable to hold a bottle. Incorrect. Holding a bottle can vary widely, and many 5-month-olds do not yet have this skill.D. Exhibits head lag when pulled to a sitting position. Correct. By 5 months, most infants should have sufficient neck muscle control to not exhibit head lag. Persistent head lag could indicate a developmental delay or neurological problem.

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