Difficulty: Medium
Average Score: 95%
Simulated
Passage / Scenario
5-month-old infantA nurse is assessing a 5-month-old infant. Which of the following findings should the nurse report to the provider?
Correct answer
D
Rationale
The correct answer is D: Exhibits head lag when pulled to a sitting position. This finding indicates poor head control, which is a developmental red flag at 5 months. It suggests possible neuromuscular weakness or delay, necessitating further evaluation by the provider. Choices A, B, and C are typical developmental milestones at 5 months. Absence of grasp reflex is expected as it disappears by 3 months. Inability to hold a bottle can be normal at this age, and rolling from back to abdomen usually begins around 5-6 months. Therefore, these findings are not concerning at this stage of development.