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Difficulty: HardDevelopmental Stages and Transitions

A practical nurse (PN) is collecting data during a wellness visit for a 30-month-old toddler. The caregiver shares several observations about the child's recent behavior at home. Which finding reported by the caregiver indicates a developmental delay that the PN must report to the registered nurse for further evaluation?

  1. My child has a vocabulary of about 15 words and mostly points to items they want.Answer
  2. B
    My child walks down the stairs by placing both feet on each individual step.
  3. C
    My child gets highly frustrated and repeatedly says 'no' when I try to help them get dressed.
  4. D
    My child can successfully build a tower using eight small wooden blocks before it falls over.

Answer

The finding that the 30-month-old child has a vocabulary of only 15 words and primarily points to communicate indicates a significant language delay that requires reporting.
The correct answer identifies a significant expressive language delay. By 30 months (2.5 years) of age, a toddler's vocabulary is expected to be expanding rapidly, typically exceeding 300 words, and the child should be using short 2- to 3-word sentences. A vocabulary of only 15 words accompanied by pointing is a milestone expected around 15 to 18 months, indicating a delay that the practical nurse must report to the registered nurse.

Step-by-Step Solution

1
Identify the expected developmental milestones for a 30-month-old (2.5-year-old) toddler across physical, cognitive, and psychosocial domains.
Expected milestones include building an 8-block tower, jumping with both feet, walking up/down stairs with both feet on one step, a vocabulary of 300+ words, and asserting independence.
Accurate baseline knowledge of age-appropriate transitions is required to identify deviations and abnormalities.
2
Evaluate the caregiver's statements against normal 30-month milestones to distinguish expected behaviors from delays.
The block tower, stair walking pattern, and negativism are all age-appropriate. The limited vocabulary is far below expectations.
Differentiating between normal developmental behaviors (even if frustrating to parents, like tantrums or slow stair walking) and true clinical delays ensures appropriate escalation of care.
3
Select the observation that represents a deviation requiring the PN to notify the RN.
The 15-word vocabulary is identified as the delay to report.
Within the practical nursing scope of practice, the PN collects data, identifies abnormal findings compared to established norms, and reports these findings to the RN or provider for diagnostic evaluation.

Key Concept

Toddler Developmental Milestones and Transitions
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Topics

Developmental Stages and Transitions

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