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Difficulty: MediumDevelopmental Stages and Transitions

A practical nurse is reviewing a developmental questionnaire completed by the caregiver of a 3-year-old client in a pediatric clinic. Which reported finding should the nurse identify as a delay in expected developmental milestones that requires reporting to the registered nurse?

  1. A
    The child believes their stuffed animals can feel pain if they are dropped.
  2. B
    The child exhibits strong distress when their usual bedtime ritual is altered.
  3. The child uses approximately 20 single words to communicate their needs.Answer
  4. D
    The child continuously asks 'why' questions during daily activities.

Answer

The child uses approximately 20 single words to communicate their needs.
By age 3, a child is expected to have an expressive vocabulary of at least 300 to 900 words and be capable of forming 3- to 4-word sentences (telegraphic speech). A vocabulary limited to approximately 20 single words is typical for a 15- to 18-month-old infant. This finding represents a significant language delay and must be immediately reported to the registered nurse or healthcare provider for further evaluation and early intervention.

Step-by-Step Solution

1
Analyze the chronological age of the client.
The client is 3 years old, placing them at the transition between the toddler and early preschooler developmental stages.
Developmental expectations and milestones are strictly evaluated based on the child's age.
2
Evaluate the behavioral and psychological findings reported by the caregiver.
Animism (believing inanimate objects have feelings), ritualism (needing strict routines), and intense curiosity (asking 'why') are all normal, expected behaviors for a 3-year-old.
Recognizing normal developmental transitions prevents unnecessary referrals for typical psychosocial behaviors.
3
Evaluate the language and communication finding.
Using only 20 single words is severely delayed for a 3-year-old, who should be speaking in 3- to 4-word sentences and have a vocabulary of several hundred words.
Identifying abnormal findings is a critical part of data collection, prompting the practical nurse to report the deviation to the registered nurse for early intervention.

Key Concept

Expected milestones and recognition of developmental delays in early childhood
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Topics

Developmental Stages and Transitions

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