A pediatric nurse must select the highest indicated next action for each independent visit. Use routine surveillance when no concern or scheduled screening is outstanding; use a validated screen when screening is due without an existing referral indication; refer when regression, substantial persistent concerns or abnormal screening already warrants evaluation. Referral may occur alongside screening and must not await a diagnostic label. Assign each record once; category totals are not supplied.
Matrix Multiple Choice
Choose your responses, then check the answer.
Explanation
Screen now for the missed 9-month assessment and the due 30-month assessment. Continue surveillance for the two reassuring, up-to-date records. Refer for regression or the already abnormal validated screen. Screening schedules, current concerns and existing results answer different questions. A previously normal screen does not override new regression; a missed routine screen still needs completion when current observation seems reassuring.
Correct answer Screen now for the missed 9-month assessment and the due 30-month assessment. Continue surveillance for the two reassuring, up-to-date records. Refer for regression or the already abnormal validated screen.
Why this is correct Screening schedules, current concerns and existing results answer different questions. A previously normal screen does not override new regression; a missed routine screen still needs completion when current observation seems reassuring.
Clinical picture Referral initiates assessment and access to support; it does not assert a specific diagnosis. Loss of motor skills also requires prompt medical evaluation. A screening questionnaire is not a substitute for evaluating a newly concerning clinical change.
Memory hook Due, concerning, or already abnormal: first identify which decision point the record has reached. A reassuring past result cannot cancel new evidence.
NCLEX decision rule Developmental surveillance occurs continually. Use validated screening at recommended visits and for appropriate concerns; refer promptly when evaluation is indicated rather than waiting for diagnostic certainty.
Why the alternatives are wrong Record 1 needs the omitted routine screen rather than referral in the absence of concerns. Record 2 has no outstanding scheduled assessment or concerning evidence. Record 3 is loss of acquired skills, not a borderline age cutoff. Record 4 requires the scheduled screen despite a reassuring brief observation. Record 5 remains under surveillance because screening is current and no new concern is present. Record 6 has already crossed an evaluation threshold, so merely repeating surveillance delays follow-up. Record 7 requires referral and medical assessment despite the older normal result. None of the records uses a CDC checklist as a diagnostic or validated screening test.
Sources
CDC developmental monitoring and screening
Practice transfer: Referral initiates assessment and access to support; it does not assert a specific diagnosis. Loss of motor skills also requires prompt medical evaluation. A screening questionnaire is not a substitute for evaluating a newly concerning clinical change.
Developmental surveillance — Ongoing collection and interpretation of developmental observations and concerns.
Validated screening — Use of a standardized tool with studied performance to identify a need for further assessment.
Regression — Loss of a skill that was previously acquired and used.