# Stage 1 — Recognize cues. Review the six-month intake and highlight the five parent-reported practices that require a change to reduce preventable harm.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=373863&lang=en  
> language: en  
> subject: Assignment/Delegation/Supervision  
> category: HPM

## Question

Stage 1 — Recognize cues. Review the six-month intake and highlight the five parent-reported practices that require a change to reduce preventable harm.

During the six-month visit, the mother reports that she places Baby J on her stomach at the beginning of nighttime sleep. The infant knows familiar people, laughs, and takes turns making sounds. She reaches for toys and brings objects to her mouth and rolls both ways during supervised floor play. At home, the parents use a mobile infant walker beside an ungated staircase with a loose railing. Baby J receives human milk plus iron-fortified cereal and varied pureed foods. Her parents turned the car seat forward-facing because her legs looked crowded. The clinic record documents vaccine products and dates through the four-month visit. The father plans to replace one human-milk feeding with a bottle of whole cow milk. The mother adds that a loose blanket and the family cat are sometimes inside the crib. Growth continues along established percentiles, and no loss of skills is reported.

## Explanation

Five practices requiring change
The actionable findings are initial prone sleep placement, a mobile walker beside an ungated staircase with a loose railing, forward-facing car-seat use, planned cow-milk replacement of a human-milk feeding, and a loose blanket plus cat inside the crib. The developmental behaviors, steady growth, iron-rich complementary foods, and documented vaccine record are reassuring or require routine reconciliation rather than correction as unsafe practices.

## In-depth explanation

Select behavior, not background
The task asks what must change now. Healthy growth and age-expected behaviors inform surveillance but are not hazards.

Sleep has two different decisions
Parents place the infant on the back for every sleep. When an infant who can comfortably roll both ways changes position independently, repeated repositioning is not required; that does not make caregiver-initiated prone placement safe. The crib remains empty.

Use equipment limits and developmental risk
Leg appearance is not the car-seat transition criterion. Rear-facing continues to the manufacturer's rear-facing height or weight limit. A mobile walker adds access and fall hazards rather than teaching safe walking.

NCLEX rule
Highlight specific modifiable practices linked to harm.

## Clinical scenario

Scenario (Stage 1 — Recognize cues)
A healthy six-month-old has reassuring growth and development, but the home interview reveals several preventable risks.

Clinical judgment target
Separate strengths from practices that require an immediate safety-plan change.

## Key concepts

- **Caregiver-initiated prone sleep** — Placing an infant on the stomach at the beginning of sleep; all sleeps should begin supine even when the infant can later roll independently.
- **Rear-facing limit** — The highest rear-facing height or weight allowed by the specific car-seat manufacturer, not a fixed second-birthday or leg-position rule.
- **Mobile infant walker** — A wheeled device that allows rapid infant movement and access to stairs, hot objects, and other hazards; AAP guidance recommends not using it.

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