# Stage 4 — Generate solutions. Which nursing actions are appropriate during Baby J's six-month well-child visit? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=373871&lang=en > language: en > subject: Assignment/Delegation/Supervision > category: HPM ## Question Stage 4 — Generate solutions. Which nursing actions are appropriate during Baby J's six-month well-child visit? Select all that apply. 1 Begin every sleep supine on a firm, flat, empty approved surface. If Baby J rolls both ways and changes position herself, leave her there while the sleep space stays empty. 2 Turn the car seat forward-facing at age 2 or sooner when the infant's legs look crowded, even when the manufacturer permits continued rear-facing use. 3 Reconcile vaccine products, prior doses, intervals, season, and health status; give each currently indicated vaccine and schedule any remaining dose. 4 Treat the six-month milestone checklist as a diagnostic screen, require an Ages and Stages Questionnaire at every six-month visit, and postpone vaccination until the score is available. 5 Keep human milk or iron-fortified formula as the primary milk before 12 months, verify iron intake, and plan CBC plus serum ferritin at 9 to 12 months. 6 Stop the mobile walker, protect the stairs and repair the railing, keep travel rear-facing to the seat limit, and teach upright supervised feeding with safely prepared foods. ## Explanation Appropriate actions: 1, 3, 5, and 6 Safe sleep begins supine in an empty approved sleep space, while an infant who rolls both ways may remain in a self-selected position (choice 1). Vaccination depends on the documented product series, intervals, season, health status, and current CDC notes (choice 3). Human milk or iron-fortified formula remains primary before 12 months, actual iron intake is verified, and human-milk-fed infants receive CBC and ferritin screening at 9 to 12 months under current AAP guidance (choice 5). Walker, stair, travel, and feeding hazards require specific changes (choice 6). Car-seat transition is not based on age 2 or leg appearance (choice 2). A milestone checklist is not a diagnostic screen, and routine validated general screening is scheduled at 9 months rather than required at every six-month visit (choice 4). ## In-depth explanation Wrong — choice 2 Rear-facing continues as long as possible until the child reaches the manufacturer's rear-facing height or weight limit. Crowded-looking legs and the second birthday are not automatic transition criteria. Wrong — choice 4 Developmental surveillance occurs now, but the CDC milestone checklist is not a substitute for validated screening. Routine standardized screening occurs at 9, 18, and 30 months and whenever concern arises; vaccines are not withheld while waiting for an unnecessary screen. Individualize routine care Vaccine products and iron screening both require history. Product-specific series and intervals determine vaccines; the primary nutrition source determines the updated iron-screening window. ## Clinical scenario Scenario (Stage 4 — Generate solutions) The nurse combines routine preventive care with concrete changes to the family's sleep, travel, feeding, and home environment. ## Key concepts - **Vaccine reconciliation** — Verification of exact products, dose dates, intervals, contraindications, precautions, season, and health indications before selecting vaccines from the current schedule. - **Primary milk source** — Human milk or iron-fortified infant formula remains the main milk nutrition before 12 months; cow milk may not replace it as a beverage during infancy. - **Developmentally prepared food** — Food modified to a child's oral and motor ability in shape, size, and texture, served while the child is upright and directly supervised. ## Related questions - [A 67-year-old client with chronic obstructive pulmonary disease attends a routine primary …](https://mymerci.kr/pages/nclex_q.php?qn_id=360522&lang=en) - [A registered nurse on a medical-surgical unit is delegating tasks at the start of shift. 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