# Stage 6 — Evaluate outcomes. Review the preventive-care timeline and answer the three outcome questions.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=373878&lang=en  
> language: en  
> subject: Assignment/Delegation/Supervision  
> category: HPM

## Question

Stage 6 — Evaluate outcomes. Review the preventive-care timeline and answer the three outcome questions.

| Time | Data |
| --- | --- |
| Six-month visit — Assessment | Growth follows established percentiles. Developmental surveillance identifies reassuring six-month behaviors and no lost skills. The nurse reconciles human-milk feeding and iron sources, vaccine products and dates, initial prone placement, crib contents, car-seat direction, mobile walker, unprotected stairs, and food preparation. |
| Six-month visit — Preventive response | Indicated vaccines are administered after current product, interval, contraindication, precaution, season, and health-status review; remaining doses receive dates. Parents demonstrate an empty supine-start sleep setup, rear-facing travel, walker removal and stair protection, and upright supervised feeding with developmentally prepared foods. |
| One week — Action verification | Every sleep begins supine in the empty crib. Baby J sometimes rolls prone independently and is left in that self-selected position because she rolls both ways. The car seat is rear-facing, the walker is no longer used, stair access is blocked, and railing repair is scheduled. |
| Nine months — Development and iron follow-up | Growth remains on trajectory. A validated general developmental screen is completed. Human milk remains the primary nutrition source with varied iron-rich complementary foods, so CBC and serum ferritin are obtained within the current AAP 9-to-12-month screening window. |
| Nine months — Ongoing prevention | The team reconciles immunization status under the current schedule and reassesses hazards for crawling and pulling to stand. Parents continue rear-facing travel to the seat limit, stair protection, an empty sleep space, and supervised developmentally appropriate feeding. |

Q1. Which follow-up finding best demonstrates correct safe-sleep understanding?

The parents place Baby J prone because she can roll
The parents begin every sleep supine in an empty crib and leave a prone position only when Baby J rolls there herself and can roll both ways
The parents keep a loose blanket in the crib but remove the cat

Q2. Which nine-month plan correctly distinguishes developmental and iron screening?

Use a validated developmental screen at 9 months and obtain CBC plus serum ferritin during the 9-to-12-month window because human milk is the primary nutrition source
Repeat only the informal milestone checklist and defer all iron assessment until symptoms appear
Diagnose normal development from growth percentiles and replace human milk with cow milk before testing

Q3. Which finding best shows that injury-prevention teaching changed the home plan?

No injury occurred during the first week despite continued walker use
The parents signed the anticipatory-guidance handout
The car seat is rear-facing, the mobile walker is no longer used, stair access is blocked, and the loose railing has a repair plan

## Explanation

Outcome evaluation
The response is effective because the parents begin every sleep supine in an empty crib, correctly leave only a self-selected position after independent rolling both ways, restore rear-facing travel, remove the walker, block stair access, and prepare foods according to developmental texture and shape. Routine prevention also closes: vaccine products and intervals are reconciled, follow-up doses have dates, validated developmental screening occurs at 9 months, and a human-milk-fed infant receives CBC and serum ferritin within the 9-to-12-month window. An injury-free week or signed handout alone would not prove these changes.

## In-depth explanation

Observe behavior
The strongest safety outcome is a verified change in sleep space, car-seat direction, walker access, stairs, and feeding—not verbal agreement by itself.

Interpret rolling correctly
Continue to place Baby J supine. Because she independently rolls both ways, parents need not turn her back repeatedly after self-positioning, provided the approved sleep space remains firm, flat, and empty.

Close longitudinal prevention
The 9-month screen and 9-to-12-month iron testing are different processes. Vaccine reconciliation continues at each visit using the current schedule and documented history.

NCLEX rule
Evaluate what the family changed, what the child demonstrated, and what future preventive step has a date.

## Clinical scenario

Scenario (Stage 6 — Evaluate outcomes)
The clinic follows the family after teaching and again as Baby J reaches the next health-supervision visit.

## Key concepts

- **Verified safety outcome** — An observed or specifically reported change in equipment, environment, positioning, or caregiver behavior that directly reduces the identified risk.
- **Self-selected sleep position** — A position reached independently after an infant placed supine rolls; an infant who rolls both ways need not be repeatedly repositioned in an otherwise safe empty sleep space.
- **Longitudinal preventive closure** — Completion or scheduling of age- and history-specific vaccines, validated screening, nutrition review, laboratory screening, and safety reassessment across visits.

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