# 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. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=569392&lang=en > language: en > subject: Developmental Stages and Transitions > category: HPM ## Question 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. **1.** At 10 months, family and clinician report no concerns, but the recommended 9-month standardized assessment was omitted during a missed visit. Select a category Complete an indicated validated screen now Continue routine developmental surveillance Initiate developmental and early-intervention referral **2.** At 15 months, recent surveillance documents progressing skills, family and clinician have no concerns, and no age-scheduled screen is outstanding. Select a category Complete an indicated validated screen now Continue routine developmental surveillance Initiate developmental and early-intervention referral **3.** At 22 months, the parent and childcare staff independently document loss of previously used words and gestures over several weeks. Select a category Complete an indicated validated screen now Continue routine developmental surveillance Initiate developmental and early-intervention referral **4.** At 30 months, current observation is reassuring, but the routine general developmental questionnaire for this visit has not been administered. Select a category Complete an indicated validated screen now Continue routine developmental surveillance Initiate developmental and early-intervention referral **5.** At 20 months, completed recent general and autism screens were reassuring; new observation and family reports show continued progress without concerns. Select a category Complete an indicated validated screen now Continue routine developmental surveillance Initiate developmental and early-intervention referral **6.** At 17 months, a correctly administered validated screen is below its referral threshold in several domains, consistent with persistent family concerns. Select a category Complete an indicated validated screen now Continue routine developmental surveillance Initiate developmental and early-intervention referral **7.** At 26 months, the child has lost previously independent walking; examination confirms the change despite an older reassuring screening result. Select a category Complete an indicated validated screen now Continue routine developmental surveillance Initiate developmental and early-intervention referral ## 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. ## In-depth explanation 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 ## Clinical scenario 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. ## Key concepts - **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. ## Related questions - [A nurse is conducting an annual well-adolescent visit for a 15-year-old client per AAP Bri…](https://mymerci.kr/pages/nclex_q.php?qn_id=366228&lang=en) - [Review the toddler's developmental surveillance timeline and determine the appropriate scr…](https://mymerci.kr/pages/nclex_q.php?qn_id=395206&lang=en) - [A client has repeated injuries and the partner answers all questions. Which nursing action…](https://mymerci.kr/pages/nclex_q.php?qn_id=397290&lang=en) - [A 57-year-old client asks about shingles vaccination. 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