A 4-Month-Old Child Is at the Clinic for a Well-Baby

Multiple Choice

A 4-month-old child is at the clinic for a well-baby checkup and immunizations. Which of these actions is most appropriate when the nurse is assessing an infant's vital signs?

A) The infant's radial pulse should be palpated, and the nurse should notice any fluctuations resulting from activity or exercise.
B) The nurse should auscultate an apical rate for 1 minute and then assess for any normal irregularities, such as sinus dysrhythmia.
C) The infant's blood pressure should be assessed by using a stethoscope with a large diaphragm piece to hear the soft muffled Korotkoff sounds.
D) The infant's chest should be observed and the respiratory rate counted for 1 minute; the respiratory pattern may vary significantly.