Final answer:
The PNP should consider referring the child for speech therapy and recommending a hearing test, as both potential speech and hearing issues could be contributing to the difficulty in pronouncing certain sounds. Monitoring and advising parents alone may not suffice if there is an underlying condition present.
Step-by-step explanation:
When a pediatric nurse practitioner (PNP) performs a developmental assessment on a 32-month-old child who has difficulty pronouncing "t, d, k, g," and whose speech is approximately 70% intelligible, the PNP should consider all aspects of the child's development and parent concerns. At this age, it's not uncommon for children to have speech sound difficulties, and most children will make pronunciation errors as they learn to speak. However, if these issues persist, it might indicate a need for further assessment or intervention.
Considering the options provided:
- Monitoring speech development and reassessing future progress (C) is typically considered when speech errors are developmentally appropriate and the child is making progress. However, consistent difficulty with specific sounds by 32 months might suggest an underlying issue that requires attention sooner.
- Referring the child for speech therapy (A) could be beneficial if there is concern regarding the intelligibility of the child's speech, especially if the errors are atypical for the child's age.
- Advising the parents to correct pronunciation at home (B) can be part of a broader strategy but may not be sufficient on its own if there are underlying speech concerns.
- Recommending a hearing test (D) could be important since hearing problems can often contribute to pronunciation and other speech issues, and addressing any hearing impairment is crucial for normal speech and language development.
In this scenario, the correct action could involve both referring the child for speech therapy to address specific speech pronunciation concerns, and recommending a hearing test to exclude hearing difficulties as a contributing factor. Further decisions should be based on the outcomes of these initial steps.