Chapter 16: The Infant-PEDS

A new mother is voicing concern she is breastfeeding her newborn too frequently. How often does the nurse instruct this mother she should expect her newborn to feed? a. Every 2 to 3 hours b. Every 4 to 6 hours c. Every 6 to 8 hours d. Every 8 to 10 hours

ANS: A Breastfed infants may require feedings at 2- to 3-hour intervals because breast milk is more easily digested. A flexible but regular schedule that provides a rest period between feedings is best for the parent and infant.

The nurse observes a 10-month-old infant using her index finger and thumb to pick up pieces of cereal. What does this behavior indicate the infant has developed? a. The pincer grasp b. A grasp reflex c. Prehension ability d. The parachute reflex

ANS: A By 1 year, the pincer-grasp coordination of index finger and thumb is well established.

The nurse is assessing a 1-year-old infant in the pediatric office. What finding should the nurse report to the physician immediately? a. Respiratory rate of 60 breaths/minute b. Pulse rate of 100 beats/minute c. Minimal verbalization d. Fussy behavior

ANS: A Respirations of a 1-year-old infant should be 20 to 40 breaths/minute. Increased respiratory rate can lead to distress and should be reported immediately. Pulse rate of 100 to 140 beats/minute is normal. Minimal verbalization and fussy behavior are not emergency situations or abnormal for this age.

The nurse is talking with a parent about tooth eruption. What teeth will the nurse explain are the first deciduous teeth to erupt? a. Lower central incisors b. Upper central incisors c. Lower lateral incisors d. Upper lateral incisors

ANS: A The first teeth to erupt, usually at about 7 months, are the lower central incisors.

The parent of a 3-month-old infant asks the nurse, "At what age do infants usually begin drinking from a cup?" What is the nurse's most accurate response? a. 5 months b. 9 months c. 1 year d. 2 years

ANS: A The infant can usually drink from a cup when it is offered at about 5 months.

When does the posterior fontanelle close? a. 2 to 3 months b. 3 to 6 months c. 6 to 9 months d. 9 to 12 months

ANS: A The posterior fontanelle closes between 2 and 3 months of age.

The nurse is aware that the 7-month-old infant can signal feeding readiness by which action(s)? (Select all that apply.) a. Pulling spoon toward mouth b. Biting at spoon with upper and lower incisors c. Pointing to food bowl d. Bouncing up and down with excitement at sight of food e. Manipulating finger foods

ANS: A, E The 7-month-old infant pulls the spoon toward his or her mouth and can manipulate finger foods. The 7-month-old infant does not have upper incisors and has not developed adequately to recognize the food container or exhibit excitement related to the sight of food.

The nurse cautions that children who have unmet hunger needs will likely display which characteristic(s)? (Select all that apply.) a. Irritability b. Ineffective feeding patterns c. No predictable sleep-wake cycle d. Distrust e. Effective parent bonding

ANS: A, B, C, D Children who experience frequent hunger do not have effective parental bonding. All other options are probable outcomes for a child who has unmet hunger needs.

The nurse is educating parents of a 2-month-old infant about immunizations. What immunizations against illness should their child receive? (Select all that apply.) a. Pertussis (whooping cough) b. Influenza c. Diphtheria d. Tetanus e. Polio

ANS: A, B, C, D, E The first DPT, polio, and flu immunizations are given at the age of 2 months.

A parent is concerned because her infant has a diaper rash. What is the best action the nurse would advise the parent to implement? a. Use commercial diaper wipes to clean the area. b. Apply a protective ointment on the area. c. Change the infant's diaper less frequently. d. Keep the diaper area covered all of the time.

ANS: B A protective ointment can be applied when the skin in the diaper area appears pink and irritated.

The nurse discusses child-proofing the home for safety with the mother of a 9-month-old infant. Which statement made by the mother would indicate an unsafe behavior? a. "I put covers on all of the electrical outlets." b. "In the car, she rides in a front-facing car seat." c. "There are locks on all of the cabinets in the house." d. "I have a gate at the top and bottom of the stairs."

ANS: B A rear-facing infant car seat should be used for infants younger than 1 year of age.

A parent brings a 6-month-old infant to the pediatric clinic for her well-baby examination. Her birth weight was 8 pounds, 2 ounces. What will the nurse weighing the infant today expect her weight to be? a. At least 12 pounds b. At least 16 pounds c. At least 20 pounds d. At least 24 pounds

ANS: B Birth weight is usually doubled by 6 months of age.

What is the earliest age at which the infant should be able to walk independently? a. 8 to 10 months b. 12 to 15 months c. 15 to 18 months d. 18 to 21 months

ANS: B For the majority of children, the milestone of walking alone is achieved between 12 and 15 months

At what age does an infant's birth weight triple? a. 9 months b. 1 year c. 18 months d. 2 years

ANS: B The infant usually triples his or her birth weight by about 12 months of age.

Parents of a 6-month-old infant ask the nurse why it is necessary to offer iron-rich formula to their child. What is the correct response? a. "The infant has limited ability to produce red blood cells." b. "The infant has ineffective digestive enzymes." c. "The infant has exhausted maternal iron stores." d. "The infant has need of the iron to support dentition."

ANS: C

The mother of an infant born prematurely tells the nurse, "The baby is irritable. She cries during diaper changes and feedings. Can you make some suggestions about what I should do to soothe her?" What is the most appropriate recommendation to help this parent? a. Play the radio or TV while you feed the infant. b. Put the infant in a room with sunlight. c. Wrap the infant snugly when you hold them. d. Change the infant's position quickly.

ANS: C A strategy that may be helpful is to swaddle the infant snugly in a light blanket with extremities flexed and hands near the face.

What would the nurse expect a 4-month-old infant to be able to accomplish? a. Hold a cup. b. Stand with assistance. c. Lift head and shoulders. d. Sit with back straight.

ANS: C Because development is cephalocaudal, of these choices, lifting the head and shoulders is the one that the infant learns to do first. The infant can usually sit with support at about 5 months of age and can sit alone at about 8 months.

What is the most appropriate activity to recommend to parents to promote sensorimotor stimulation for a 1-year-old infant? a. Ride a tricycle. b. Spend time in an infant swing. c. Play with push-pull toys. d. Read large picture books.

ANS: C Push-pull toys are appropriate to promote sensorimotor stimulation for a 1-year-old infant

The nurse is assessing development in a 9-month-old infant. What would the nurse expect to observe? a. Speaking in 2-word sentences b. Grasping objects with palmar grasp c. Creeping along the floor d. Beginning to use a spoon rather sloppily

ANS: C The 9-month-old infant tries to creep, has developed pincer movement, and can grasp a spoon without keeping food on it.

What is the earliest age at which an infant is able to sit steadily alone? a. 4 months b. 5 months c. 8 months d. 15 months

ANS: C The infant can sit alone without support at about 8 months of age.

What is an abnormal finding in an evaluation of growth and development for a 6-month-old infant? a. Weight gain of 4 to 7 ounces per week b. Length increase of 1 inch in 2 months c. Head lag present d. Can sit alone for a few seconds

ANS: C The infant should be holding the head up well by 5 months of age. If head lag is present at 6 months, the child should undergo further evaluation.

Which statement indicates the mother of an 8-month-old infant understands infant sleep patterns? a. "I put the baby in my bed until she falls asleep, then I put her in her crib." b. "I let the baby skip an afternoon nap so that she will fall asleep earlier." c. "I put the pacifier in the crib so that she can find it when she wakes up." d. "I rock the baby back to sleep if she wakes up at night."

ANS: C The parent should assist the infant to develop self-soothing behaviors so that the infant can get back to sleep on her own

What statement made by a parent indicates correct understanding of infant feeding? a. "I've been mixing rice cereal and formula in the baby's bottle." b. "I switched the baby to low-fat milk at 9 months." c. "The baby really likes little pieces of chocolate." d. "I give the baby new foods before he takes his bottle."

ANS: D New solid foods should be introduced before formula or breast milk to encourage the infant to try new foods.

A mother calls the pediatrician's office because her infant is "colicky." What is the most helpful measure the nurse can suggest to the mother? a. Sing songs to the infant in a soft voice. b. Place the infant in a well-lit room. c. Walk around and massage the infant's back. d. Rock the fussy infant slowly and gently.

ANS: D One technique the nurse can offer parents of a fussy infant is to rock the infant gently and slowly while being careful to avoid sudden movements.

What will the nurse advise a parent to do when introducing solid foods? a. Begin with one tablespoon of food. b. Mix foods together. c. Eliminate a refused food from the diet. d. Introduce each new food 4 to 7 days apart.

ANS: D Only one new food is offered in a 4- to 7-day period to determine tolerance.

A mother is concerned because her 10-month-old infant is lethargic. What is the best action the nurse can advise this mother to implement? a. Keep the infant's room well lit. b. Rub the infant's soles vigorously. c. Offer the infant a pacifier. d. Handle the infant slowly and gently.

ANS: D Some infants respond to stimulating environments by shutting down. Move and handle infants slowly and gently.

How might the nurse demonstrate the parachute reflex with an infant? a. Lifting the infant high in the air above her head b. Holding the infant in a football hold, cradling the head c. Seating the infant in a stroller in an upright position d. Placing the infant downward into the crib

ANS: D The infant, when placed downward in a prone position, will protectively extend the arms.

Parents of an infant inform the nurse they are planning home preparation of solid foods. What directions should the nurse provide? (Select all that apply.) a. Boil foods in a large amount of water. b. Do not freeze foods. c. Add 1 teaspoon of salt per cup. d. Puree food in electric blender. e. Add sugar sparingly.

ANS: D, E Home-prepared infant food can be strained and pureed in an electric blender. Sugar should be added sparingly. Food should be boiled in small amounts of water and not over cooked to avoid destroying nutrients. Foods may be frozen in ice cube trays and defrosted for use.

What should the teaching plan include about infant fall precautions? (Select all that apply.) a. Remove all unsteady furniture. b. Keep crib rails up and in locked position. c. Steady infant with hand when on changing table. d. Use tray attachment on high chair as restraint. e. Keep infant seat on the floor while indoors.

ANS: A, B, C, E The tray attachment to a high chair is an inadequate restraint. All other options are good precautions to prevent an infant from a fall.

The nurse is preparing to outline principles of discipline for parents of an infant. What information should the nurse include? (Select all that apply.) a. Firmly say "No." b. Distract the child to another activity. c. Bribe the child with a sweet treat. d. Remain consistent. e. Ignore the child until behavior improves.

ANS: A, B, D Parental approval is important to the infant, and setting limits early is essential. Principles of discipline at this age include the following: lowering the voice to say no firmly, removing the child from the situation, distraction, and consistency.

What will the nurse take into consideration when educating parents regarding infant nutrition? (Select all that apply.) a. Cultural practices b. Sex of the infant c. Parental knowledge d. Infant's developmental level e. Parent-child interaction

ANS: A, C, D, E Parents have many concerns about feeding their infant during the first year of life. This is a period when readiness to receive nutrition education is usually high; therefore, the nurse looks for opportunities to provide accurate information. Assessment of parental knowledge; infant development, behavior, and readiness; parent-child interaction; and cultural and ethnic practices is important. Sex of the infant does not enter into nutritional education.