Chapter 9. Health Promotion of the Infant and Family

ANS: A Sucking is an infants chief pleasure, and the infant may not be satisfied by bottle-feeding or breastfeeding alone. During infancy and early childhood, there is no need to restrict nonnutritive sucking. The nurse should explore with the mother her feelings about a pacifier versus the thumb. No data support that the child has sensory deprivation.

A breastfed infant is being seen in the clinic for a 6-month checkup. The mother tells the nurse that the infant recently began to suck her thumb. Which is the best nursing intervention? a. Reassure the mother that this is normal at this age. b. Recommend the mother substitute a pacifier for her thumb. c. Assess the infant for other signs of sensory deprivation. d. Suggest the mother breastfeed the infant more often to satisfy her sucking needs.

ANS: C Infants are usually in the secondary circular reaction stage from ages 4 to 8 months. This stage is characterized by a continuation of the primary circular reaction for the response that results. Shaking is performed to hear the noise of the rattle, not just for shaking. The use of reflexes stage is primarily during the first month of life. The primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from ages 1 to 4 months. The fourth sensorimotor stage is coordination of secondary schemata, which occurs at ages 9 to 12 months. This is a transitional stage in which increasing motor skills enable greater exploration of the environment.

According to Piaget, a 6-month-old infant should be in which developmental stage? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata

ANS: D Six months is earlier than expected to have six teeth. At age 6 months, most infants have two teeth. Although unusual, having six teeth at 6 months is not dangerous.

An infant, age 6 months, has six teeth. The nurse should recognize that this is what? Normal tooth eruption Delayed tooth eruption Unusual and dangerous Earlier than expected tooth eruption

ANS: C Health practices should be most important. With the need for diaper changes and assistance with feeding, young children are at increased risk when handwashing and other hygienic measures are not consistently used. Developmentally appropriate toys are important, but hygiene and the prevention of disease transmission take precedence. An infant should not have snacks. This is a concern for an older child. Certified caregivers for each age group may be an indicator of a high- quality facility, but parental observation of good hygiene is a better predictor of care.

At a well-child visit, parents ask the nurse how to know if a daycare facility is a good choice for their infant. Which observation should the nurse stress as especially important to consider when making the selection? a. Developmentally appropriate toys b. Nutritious snacks served to the children c. Handwashing by providers after diaper changes d. Certified caregivers for each of the age groups at the facility

ANS: C Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months, an infant can sit with support. At age 6 months, the infant will maintain a sitting position if propped. By 10 months, the infant can maneuver from a prone to a sitting position.

At which age can most infants sit steadily unsupported? a. 4 months b. 6 months c. 8 months d. 12 months

ANS: C Between ages 6 and 8 months, fear of strangers and stranger anxiety become prominent and are related to infants ability to discriminate between familiar and unfamiliar people. At 2 months, infants are just beginning to respond differentially to their mothers. The infant at age 4 months is beginning the process of separation-individuation, which involves recognizing the self and mother as separate beings. Twelve months is too late; the infant requires referral for evaluation if he or she does not fear strangers by this age.

At which age do most infants begin to fear strangers? a. 2 months b. 4 months c. 6 months d. 12 months

ANS: C The child can recognize familiar objects at approximately age 3 months. For the first 2 months of life, infants watch and observe their surroundings. The 4-month-old infant is beginning to develop handeye coordination.

At which age does an infant start to recognize familiar faces and objects, such as his or her own hand? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: B At age 2 months, the infant has a social, responsive smile. A reflex smile is usually present at age 1 month. A 3-month-old infant can recognize familiar faces. At age 4 months, infants can enjoy social interactions.

At which age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: C Beginning at about age 10 months, an infant is able to ascribe meaning to the words mama and dada. Four to 6 months is too young for this behavior to develop. At 14 months, the child should be able to attach meaning to these words. By age 1 year, the child can say three to five words with meaning and understand as many as 100 words.

At which age should the nurse expect most infants to begin to say mama and dada with meaning? a. 4 months b. 6 months c. 10 months d. 14 months

ANS: C Most infants can pull themselves to a standing position at age 9 months. Infants who are not able to pull themselves to standing by age 11 to 12 months should be further evaluated for developmental dysplasia of the hip. At 6 months, infants have just obtained coordination of arms and legs. By age 8 months, infants can bear full weight on their legs.

By which age should the nurse expect that an infant will be able to pull to a standing position? a. 5 to 6 months b. 7 to 8 months c. 11 to 12 months d. 14 to 15 months

ANS: C At 2 months of age, an infant should turn his or her head to the side when a noise is made at ear level. At birth, infants respond to sound with a startle or Moro reflex. An infant responds to his or her name and locates sounds by turning his or her head in a curving arc at age 6 to 9 months.

During the 2-month well-child checkup, the nurse expects the infant to respond to sound in which manner? a. Respond to name. b. React to loud noise with Moro reflex. c. Turn his or her head to side when sound is at ear level. d. Locate sound by turning his or her head in a curving arc.

ANS: C Rolling from the abdomen to the back is developmentally appropriate for a 5-month-old infant. The ability to roll from the back to the abdomen is developmentally appropriate for an infant at age 6 months. Sitting erect without support is a developmental milestone usually achieved by 8 months. A 10-month-old infant can usually move from a prone to a sitting position.

In terms of gross motor development, what should the nurse expect an infant age 5 months to do? a. Sit erect without support. b. Roll from the back to the abdomen. c. Turn from the abdomen to the back. d. Move from a prone to a sitting position.

ANS: A When the infant is suspended in a horizontal prone position, the head is raised and the legs and spine are extended; this describes the Landau reflex. It appears at 6 to 8 months and persists until 12 to 24 months. The parachute reflex occurs when the infant is suspended in a horizontal prone position and suddenly thrust downward; the infant extends the hands and fingers forward as if to protect against falling. This appears at age 7 to 9 months and lasts indefinitely. Body righting occurs when turning the hips and shoulders to one side causes all other body parts to follow. It appears at 6 months of age and persists until 24 to 36 months. The labyrinth-righting reflex appears at 2 months and is strongest at 10 months. This reflex involves holding infants in the prone or supine position. They are able to raise their heads.

The nurse is checking reflexes on a 7-month-old infant. When the infant is suspended in a horizontal prone position, the head is raised and the legs and spine are extended. Which reflex is this? a. Landau b. Parachute c. Body righting d. Labyrinth righting

ANS: B Music boxes and soft mobiles are appropriate play activities for a 2-month-old infant. A ball of yarn to pull apart or different textured fabrics are appropriate for an infant at 6 to 9 months. A cup and spoon or pushpull toys are appropriate for an older infant. Infants of all ages should be exposed to appropriate types of stimulation.

The nurse is discussing development and play activities with the parent of a 2-month-old boy. Which statement by the parent would indicate a correct understanding of the teaching? a. I can give my baby a ball of yarn to pull apart or different textured fabrics to feel. b. I can use a music box and soft mobiles as appropriate play activities for my baby. c. I should introduce a cup and spoon or pushpull toys for my baby at this age. d. I do not have to worry about appropriate play activities at this age.

ANS: B By age 10 months, children are able to associate meaning with words. The father is using both verbal and physical cues to alert the child to dangerous situations. A time-out is not appropriate. The child is just learning about the environment. Physical discipline should be avoided. The 10- month-old child is too young to understand the purpose of an electrical outlet.

The nurse is interviewing the father of a 10-month-old girl. The child is playing on the floor when she notices an electrical outlet and reaches up to touch it. Her father says no firmly and moves her away from the outlet. The nurse should use this opportunity to teach the father what? a. That the child should be given a time-out b. That the child is old enough to understand the word no c. That the child will learn safety issues better if she is spanked d. That the child should already know that electrical outlets are dangerous

ANS: B Parents need to learn that a spoiled child is a response to inconsistent discipline and limit setting. It is important to meet the infants developmental needs, including comforting and cuddling. The data suggest that responding to a childs crying can actually decrease the overall crying time. Allowing him to cry for no longer than 15 minutes and then picking him up will reinforce prolonged crying. Infants at this age have other needs besides feeding. The parents should be taught to identify their infants cues. Counseling parents on letting the baby cry himself to sleep when not soiled or wet refers to sleep issues, not general infant behavior.

The parents of a 2-month-old boy are concerned about spoiling their son by picking him up when he cries. What is the nurses best response? a. Allow him to cry for no longer than 15 minutes and then pick him up. b. Babies need comforting and cuddling. Meeting these needs will not spoil him. c. Babies this young cry when they are hungry. Try feeding him when he cries. d. If he isnt soiled or wet, leave him, and hell cry himself to sleep

ANS: A A 12-month-old child is able to pull to a stand and walk holding on or independently. Appropriate toys for this age child include large pushpull toys for kinetic stimulation. A cradle gym should not be placed across the crib. Finger paints are appropriate for older children. A 12- month-old child does not have the stability to use a stick horse.

What information should be given to the parents of a 12-month-old child regarding appropriate play activities for this age? a. Give large pushpull toys for kinetic stimulation. b. Place a cradle gym across the crib to help develop fine motor skills. c. Provide the child with finger paints to enhance fine motor skills. d. Provide a stick horse to develop gross motor coordination.

ANS: A Because object permanence is a new achievement, peek-a-boo is an excellent activity to practice this new skill for visual stimulation. Playing pat-a-cake and showing how to clap hands help with kinetic stimulation. Imitating animal sounds helps with auditory stimulation.

What is an appropriate play activity for a 7-month-old infant to encourage visual stimulation? a. Playing peek-a-boo b. Playing pat-a-cake c. Imitating animal sounds d. Showing how to clap hands

ANS: D At age 5 months, the infant should be able to voluntarily grasp an object. The grasp reflex is present in the first 2 to 3 months of life. Gradually, the reflex becomes voluntary. The neat pincer grasp is not achieved until age 11 months. At age 12 months, an infant will attempt to build a tower of two cubes but will most likely be unsuccessful.

Which characteristic best describes the fine motor skills of an infant at age 5 months? a. Neat pincer grasp b. Strong grasp reflex c. Builds a tower of two cubes d. Able to grasp object voluntarily

ANS: C Teething pain is a result of inflammation, and cold is soothing. A frozen teething ring or ice cube wrapped in a washcloth helps relieve the inflammation. Aspirin is contraindicated secondary to the risks of aspiration. Hydrogen peroxide does not have an anti-inflammatory effect. Warmth increases inflammation.

Which intervention is the most appropriate recommendation for relief of teething pain? a. Rub gums with aspirin to relieve inflammation. b. Apply hydrogen peroxide to gums to relieve irritation. c. Give the infant a frozen teething ring to relieve inflammation. d. Have the infant chew on a warm teething ring to encourage tooth eruption.