PEDS PrepU G&D of the Newborn and Infant
A 9-month-old has been brought to the clinic for a well-child visit. The mother reports her son was born 6 weeks prematurely. During the data collection, the child's mother reports her son seems to be a few months "behind" what she recalls from her older children. What is the best response by the nurse? "We will need to check this out since any delays related to prematurity should be resolved by the time a child is 6 months old." "All children mature and develop at different rates so it is unwise to compare them in this way." "Delays are normal when a child is premature." "You should talk with the doctor about getting your son tested."
"Delays are normal when a child is premature." Explanation: When infants are born prematurely delays may be noted. When assessing the growth and development of a premature infant, use the infant's adjusted age to determine expected outcomes. To determine adjusted age, subtract the number of weeks that the infant was premature from the infant's chronological age. Plot growth parameters and assess developmental milestones based on adjusted age. Delays will not necessarily be resolved by the age of 6 months. While the mother should talk with the physician about concerns, this is not the best initial response by the nurse.
The nurse conducting a 6-month well-baby check-up assesses for the presence/absence of the asymmetric tonic neck reflex. At this age the reflex: should have disappeared. should be pronounced and easy to elicit. is expected to appear within 1 month. is a protective reflex and retained for life.
should have disappeared. Explanation: This primitive (not protective) reflex should be present at birth and disappear around age 4 months.
A 12-month-old seen at a walk-in clinic weighed 8 pounds 4 ounces (3750 g) at birth. Weight now is 20 pounds 8 ounces (9300 g). The nurse determines: the child weighs less than expected for age. the child weighs more than expected for age. the child weighs the expected amount for age. the weight assessment is blatantly inaccurate.
the child weighs less than expected for age. Explanation: Birth weight should triple by 12 months. The child should weigh near 24 pounds 12 ounces (11250 g). The child is underweight for age.
The infant weighs 6 lb 8 oz (2,950 g) at birth. If the infant is following a normal pattern of growth, what would be an expected weight for this child at the age of 12 months? 10 lb 8 oz (4760 g) 13 lb (5900 g) 15 lb 4 oz (6920 g) 19 lb 8 oz (8825 g)
19 lb 8 oz (8825 g) Explanation: The average newborn weighs 7.5 lb (3400 g). The average newborn loses 10% of birth weight over the first week of life but regains it in about 10 to 14 days. Most infants double their birth weight by 4 to 6 months of age and triple their birth weight by the time they are 1 year old. If the newborn weighed 6 lb 8 oz (2,950 g) at birth and tripled that weight at 12 months, the infant should weigh 19 lb 8 oz (6.5 lb × 3 = 19.5 lb) or 8825 g.
The nurse is assessing a 1-year-old at the well-child annual visit and notes the child is meeting the growth parameters. After noting the birth weight was 8 pounds (3.6 kg) and length was 20 inches (50.8 cm) long, which measurements reflecting height/weight would the nurse expect to document for this visit? 16 lb (7.2 kg) and 26 inches (65 cm) 20 lb (9.1 kg) and 28 inches (70 cm) 24 pounds (10.8 kg) and 30 inches (75 cm) 28 pounds (12.7 kg) and 32 inches (80 cm)
24 pounds (10.8 kg) and 30 inches (75 cm) Explanation: By 1 year of age, the infant should have tripled his or her birth weight and grown 10 to 12 inches (25 to 30 cm). If this infant was 8 pounds (3.6 kg) at birth, at 1 year, this child should weigh 24 pounds (8 x 3 = 24) and grown to 30 to 32 inches (20 + 10 to 12 = 30 to 32 inches). Most of the growing occurs during the first 6 months with the infant's birth weight doubling and height increasing about 6 inches (15 cm). Growth slows slightly during the second 6 months but is still rapid.
The parents of an 8-month-old infant voice concern to the nurse that their infant is not developing motor skills as they should. What question should the nurse ask to help determine if their fears are warranted? "Does your infant move a toy back and forth from one hand to the other when you give it to them?" "Does your infant place toys into a box or container and take them out?" "Is your infant able to drink with a cup by themselves?" "Is your infant able to hold a pencil and scribble on paper?"
"Does your infant move a toy back and forth from one hand to the other when you give it to them?" Explanation: Transferring an object from one hand to the other is expected at 7 months of age, so this ability would be expected of an 8-month-old. The other questions relate to abilities that are not expected until later months. Questioning the parents about these skills would not help in determining if the infant has the motor skill developmental level that should be expected.
A client who is breastfeeding asks the nurse if she can give the newborn a pacifier. Which nursing response is most appropriate? "I know a lot of people who breastfed and also gave their newborns a pacifier." "This decision should be made by you and your partner based on your personal preferences." "I will request the lactation consultant come talk to you about pacifier usage while breastfeeding." "It is recommended to wait until breastfeeding is well-established before introducing a pacifier."
"It is recommended to wait until breastfeeding is well-established before introducing a pacifier." Explanation: It is recommended to wait to introduce a pacifier once breastfeeding is well-established, which can take about 1 month. This is to limit nipple confusion and promote an adequate milk supply. Stating other people have done this does not provide education to the client, nor does it address this specific client's situation. While the decision is up to the newborn's parents, this response does not address the client's concern. Requesting a lactation consultant come does not address the client at this moment. The nurse can provide education now, and also request the consultant for follow-up information.
The postpartum nurse observes new parents as they put their newborns in the bassinet to sleep. Which action(s) by a new parent require further instruction from the nurse? Select all that apply. A parent places a newborn on its side after falling asleep. A parent states all of their children like sleeping on their abdomen and this newborn likes it too. A parent places the comforter the grandparent made over the newborn's body. A parent tells their spouse to be sure to place the newborn on their back when putting the newborn in the bassinet. A parent states their newborn looks too warm, so they are moving the bassinet in front of the air conditioner to cool off the newborn.
A parent places a newborn on its side after falling asleep. A parent states all of their children like sleeping on their abdomen and this newborn likes it too. A parent places the comforter the grandparent made over the newborn's body. A parent states their newborn looks too warm, so they are moving the bassinet in front of the air conditioner to cool off the newborn. Explanation: Newborns and infants should be on their backs when sleeping to help prevent sudden unexplained infant death (SUID). A firm mattress without pillows or comforters should also be used. The newborn's bed should be placed away from air conditioner vents, open windows, and open heaters.
When performing neurological reflexes on the infant, which primitive reflex will be present longest? Moro Babinski rooting step
Babinski Explanation: Primitive reflexes are subcortical and involve a whole-body response. Selected primitive reflexes present at birth include Moro, root, suck, asymmetric tonic neck, plantar and palmar grasp, step, and Babinski. Except for the Babinski, which disappears around 1 year of age, these primitive reflexes diminish over the first few months of life, giving way to protective reflexes.
The nurse is providing client education to the parent about bathing the infant. What would be important to instruct the parent? Infants need a daily bath Soap lubricates and oils an infant's skin Bath time provides an opportunity for play Never use soap on an infant's hair
Bath time provides an opportunity for play Explanation: The work of children is play. Play provides a natural way for the infant to learn. In early infancy infants prefer their parents rather than toys. Parents can talk and sing to infants during feeding, bathing, and changing diapers. Infants do not need a daily bath as long as the diaper area is washed with diaper changes. Soap is actually drying to an infant's skin. Washing the hair with soap can help remove excess oil.
A newborn requires skin care that includes bathing. Besides hygiene, what is another reason for bathing the newborn? Bathing can prevent infection. Bathing is a great time to apply lotion. Bathing is a time for bonding with the parents. Bathing helps moisten the skin.
Bathing is a time for bonding with the parents. Explanation: The parents can use bath time for bonding with their newborn. This can be done with talking, cooing, and singing. Bath time should be slow-paced and nonstressful. Newborns prefer interacting with parents over toys and they love to watch people's faces. Bathing can help prevent infection, but it is a secondary response. Using soaps on the skin tends to dry the skin, not moisten it. After bathing, lotion can be applied. It is soothing to the baby and keeps the skin softened.
The nurse is reviewing the diet of an 8-month-old infant with the mother who reveals she has been using evaporated milk to make the formula. Which additional ingredient should the nurse ensure she is including in the formula? Vitamin D Vitamin E Iron Calcium
Iron Explanation: Infants who are fed home-prepared formulas (based on evaporated milk) need supplemental vitamin C and iron. Evaporated milk has adequate amounts of vitamin D, which is unaffected by heat used in the preparation of formula. Calcium and vitamin E would not be a concern in this infant's formula.
What action shows an example of Erik Erikson's developmental task for the infant? The infant cries and the caregiver picks the child up. The infant cries when they have a wet diaper. The infant smiles as people walk past the crib. The infant plays the game peek-a-boo.
The infant cries and the caregiver picks the child up. Explanation: Erikson's psychosocial developmental task for the infant is to develop a sense of trust. The development of trust occurs when the infant has a need and that need is met consistently. Crying with a wet diaper without a change of the diaper leads to an unmet need. Playing peek-a boo and smiling are developmental tasks that indicate a normal healthy, happy baby. These would be attributed to Piaget theory.
The nurse is assessing the sleeping practices of the parents of a 4-month-old girl who wakes repeatedly during the night. Which parent comment might reveal a cause for the night waking? They sing to her before she goes to sleep. They put her to bed when she falls asleep. If she is safe, they lie her down and leave. The child has a regular, scheduled bedtime.
They put her to bed when she falls asleep. Explanation: If the parents are keeping the child up until she falls asleep, they are not creating a bedtime routine for her. Infants need a transition to sleep at this age. If the parents are singing to her before she goes to bed, if she has a regular, scheduled bedtime, and if they check on her safety when she wakes at night, then lie her down and leave, they are using good sleep practices.
A new mother reports that she is exhausted and that the little sleep she gets is determined by her baby. Which suggestion should the nurse prioritize to help the mother establish healthy sleeping patterns in her infant? Put the baby to bed at various times of the evening. Let the baby cry during the night and she will eventually fall back to sleep. Use the crib for sleeping only, not for play activities. Wake the baby from afternoon naps after 1 hour to ensure she is sleepy by nighttime.
Use the crib for sleeping only, not for play activities. Explanation: A consistent bedtime routine is usually helpful in establishing healthy sleeping patterns and in preventing sleep problems. Using the crib for sleeping only helps the child associate the bed with sleep. Depriving the baby of sleep during the afternoon or evening will make the baby over-tired and less able to establish a healthy sleeping pattern. While letting a baby cry for a while is acceptable, this does not promote consistency in the baby's sleeping pattern.
Which assessment findings if noted in a 4-month-old infant would the nurse recognize as normal growth and development? holds head up when prone, bears partial weight on legs, reflexes are fading follows object past midline with eyes, keeps hands fisted, rolls over rolls over, grasp reflex fading, cooing sound uses palmer grasp, starts to make vowel sounds, reaches out
holds head up when prone, bears partial weight on legs, reflexes are fading Explanation: At 4 months of age, the infant should be able to hold the head up when prone and bear partial weight on the legs; newborn reflexes are beginning to fade. The nurse should recognize these changes as normal growth and development.
The nurse is assessing the oral cavity of a 4-month-old infant. Which finding is consistent with a child of this age? 1 to 3 natal teeth no teeth 1 to 2 lower teeth 1 upper tooth
no teeth Explanation: Normally infants are not born with teeth. Occasionally there are one or more teeth at birth. These are termed natal teeth and are often associated with anomalies. The first primary teeth typically erupt between the ages of 6 and 8 months.
The nurse is educating the mother of a newborn about feeding practices. The nurse correctly advises the mother that: the best feeding schedule offers food every 4 to 6 hours. most newborns need to eat about 4 times per day. the newborn's stomach can hold between 0.5 oz and 1 oz. demand scheduled feeding is associated with increased difficulty getting the baby to sleep through the night.
the newborn's stomach can hold between 0.5 oz and 1 oz. Explanation: The capacity of the normal newborn's stomach is between 0.5 oz and 1 oz. The recommended feeding plan is to use a demand schedule. Newborns may eat as often as 1.5 to 3 hours. Demand scheduled feedings are not associated with problems sleeping at night.
The student nurse is reviewing the records of a pediatric client. Which statement about the client's progress indicates the need for further instruction? "Maturation refers to the child's increases in body size." "Development refers to the increase in skills the child demonstrates as they grow and age." "Increases in body size are referred to as growth." "Both growth and development are influenced by heredity."
"Maturation refers to the child's increases in body size." Explanation: Growth refers to an increase in physical size. Development is the sequential process by which infants and children gain various skills and functions. Heredity influences growth and development by determining the child's potential, while environment contributes to the degree of achievement. Maturation refers to an increase in functionality of various body systems or developmental skills.
The nurse is providing a nutrition workshop for the parents of infants. The nurse understands that further instruction is required when hearing which comments from the parents? Select all that apply. "Food is so expensive. I can't afford for my child to leave any food on the plate." "I have tried at least 10 times with every green vegetable and I can't get my son to like them." "I try to eat healthy in front of my daughter so she will hopefully pick up good eating habits." "I let my child eat whatever he wants right now so that we don't argue about food. Hopefully he will like healthy foods when he grows up." "I plan on encouraging my son to cook with me when he is old enough so that he will enjoy a variety of foods and learn how to cook too."
"Food is so expensive. I can't afford for my child to leave any food on the plate." "I have tried at least 10 times with every green vegetable and I can't get my son to like them." "I let my child eat whatever he wants right now so that we don't argue about food. Hopefully he will like healthy foods when he grows up." Explanation: Encouraging children to eat everything on their plate can lead to overeating and obesity. Children may need to be exposed to new food at least 20 times before determining if they like it or not. Letting a child eat whatever he wants does not lead to good choices as the child matures.
The nurse is reinforcing teaching with a group of caregivers related to the nutritional needs of the infant. One caregiver asks why the 6-month-old infant needs to have solid foods when breast milk is such a good source of nutrition. What is the best response by the nurse? "Milk will not fully provide the infant's needs for iron, which is found in solid foods." "By this age, the infant becomes interested in trying new skills." "The extrusion reflex must be developed and feeding solid foods will help the infant to develop this reflex." "Breastfeeding will become painful for you when the infant gets more teeth, so the infant needs to eat solid foods."
"Milk will not fully provide the infant's needs for iron, which is found in solid foods." Explanation: At about 4 to 6 months of age, the infant's milk consumption alone is not likely to be sufficient to meet caloric, protein, mineral, and vitamin needs. In particular, the infant's iron supply becomes low, and supplements of iron-rich foods are needed. It is also around 4 to 6 months when the infant is able to swallow solids effectively and has the necessary enzymes to digest them. It is true that the child becomes interested in new skills, but this is not the primary rationale for introducing solids. Few parents will understand the "extrusion reflex" so using that term is not effective in teaching. The nurse should, however, describe the reflex to the parents. Breastfeeding does not become painful when the child develops teeth. Many parents breastfeed for long after their infants develop teeth.
The nurse is educating the parents of a newborn prior to discharge home. The parents demonstrate teaching was successful when making which statement(s)? Select all that apply. "I will not be concerned if my newborn has stools that begin to have a yellowish color to them." "We should get some rest in about 1 month when the newborn starts sleeping through the night." "I plan to add a little rice cereal to my breast milk so my newborn will sleep longer at night." "I understand it is normal for newborns to lose 5% to 10% of their bodyweight after birth." "My newborn can see up-close things, like our faces, better than things at a distance."
"I will not be concerned if my newborn has stools that begin to have a yellowish color to them." "I understand it is normal for newborns to lose 5% to 10% of their bodyweight after birth." "My newborn can see up-close things, like our faces, better than things at a distance." Explanation: Newborn stools will become yellowish in color after the first few days of life. Newborns typically lose 5% to 10% of their birthweight the first few days of life, and begin to gain weight after this period. Newborns have better up-close vision and begin to recognize human faces during their newborn stage. Most infants will not sleep through the night until about 3 months of age. There is no evidence that rice cereal keeps a newborn from waking and the practice of feeding rice cereal to newborns is discouraged by physicians as the newborn needs formula or breast milk specifically.
The nurse is evaluating the effectiveness of nutrition counseling for new mothers. Which comments by the mothers indicate the need for more instruction? Select all that apply. "It is much healthier if I puree my own baby food and add a very small amount of salt to make it taste better." "As long as I wait for at least 3 days to introduce new foods I should be able to determine if my child has any food allergies." "No-spill sippy cups are a good way to limit the amount of juice that comes into contact with the baby's teeth." "My mother said that I shouldn't introduce rice cereal as the first solid food, but I'm confident that is best." "I can start giving my baby a small snack like cheerios around 8 months of age."
"It is much healthier if I puree my own baby food and add a very small amount of salt to make it taste better." "No-spill sippy cups are a good way to limit the amount of juice that comes into contact with the baby's teeth." Explanation: Either home-made pureed or pre-packaged baby food is acceptable, but neither should have any spices (eg, salt, cinnamon) added to it. No-spill sippy cups actually allow juice to be in constant contact with the teeth because they are much like bottles in that the child must suck on them to get a drink.
During the first visit to the pediatrician's practice the nurse is performing an admission interview and assessment of a 4-week-old infant. The mother states, "I am sure my baby girl knows my smell because she is much more settled in my arms rather than my mother's arms when she is upset." What is an appropriate response by the nurse? "Babies really can't tell the difference between people at that age." "Maybe she just knows your voice better than your mother's." "You may be right, since infants can sense their mother's smell as early as 7 days old." "I'm not sure a 4-week-old infant can tell their mother from another woman's smell."
"You may be right, since infants can sense their mother's smell as early as 7 days old." Explanation: The sense of smell develops rapidly: the 7-day-old infant can differentiate the smell of his or her mother's breast milk from that of another woman and will preferentially turn toward the mother's smell.
The nurse enters a client's room to find the new mother crying softly. The client states, "I had my heart set on breastfeeding but my infant was born with a cleft lip. My dreams of breastfeeding are destroyed." Which response by the nurse is appropriate? "I am so sorry your infant has a cleft lip. Bottle feeding will be easiest for you and your infant." "You may still breastfeed your infant. I will show you appropriate techniques to use." "You can use a supplemental nursing system to get a similar experience." "You should speak with a lactation consultant before making a decision on which feeding method to use."
"You may still breastfeed your infant. I will show you appropriate techniques to use." Explanation: The nurse should be therapeutic and reassure the mother that breastfeeding may still be an option. Infants with cleft lips may still successfully breastfeed once appropriate techniques are learned and implemented. A supplemental nursing system is used to provide supplemental milk to breastfeeding babies. Telling the client to speak with a lactation consultant does not address the client's current concern.
An infant is breastfed. When assessing the stools, which findings would be typical? Harder stools than those of bottle-fed infants Fewer stools than bottle-fed infants Less constipation than bottle-fed infants A strong odor
Less constipation than bottle-fed infants Explanation: The first stool of the infant is meconium. It is the result of digestion of amniotic fluid and it is black-green color and sticky. Following that, in 1 to 2 days the infant's stools change to a yellowish-tan color. The stools of breastfed infants tend to be yellow-tan. They are looser in texture and appear "seedy." The stool of a bottle-fed baby has the consistency of peanut butter. The stools of breastfed babies generally have no odor since all milk is digested. Some babies will have a bowel movement with every feeding but it is small. Bottle-fed babies have less stools each day but they are larger and more likely to have an associated odor.
The parent of a 1-month-old infant voices concern about the infant's respirations. The parent states the respirations are rapid and irregular. Which information should the nurse provide? The normal respiratory rate for an infant at this age is between 20 and 30 breaths per minute. The respirations of a 1-month-old infant are normally irregular and periodically pause. An infant at this age should have regular respirations. The irregularity of the infant's respirations is concerning; I will notify the health care provider.
The respirations of a 1-month-old infant are normally irregular and periodically pause. Explanation: The normal respiratory rate for a 1-month-old infant is 30 to 60 breaths per minute. By 1 year of age, the rate will be 20 to 30 breaths per minute. The respiratory patterns of the 1-month-old infant are irregular. There may normally be periodic pauses in the rhythm.
Which activity will the nurse encourage new parents to complete in order to assist their infant in accomplishing Erikson's developmental task for the first year of life? Praise the infant when a new milestone is reached. Respond promptly when the infant cries. Read age-appropriate books to the infant daily. Appropriately enunciate words when speaking to the infant.
Respond promptly when the infant cries. Explanation: The developmental task of the infant year, according to Erikson, is to gain a sense of trust. This can be accomplished by promptly meeting the infant's needs during the first year of life. If the infant does not learn to trust, mistrust will develop. Praising will help meet the future developmental tasks of the child. Reading books and appropriately enunciating words will aid in the infant's language development.
Which milestone would the nurse expect an infant to accomplish by 8 months of age? Sitting without support Creeping on all fours Pulling self to a standing position Being able to sit from a standing position
Sitting without support Explanation: Physical development of infants occurs in a cephalocaudal fashion. That means they must learn to control and lift their heads first. This is followed by the ability to turn over. Once this occurs the remainder of development occurs quickly. Most infants are able to sit unsupported by 8 months. They are able to creep at 9 months and pull to a standing position by 10 months. At 12 months the infant is able to sit from a standing position and is learning to walk.
A nurse is talking to and making facial expressions at a 9-month-old baby girl during a routine office visit. What is the most advanced milestone of language development that the nurse should expect to see in this child? The infant says "da-da" when looking at her father The infant squeals with pleasure The infant coos, babbles, and gurgles The infant imitates her father's cough
The infant says "da-da" when looking at her father Explanation: By 9 months, an infant usually speaks a first word: "da-da" or "ba-ba." The other answers refer to earlier milestones in language development. In response to a nodding, smiling face, or a friendly tone of voice, a 3-month-old infant will squeal with pleasure or laugh out loud. By 4 months, infants are very "talkative," cooing, babbling, and gurgling when spoken to. At 6 months, infants learn the art of imitating. They may imitate a parent's cough, for example, or say "Oh!" as a way of attracting attention.
The nurse is assessing the neurological status of a 10-month-old infant. Which finding(s) does the nurse determine to be abnormal when performing this assessment? Select all that apply. The infant turns to the right side, searching with mouth, when the right side of the cheek is stroked. The infant demonstrates reflexive sucking when nipple or finger is placed in infant's mouth. The infant reflexively grasps when the nurse touches the palm. The infant fans and extends the toes when the nurse strokes along the lateral aspect of the sole and across the plantar surface of the foot. With sudden extension of the infant's head, the arms abduct and move upward and the hands form a "C".
The infant turns to the right side, searching with mouth, when the right side of the cheek is stroked. The infant demonstrates reflexive sucking when nipple or finger is placed in infant's mouth. The infant reflexively grasps when the nurse touches the palm. With sudden extension of the infant's head, the arms abduct and move upward and the hands form a "C". Explanation: The primitive reflexes (root, suck, palmar grasp, moro) should be absent by 10 months of age. A positive Babinski sign normally persists until 12 months of age so the presence of this sign would be considered a normal finding in the 10-month-old.
The nurse is performing an assessment on a 8-month-old infant. The infant's medical history notes that he was born at 32 weeks' gestation. The infant is progressing normally. At what adjusted age should the nurse expect the infant's developmental accomplishments? The infant can be expected to display developmental skills consistent with a 8-month-old infant. By 8 months of age, the child's skill level will vary greatly and cannot be predicted. The infant will most likely present with developmental skills consistent with a 6-month-old infant. The infant will likely show the skills of an infant with the adjusted age of 7 months.
The infant will most likely present with developmental skills consistent with a 6-month-old infant. Explanation: When assessing the growth and development of a premature infant, the nurse will use the infant's adjusted age to determine expected outcomes. To determine adjusted age, the nurse subtracts the number of weeks that the infant was premature from the infant's chronological age. The infant who was born at 32 weeks' gestation was 8 weeks (or 2 months) premature. To determine the adjusted age, the nurse subtracts 2 months from the chronological age of 8 months: 6 months.
The nurse is examining an 8-month-old girl for appropriate development during a regular check-up. Which observation points to a developmental risk? Uses only the left hand to grasp Picks up small objects using entire hand Crawls with stomach down Cannot pull self to standing
Uses only the left hand to grasp Explanation: Favoring one hand over the other may be a warning sign that proper motor development is not occurring in the other arm or hand. Grasping small objects with the entire hand is common at 8 months and precedes the pincer grasp, which is used about 2 months later. Crawling with stomach down and being unable to pull to standing are abilities that may not occur for another 4 to 8 weeks.
