Care of the Newborn and Infant Overview

What is a newborn/infant's normal urinary output?

6-10 diapers/day

The nurse is caring for a term neonate suffering from meconium aspiration in the nursery. The nurse reviews orders for a peripherally inserted central catheter (PICC) line placement and intubation. Which statement demonstrates the nurse's knowledge of painful procedures as related to a neonate?

The newborn's pain pathway components are developed enough at birth to experience pain.

When should solid foods be introduced to infants' diets, and how should these foods be initially prepared? a) At birth, in their natural form b) At 1 month, mashed and pureed c) At 4-6 months, soft and mashed until teeth erupt d) At 9-12 months, in whole pieces

At 4-6 months, soft and mashed until teeth erupt

An infant is breastfed. When assessing the stools, which findings would be typical?

Less constipation than bottle-fed infants

What is the asymmetric tonic neck reflex?

Lying supine, extremities are extended on side of the body to which head is turned and opposite extremities are flexed

What is the average blood pressure in a 1 year old?

100/50

Babies start cruising at... (Toes -> walking -> ...)

12 months

How long do newborns sleep?

16-20 hours/day

When does an infant typically double their birth weight? a) 2-3 months b) 4-6 months c) 9-12 months d) 12-18 months

4-6 months

What is the average blood pressure of a newborn?

60/40

What does "tummy time" do for babies?

Helps strength and coordination (*Always observe*)

When is spitting up bad?

If they cry and experience no weight gain

What are common musculoskeletal deformities?

Metatarsus adductus (deviated inward; should grow out of) Dysplasia of hip: unequal length (Bartlow and Orlani to diagnose)

At what age can children start drinking cow's milk?

1 year

What is the sucking reflex?

Reflexive sucking when nipple or finger is placed in mouth

What is the plantar and palmar grasp?

Reflexively grasps when palm is touched

How do babies communicate at 3-6 months?

babbles

Anticipatory guidance for an infant for the 4th month should include the fact that the infant will be able to achieve which developmental milestone?

be able to turn over onto the back

How do babies communicate at 9-12 months?

follow simple directions

Babies start crawling at... (Knees -> crawling -> ...)

9 months

The nurse has just finished administering the DTaP vaccine to a 2-month-old and is educating the parent about immunization. Which statement is accurate?

"Bring her back for the second dose when she is 4 months old."

How do babies communicate at 6-9 months?

"Dada" "Mama"

What is the key gross motor milestone for 9-12 months?

Cruises

What are signs of a potential cardiac deficit?

Cyanotic with crying, fatigue with feeding, diaphoretic while feeding

What is the key gross motor milestone for 0-3 months?

Lifts head when prone

The nurse is caring for a 6-month-old infant who has been hospitalized since birth. Which nursing intervention is the most beneficial to this client's psychosocial health?

Maintain consistent caregivers to promote trust and attachment.

You're doing an assessment on an infant. You lift his arms and shoulders up and put them down. The infant's arms abduct and move up, while his hands form a "C." What reflex is this?

Moro reflex

The nurse is performing a vision screening for a 2-month-old. Which technique should the nurse use?

Move a card with a black-and-white checkerboard pattern in a 180-degree arc past the infant.

What is the key gross motor milestone for 3-6 months?

Rolls both directions

The nurse caring for a hospitalized child with failure to thrive (FTT) will focus first on:

assisting the child to attain adequate nutrition to demonstrate weight gain.

What does a bulging fontanel mean?

over-hydration or increased ICP

The best way for an infant's parent to help the child complete the developmental task of the first year is to:

respond to the infant consistently.

The nurse is assessing a 2-month-old formula-fed infant who is experiencing colic. Which type of bowel movements should the nurse expect to occur with this health problem?

yellow and semisoft

When does the posterior fontanel close?

2 months

At what age does the anterior fontanel typically close? a) 1 month b) 2 years c) 6 months d) 3 years

2 years

Babies lift their head at... (Head -> lifting head -> ...)

3 months

When do most infant reflexes disappear?

4 months

Which milestone would the nurse expect an infant to accomplish by 8 months of age?

Sitting without support

When children are not able to communicate pain verbally, the nurse can use a behavioral assessment. The nurse knows that this assessment will least likely include:

sleep patterns.

The nurse is assessing an infant at the 6-month well-baby check-up. The nurse notes that at birth the baby weighed 8 lb (3600 g) and was 20 in (50.8 cm) in length. Which finding is consistent with the normal infant growth and development?

weight of 16 lb (7300 g) and length of 26 in (66.0 cm)

The nurse is assessing Julie, a 3-month-old infant. Which developmental milestone would the nurse expect?

Julie can hold her head erect and steady.

What is a newborn's stool in the first 24 hours?

Meconium (no meconium is concerning)

What are the main foods to avoid for children under 5?

NO popcorn or peanuts because of the danger of aspiration

What antipyretics should you give a <3 month old?

NO tylenol (if 104 degree fever or higher = ER visit)

What are the early warning signs for vision problems in infants at 7 months? a) Not responding to loud noises b) Not tracking interesting objects by 6 months c) Pulsating anterior fontanel d) Sudden extension of head

Not tracking interesting objects by 6 months

Babies roll over at... (Shoulder -> rolling over -> ...)

6 months

The rash in roseola is pruritic. Which measure would you teach the parent to provide comfort?

Apply cool compresses to the skin to stop local itching.

What is the key gross motor milestone for 6-9 months?

Crawls

A 6-month-old infant is admitted to the hospital because of a fever. When the nurse obtains a health history, what data would be obtained first?

Details about the fever

At 6 months, they will sleep 6-8 hours/ nigt with 2-3 naps. They will also start to wake up in the night. What should you do?

Don't feed them

What is the key fine motor milestone for 3-6 months?

Hold bottle

When assessing physical growth in newborns, what is the expected weight change during the first week of life? a) Gain 10% of body weight b) Maintain the same weight c) Lose 10% of body weight d) Double their birth weight

Lose 10% of body weight

What are the protective reflexes?

Neck righting (Neck keeps head in upright position when body is tilted) Parachute (Protective extension with arms when held up in the air and moved forward, reaches forward to catch self)

You're doing an assessment on an infant. When you stroke his cheek, he turns to that side and searches with is mouth. What reflex is this?

Rooting reflex

What is the recommended position for a newborn to sleep in to reduce the risk of sudden infant death syndrome (SIDS)? a) Prone (on the stomach) b) Supine (on the back) c) Lateral (on the side) d) Upright (in a sitting position)

Supine (on the back)

What does a baby with Roseola Subitum (Sixth Disease) look like?

persistent high fever for 3-7 days at or above 103

What do you not give a baby ibuprofen until 6 months?

prostaglandin inhibitor (can close ductus arteriosus and will kill infant < 3 months)

You are completing an otoscopic exam on a 1 year old. Which way do you pull the pinna?

pull pinna down (<3 years: little ones go down)

What developmental theory does Erikson categorize newborns and infants?

Trust v. Mistrust (parents respond to basic needs -> creates sense of trust)

What antipyretics should you give a 3-6 month old?

Tylenol

What antipyretics should you give to a > 6 month old?

Tylenol or Motrin

What do newborns prefer to look at?

Human faces/black and white patterns

A nurse is providing health promotion education to a family of an infant at the family birth center. The nurse knows the parents need more education when they state which response?

"I will switch to whole milk when my infant is around 6 months of age."

What is the step reflex?

With one foot on a flat surface, infant puts the other foot down as if to step

What is a concerning work of breathing in an infant?

Chest sinks and belly pushes out; mottled skin

What does a sunken fontanel mean?

Dehydration

What are early warning signs for hearing problems?

Does not respond to loud noises and does not locate sound at 4 months

The mother of a 1-month-old baby is scheduling the next well-child visit for her baby. Which statement by the mother indicates an understanding of the recommended appointment schedule?

"My baby will need to again be seen when he is 2 months old."

The parents of a 12-month-old child tell the nurse the child has stopped walking and is now only crawling or sitting with support. How should the nurse respond?

"This is a concern. Let's be sure the physician is aware of this change."

The nurse is assessing a 6-month-old infant in the clinic. Which characteristic represents normal language development for this age?

Babbling

Which pattern of growth refers to the progression of development from head to toe in infants? a) Proximodistal b) Cephalocaudal c) Distalproximal d) Caudalcephalic

Cephalocaudal

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 nurse is conducting a physical examination of an 8-month-old infant. Which observation may be cause for concern about the infant's neurologic development?

The infant displays an asymmetric tonic neck reflex (fencing reflex).

The nurse is teaching a new mother about the development of sensory skills in her newborn. What would alert the mother to a sensory deficit in her child?

The newborn does not respond to a loud noise.

The nurse is assessing for pain in a 2-month-old infant. Which behavior indicates that this baby is experiencing pain?

continued crying after diaper change and being fed

The nurse is preparing a list of abilities of 10-month-olds to use in teaching a parenting group. Which ability should appear at this age?

cruises

What is colic?

crying with no physical cause (occurs >3 hours for > 3 weeks)

What is the the Moro reflex in infants? a) turn the head in the direction of a stroked cheek b) reflexively suck when a nipple or finger is placed in the mouth c) extend the head and abduct the arms in response to a sudden movement d) grasp reflexively when the palm is touched

extend the head and abduct the arms in response to a sudden movement

What is failure to thrive?

inadequate growth

A parent asks if her newborn's undescended testicles will need surgery to repair. What is the best response by the nurse?

There is a chance the testicles will descend on their own.

How is the Babinski reflex different in babies than adults?

Babies are opposite from adults, so their toes fan out and hyperextend

The parent of an infant asks the nurse when to begin brushing the infant's teeth. What would be the nurse's best response?

as soon as the first tooth erupts