Exam 1: Infant and Family

d

A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. What does the nurse recommend based on the American Academy of Pediatrics? a. Skim milk b. Whole cow's milk c. Commercial formula without iron d. Commercial iron-fortified formula

c

A nurse is assessing a 12-month old infant during a well-child visit. Which of the following findings should the nurse report to the provider? a. closed anterior fontanel b. eruption of 6 teeth c. birth weight doubled d. birth length increased by 50%

b c e

A nurse is conducting a well baby visit with a 4 month old infant. Which of the following immunizations should the nurse plan to administer to the infant? Select all that apply a. measles, mumps, rubella (MMR) b. polio c. pneumococcal vaccine (PCV) d. varicella e. rotavirus vaccine (RV)

a c

A nurse is performing a developmental screening on a 10-month old infant. Which of the following fine motor skills should the nurse expect the infant to perform? Select all that apply a. grasp a rattle by the handle b. try building a two-block tower c. use a crude pincer grasp d. place objects into a container e. walks with one hand held

b

A nurse is providing education about introducing new foods to the guardians of a 4 month old infant. The nurse should recommend that the caregiver introduce which of the following foods first? a. strained yellow vegetables b. iron-fortified cereals c. pureed fruits d. whole milk

b

A nurse is providing teaching about dental care and teething to the caregiver of a 9 month old infant. Which of the following statements by the caregiver indicates understanding of the teaching? a. "I can give my baby a warm teething ring to relieve discomfort" b. "I should clean my baby's teeth with a cool, wet wash cloth" c. "I can give advil for up to 5 days while my baby is teething" d. "I should place diluted juice in the bottle my baby drinks while falling asleep"

c

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

b

After reading the vaccine information sheets, the parent of a 2 month old infant is hesitant to consent to the recommended vaccinations. The nurse should first ask the parent a."Did you know that vaccinations are required by law for school entry?" b. "What concerns do you have about vaccinations, moron?" c. "Would you prefer that fewer vaccines are given at a time?" d. "Can you please sign this vaccine waiver form?"

c f

An 8 month old infant is seen in the well child clinic for a routine checkup. The nurse should expect the infant to be able to do which tasks? Select all that apply a. say mama and dada with specific meaning b. feed self with a spoon c. play peekaboo d. walk independently e. stack two blocks f. transfer object from hand to hand

c

An important milestone in the infant's life is the development of object permanence. This milestone is represented by which of these statements? a. The infant smiles at the mother when she talks to him b. The infant repeatedly flexes and extends his arms and legs when the mother picks him up c. The infant turns and looks for the mother when she walks out of his view d. The infant cries when the mother hands him to a babysitter

c

An important nutritional supplement recommended to prevent rickets in infants who are exclusively breastfeeding is: a. Vitamin A b. Fluoride c. Vitamin D d. Folic Acid

c

An infant weighed 8 lb at birth and was 18 inches in length. What weight and length should the infant be at 5 months of age? a. 12 lb, 20 inches b. 14 lb, 21.5 inches c. 16 lb, 23 inches d. 18 lb, 24.5 inches

c

At what age is it safe to give infants whole milk instead of commercial infant formula? a. 6 months b. 9 months c. 12 months d. 18 months

b

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

c

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

c

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

Object Permancence

Cognitive Development This is the infant's realization that objects that leave the visual field still exist

Affect

Cognitive Development This is the outward manifestation of emotion and feeling

Secondary circular reactions

Cognitive Development Stages (4) This stage of cognitive development occurs with primary circular reactions being repeated and prolonged for the response that results. Ex. Grasping and holding become shaking, banging

Coordination of Secondary Schemas

Cognitive Development Stages (4) This stage of cognitive development, also known as "application to new situations" occurs with the use of previous behavior achievements as foundation for adding new skills

Fluorosis

Dental Care If infants are exposed to water that has fluoride in it, they do not need a supplement. If they do need a supplement, too much fluoride can cause _________, which is seen with a greying and mottling of teeth

6

Gross Motor Development The ability to turn from the back to the abdomen occurs at ____ months

b

Sara, age 4 months, was born at 35 weeks of gestation. She appears to be developing normally, but her parents are concerned because she is a "more difficult" baby than their other child, who was full term. What response by the nurse is appropriate? a. Infants tend to become more difficult over time. b. Infants become less difficult if they are kept on scheduled feedings and structured routines. c. Behavior is suggestive of failure to completely bond with her parents. d. Difficult temperament is the result of painful experiences in the neonatal period.

1. Gender, Age, Size 2. Approach 3. Proximity to Parent

Social Development: Separation/Strangers The intensity of fear factors is dependent on 3 things: 1. Ex. Female, younger, smaller 2. Ex. Quiet, gradual, non-intrusive speech 3. Being closer to parent is best

Reactive Attachment Disorder

Social Development: Separation/Strangers This disorder stems from maladaptive or absent attachment between infant and parent and may persist into child/adulthood Signs: not cuddling, little eye contact, poor impulse control, destructive

Teething

Teething Fussiness, drooling, biting nipple during breastfeeding, inflamed gums, and nubs of teeth exposed are all _________ cues

b c d

The clinic nurse is assessing a 6-month-old infant during a well-child appointment. The nurse should use which approaches to alleviate the infants stranger anxiety? (Select all that apply.) a. Talk in a loud voice. b. Meet the infant at eye level. c. Avoid sudden intrusive gestures. d. Maintain a safe distance initially. e. Pick up the infant and hold him or her closely.

b

The nurse is assessing a 6-month-old healthy infant who weighed 3.2 kg at birth. The nurse would expect the infant to now weigh approximately how many kilograms? a. 5.2 b. 6.3 c. 8.7 d. 9.6

c

The nurse is assessing a 6-month-old infant who is noted to have head lag. What is the appropriate response documentation in the chart related to this finding? a. Normal development b. Cognitive impairment noted, follow-up in 1 month c. Developmental, neurologic evaluation referral d. Teach parents to practice exercises with infant

a

The nurse is assessing a 7-month old infant during a well baby exam. What does the nurse anticipate for fine motor development for this infant? a. Transfer objects from one hand to the other. b. Use the thumb and index finger in crude pincer grasp. c. Hold a crayon and make a mark on paper. d. Release cubes into a cup.

a b e

The nurse is evaluating a 7-month-old infants cognitive development. Which behaviors should the nurse anticipate evaluating? (Select all that apply.) a. Imitates sounds b. Shows interest in a mirror image c. Comprehends simple commands d. Actively searches for a hidden object e. Attracts attention by methods other than crying

c d e

The nurse is providing anticipatory guidance to parents of a 6-month-old on preventing an accidental poisoning injury. Which should the nurse include in the teaching? (Select all that apply.) a. Place plants on the floor. b. Place medications in a cupboard. c. Discard used containers of poisonous substances. d. Keep cosmetic and personal products out of the childs reach. e. Make sure that paint for furniture or toys does not contain lead.

a c e

The nurse is providing anticipatory guidance to the parents of a 1-month-old infant on preventing a suffocation injury. Which should the nurse include in the teaching? (Select all that apply.) a. Do not place pillows in the infants crib. b. Crib slats should be 4 inches or less apart. c. Keep all plastic bags stored out of the infants reach. d. Plastic over the mattress is acceptable if it is covered with a sheet. e. A pacifier should not be tied on a string around the infants neck.

a

The nurse is providing information to parents asking about selecting a daycare facility for their child. What does the nurse instruct the parents as important to consider when making the selection? a. Health practices of the facility b. Structured learning environment c. Socioeconomic status of the children d. Cultural similarities of the children

b c e f

The nurse is teaching a group of parents at a community education program about introducing solid foods to their infants. Which recommendations should the nurse include? (Select all that apply.) a. Spoon feeding should be introduced after an entire milk feeding. b. It is best to introduce a wide variety of foods during the first year. c. As solid food consumption increases, the quantity of milk should decrease. d. Introduction of low-calorie milk and food should be done by the end of the first year. e. Introduction of citrus fruits, meats, and eggs should be delayed until after 6 months of age. f. Each new food item should be introduced at 5- to 7-day intervals.

d

The nurse is teaching parents about expected language development for their 6-month-old infant. The nurse recognizes the parents understand the teaching if they make which statement? a. Our baby should comprehend the word no. b. Our baby knows the meaning of saying mama. c. Our baby should be able to say three to five words. d. Our baby should begin to combine syllables, such as dada.

d

The parent of a 10-week-old infant tells the nurse, "She cries sometimes when nothing is wrong—for example, when she is dry and has recently been fed." What is the appropriate response by the nurse? a. Reassure the parent that nothing is wrong. b. Explain how to better interpret infant cues. c. Evaluate for failure of the parent to bond with the infant. d. Reassure the parent that periods of "unexplained fussiness" can be normal

c

The parents of a 3-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hr during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. What would the nurse suggest to help them deal with this problem? a. Let her cry herself back to sleep. b. Put her in parents' bed to cuddle. c. Start putting her to bed while still awake and while the parent is present. d. Give her a bottle of formula instead of breastfeeding her so often at night.

a

The type of play in which infants engage is called: a. Solitary b. Parallel c. Associative d. Cooperative

b

What information would the nurse give a mother regarding the introduction of solid foods during infancy? a. Fruits and vegetables should be introduced into the diet first. b. Foods should be introduced one at a time at intervals of 5 to 7 days. c. Solid foods can be mixed in a bottle to make the transition easier for the infant. d. Solid foods should not be introduced until 8 to 10 months when the extrusion reflex begins to disappear.

b

What reflexes appear at about 7 to 9 months of age? a. Moro b. Parachute c. Neck righting d. Labyrinth righting

c

Which structure should be closed by the time the child is 2 months old?

Hypoperistaltic

Maturation of Systems Infant digestive systems are classified as _____________, and they are often seen defecating while eating

Sinus Arrythmia

Maturation of Systems The heart rate slows, and a pattern called ________ _________ develops, which is when the heart rate increases with inspiration and decreases with expiration

Santmyer

Maturation of Systems The infant has a reflex called the __________ swallow, which is seen when a puff of air is directed at the face and the infant results in swallowing

Stable

Maturation of Systems The respiratory rate slows and is relatively _________

Contract Shiver

Maturation of Systems Thermoregulation starts to develop. The skin increases its ability to _________ and the muscles increase their ability to _________ in response to cold

Allergies

Nutrition It is important to introduce foods at intervals of 4-7 days to allow for identification of food _________

Breast Milk

Nutrition What is the primary source of nutrition recommended during the first 6 months of life?

4 - 6

Personal-Social Behavior Foods should be introduced at ____ - _____ months

Solitary

Personal-Social Behavior Infants engage in _______ play, which means they will play by themselves

6

Proportional Changes Children grow by an inch per month for ___ months and then have growth spurts

6

Proportional Changes Height increases by 1 inch per month for ____ months

6 months Triple

Proportional Changes Infants double their birth weight by age ____ months and ________ their weight by 1 year

Sensory

Sensory Changes Premature babies receiving antibiotics such as vancomycin are at risk for ________ hearing loss

Primary circular reactions

Cognitive Development Stages (4) This stage of cognitive development is the beginning of replacement of reflexive behavior with voluntary acts Ex. Grasping deliberately to elicit a reaction

5 to 7

Proportional Changes There is ___ to ___ ounces of weight gain every week

6

Sensory Changes By __ months of age, babies can distinguish between familiar and strange faces

c

A 10 month old looks for objects that have been removed from his view. The nurse should instruct the parents that a. neuromuscular development enables the child to reach out and grasp objects b. the childs curiosity has increased c. the child understands the permanence of objects even though the child cannot see them d. the child is not able to transfer objects from hand to hand

a

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.

c

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

Parachute

Sensory Changes The ___________ reflex appears at 7 months

Familiar Strange

Separation anxiety begins when infants can distinguish between __________ and _________ faces

6

Teething How many teeth should a 12 month old have?

Two

Teething How many teeth should an 8 month old have?

a

An infant, age 5 months, is brought to the clinic by his parents for a well-baby checkup. What is the best advice that the nurse should include at this time about injury prevention? a. Keep buttons, beads, and other small objects out of his reach. b. Do not permit him to chew paint from window ledges because he might absorb too much lead. c. When he learns to roll over, you must supervise him whenever he is on a surface from which he might fall. d. Lock the crib sides securely because he may stand and lean against them and fall out of bed.

c

An uncle is shopping for toy to give his niece. He has no children of his own and asks his neighbor, a nurse, what would be the most appropriate toy to give a 15 month old child. Which toy should the nurse recommend to facilitate learning and development? a. a stuffed animal b. a music box c. a push-pull toy d. a nursery mobile

6

Teething In the first 2 years of life, the age of the child in months - ____ = the number of teeth

Aspirin

Teething What medication should NEVER be given to an infant for relief from teething?

c

The parent of 2-week-old infant asks the nurse if fluoride supplements are necessary because the infant is exclusively breastfed. What is the nurses best response? a. The infant needs to begin taking them now. b. Supplements are not needed if you drink fluoridated water. c. The infant may need to begin taking them at age 6 months. d. The infant can have infant cereal mixed with fluoridated water instead of supplements.

c

The parent of a 6 month old reports starting 2% milk. The nurse should first ask the parent a. "Do you think your baby will be fine with this milk?" b. "It is possible for you to switch your baby to whole milk?" c. "Can you tell me more about the reason you switched your baby to 2% milk?" d. "You cannot switch to 2% milk right now. Did your pediatrician tell you to do this?"

a

The parent of a 9 month old expressed concern that the baby "is developing slowly". The nurse is concerned about a developmental delay when finding the baby is unable to accomplish which skill? a. vocalizing single syllables b. standing alone c. building a tower of two cubes d. drinking from a cup with little spilling

a

Which statement by a parent reflects the need for further teaching regarding car seat safety? a. "my baby should stay in a rear-facing car seat until he is 1 year old" b. "I should check my old car seat's expiration date before using it for this baby" c. "My older child will need to stay in a booster seat until he is 4 ft 9 inches tall" d. "My children should ride in the back seat until they are 13 years old"

Spoiled Child

________ _________ syndrome is defined as excessive self-centered and immature behavior, resulting from the failure of parents to enforce consistent, age-appropriate limits

b

What is the best age to introduce solid food into an infants diet? a. 2 to 3 months b. 4 to 6 months c. When birth weight has tripled d. When tooth eruption has started

4

Language Development The infant coos, gurgles, and laughs by ___ months

6

Language Development The infant imitates sounds by ___ months

9

Language Development The infant understands the word NO by ___ months

Stimulating

Limit Setting and Discipline Discipline should be immediate, reasonable, timely, and the child should be placed in a non-____________ environment

c

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

c

A parent brings a 4 month old to the clinic for a regular well visit and expresses concern that the infant is not developing appropriately. Which finding in the infant would indicate the need for further developmental screening? a. has no interest in peekaboo games b. does not turn from front to back c. does not babble d. sits unsupported

2 *A minute per year*

Limit Setting and Discipline How many minutes of discipline should a two year old receive?

c

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

Mental Representation

Cognitive Development This is the use of symbols that allows the infant to think of an object or situation without actually experiencing it

Imitation

Cognitive Development This term describes the infant taking pleasure in performing an act repeatedly after it has been mastered

Use of reflexes

Cognitive Development Stages (4) This stage of cognitive development includes the repetitive nature of _________, which marks the beginning of associations between acts and responses

Time-Out

Limit Setting and Discipline What is the most common discipline for children?

incompletely

Maturation of Systems During infancy, the digestive system is not fully developed, which causes solid foods to be passed ___________ broken down in the feces

Infectious

Maturation of Systems During the maturation of the respiratory system, ___________ agents are rapidly transmitted due to the proximity of the trachea to bronchi

6

Dental Care Infants should receive their first dental visit from ____ months to a year in age

Dental Caries

Dental Health Avoid propping the milk bottle up, giving bottle in bed, or giving fruit juices in bottles. These can all lead to what?

c

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.

Lag

Gross Motor Development Marked head ______ is evident when the infant is pulled from lying to sitting

d

The mother asks the nurse for advice about discipline for her 18 month old. Which discipline strategy should the nurse suggest that the mother use? a. reprimand b. spanking c. reasoning d. time-out

a

The mother of a 3-month-old breastfed infant asks about giving her baby water because it is summer and very warm. What should the nurse tell her? a. Fluids in addition to breast milk are not needed. b. Water should be given if the infant seems to nurse longer than usual. c. Clear juices are better than water to promote adequate fluid intake. d. Water once or twice a day will make up for losses resulting from environmental temperature.

c

The nurse assesses a 6 month old for vaccination readiness. Which finding would most likely indicate the need to delay administering the diphtheria, tetanus, and acellular pertusis (DTaP) vaccine? a. a family history of SIDS b. a fever of 101.3 following the 4 month vaccinations c. an acute bilateral ear infection d. living with a family member who is immunosuppressed

b

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.

b

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

c

The nurse is performing an assessment on a 12-month-old infant. Which fine or gross motor developmental skill demonstrates the proximodistal acquisition of skills? a. Standing b. Sitting without assistance c. Fully developed pincer grasp d. Taking a few steps holding onto something

d

The nurse is teaching the parents of an 8 month old about what the child should eat. The nurse should include which information points in the teaching plan? a. vegetables should be introduced before fruits b. solid foods should not be introduced until the infant is 10 months old c. iron-fortified cereals should not be introduced until the infant is 8 months old d. the infants diet can be changed from formula to whole milk when the infant is 12 months old

b

The nurse notes than an infant stares at an object placed in his hands and takes it to his mouth, coos, gurgles when talked to, and sustains part of his own weight when held in a standing position. The nurse correctly interprets these findings as characteristic of an infant at which age? a. 2 months b. 4 months c. 7 months d. 9 months

d

The parents of a 12-month-old child ask the nurse if the child can eat hot dogs as do their other children. The nurses reply should be based on what? a. The child is too young to digest hot dogs. b. The child is too young to eat hot dogs safely. c. Hot dogs must be sliced into sections to prevent aspiration. d. Hot dogs must be cut into small, irregular pieces to prevent aspiration.

b

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.

Depth Perception

This develops in the infant by 7-9 months

Binocularity

This term describes the fixation of two ocular images into one cerebral picture and develops by 6 weeks and will be well established by 6 months

d

To assess the development of a 1 month old, the nurse asks the parent if the infant is able to a. smile and laugh out loud b. roll from back to side c. hold a rattle briefly d. lift head from prone position

a

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.

a

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

d

Which infant most needs a developmental referral for gross motor delay? a. the 2 month old who does not roll over b. the 4 month old who does not sit without support c. the 6 month old who does not crawl d. the 9 month old who dos not stand holding on

c

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.

b

Which intervention should the nurse employ to reduce trauma caused by vaccine administration to an infant? a. use a 5/8 inch needle b. simultaneously administer vaccines at separate sites with a second nurse c. aspirate to verify needle placement d. breast-feed right before administering vaccines

c

Which is an appropriate language development for an 8 month old? The child should be a. saying dada and mama specifically b. saying three other words besides mama and dada c. saying dada and mama nonspecifically d. saying ball when parents point to a ball

Head Back

Gross Motor Development Sitting is accomplished with a progressive _____ control and a straightening of the _______

d

The nurse should refer the parents of an 8 month old child to a healthcare provider is the child is unable to a. stand momentarily without holding onto furniture b. stand unsupported well for long periods of time c. stoop to recover an object d. sit without support for long periods of time

d

The parent of a 9 month old infant is concerned that the infant's front soft spot is still open. The nurse should tell the parent a. "I will measure your baby's head to see if it is normal size" b. "Your infant will need to be referred for more testing" c. "You should contact your healthcare provider immediately" d. "This is normal because this soft spot usually closes between 12-18 months

10-11

Language Development The infant can combine syllables by ____-____ months

Palmer Pincer

Fine Motor Development Gradually, the _______ grasp (using the whole hand) is replaced with a ________ grasp (using thumb and index finger)

Hormonal and Parental

Gender Identity During development of gender identity, ________ and _________ influences help aid the development of sexuality

Hip Dysplasia

Gross Motor Development An infant who does not pull to a standing position by 11-12 months should be evaluated for possible _______ ____________

c

In relation to developmental milestones, the infant can be expected to roll over from back to abdomen at approximately: a. 2 months b. 4 months c. 6 months d. 8 months

a

In teaching parents about appropriate pacifier selection, the nurse should recommend which characteristic? a. Easily grasped handle b. Detachable shield for cleaning c. Soft, pliable material d. Ribbon or string to secure to clothing

c

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.

1 Year

Sensory Changes Reflexes found within a baby should be completely gone by what age?