OB Chapter 31; The Infant and Family
In terms of gross motor development, what would the nurse expect a 5-month-old infant to do (select all that apply)? a. Roll from abdomen to back. b. Put feet in mouth when supine. c. Roll from back to abdomen. d. Sit erect without support. e. Move from prone to sitting position.
A, B
Pacifiers can be extremely dangerous because of the frequency of use and the intensity of the infants suck. In teaching parents about appropriate pacifier selection, the nurse should explain that a pacifier should have which characteristics (select all that apply)? a. Easily grasped handle b. One-piece construction c. Ribbon or string to secure to clothing d. Soft, pliable material e. Sturdy, flexible material
A, B, E
A nurse has completed a teaching session for parents about baby-proofing the home. Which statements made by the parents indicate an understanding of the teaching (select all that apply)? a. We will put plastic fillers in all electrical plugs. b. We will place poisonous substances in a high cupboard. c. We will place a gate at the top and bottom of stairways. d. We will keep our household hot water heater at 130 degrees. e. We will remove front knobs from the stove.
A, C, E
Which interventions should the nurse implement when caring for a family of a sudden infant death syndrome (SIDS) infant (select all that apply)? a. Allow parents to say goodbye to their infant. b. Once parents leave the hospital, no further follow-up is required. c. Arrange for someone to take the parents home from the hospital. d. Avoid requesting an autopsy of the deceased infant. e. Conduct a debriefing session with the parents before they leave the hospital.
A, C, E
Apnea of infancy has been diagnosed in an infant who will soon be discharged with home monitoring. When teaching the parents about the infant's care, what is the most important information the nurse should include in the discharge teaching plan? A. Cardiopulmonary resuscitation (CPR) B. Administration of intravenous (IV) fluids C. Reassurance that the infant cannot be electrocuted during monitoring D. Advice that the infant not be left with other caretakers such as baby-sitters
A; Cardiopulmonary resuscitation (CPR)
The nurse educator instructs a nursing student that according to Erikson, infancy is concerned with acquiring a sense of: A. trust. B. industry. C. initiative. D. separation.
A; Trust
The mother of a 3-month-old breastfed infant asks about giving her baby water since it is summer and very warm. The nurse should recommend that: 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. water once or twice a day will make up for losses caused by environmental temperature. D. clear juices would be better than water to promote adequate fluid intake.
A; fluids in addition to breast milk are not needed.
A nurse is conducting education classes for parents of infants. The nurse plans to discuss sudden infant death syndrome (SIDS). Which risk factors should the nurse include as increasing an infants risk of a SIDS incident(select all that apply)? a. Breastfeeding b. Low Apgar scores c. Male sex d. Birth weight in the 50th or higher percentile e. Recent viral illness
B, C, E
A nurse is preparing to administer routine immunizations to a 4-month-old infant. The infant is currently up to date on all previously recommended immunizations. Which immunizations will the nurse prepare to administer (select all that apply)? a. Measles, mumps, and rubella (MMR) b. Rotavirus (RV) c. Diphtheria, tetanus, and acellular pertussis (DTaP) d. Varicella e. Haemophilus influenzae type b (HIB) f. Inactivated poliovirus (IPV)
B, C, E, F
The parents of a 5-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. What should the nurse suggest to help them deal with this problem? A. Putting her in parents' bed to cuddle B. Beginning to put her to bed while still awake C. Letting her cry herself back to sleep D. Giving her a bottle of formula instead of breastfeeding her so often at night
B; Beginning to put her to bed while still awake
A mother is bringing her 4-month-old infant into the clinic for a routine well-baby check. The mother is exclusively breastfeeding. There are no other liquids given to the infant. What vitamin does the nurse anticipate the provider will prescribe for this infant? A. Vitamin B B. Vitamin D C. Vitamin C D. Vitamin K
B; Vitamin D
The exhausted parents of a 2-month-old infant with colic ask the nurse what is the best method to promote comfort and sleep for the infant. The nurse's initial action is to: A. advise the mother to follow a milk-free diet for 3 to 5 days. B. take a thorough, detailed history of usual daily events. C. administer simethicone drops to provide relief from gas pains. D. explain that the parents need to stay calm so the infant will remain calm.
B; take a thorough detailed history of usual daily events
A parent of an 8-month-old infant tells the nurse that the baby cries and screams whenever he or she is left with the grandparents. The nurse's reply should be based on knowledge that: A. the infant is most likely spoiled. B. this is a normal reaction for this age. C. this is an abnormal reaction for this age. D. grandparents are not responsive to that infant.
B; this is a normal reaction for this age.
At what age would the nurse advise parents to expect their infant to be able to say "mama" and "dada" with meaning? A. 4 months B. 6 months C. 10 months D. 14 months
C: 10 months
A 4-month-old infant is brought to the clinic by his parents for a well-baby checkup. What should the nurse include at this time concerning injury prevention? A. "Never shake baby powder directly on your infant because it can be aspirated into his lungs." B. "Do not permit your child to chew paint from window ledges because he might absorb too much lead." C. "When your baby learns to roll over, you must supervise him whenever he is on a surface from which he might fall." D. "Keep doors of appliances closed at all times."
C; "When your baby learns to roll over, you must supervise him whenever he is on a surface from which he might fall."
A nurse is providing education to a community group in preparation for a mission trip to a third world country with limited access to protein-based food sources. The nurse is aware that children in this country are at increased risk for: A. rickets. B. marasmus. C. kwashiorkor. D. pellagra.
C; Khawshiokor
The nurse in the pediatric clinic identifies which infants at risk for developing vitamin D-deficient rickets? A. Lacto-ovo vegetarians B. Those who are breastfed exclusively C. Those using yogurt as primary source of milk D. Those exposed to daily sunlight
C; Those using yogurt as a primary source of milk.
The nurse is assessing a 6-month-old infant who smiles, coos, and has a strong head lag. The nurse should recognize that: A. this assessment is normal. B. the child is probably cognitively impaired. C. developmental/neurologic evaluation is needed. D. the parent needs to work with the infant to stop head lag.
C; developmental/neurologic evaluation is needed.
The MOST appropriate recommendation for relief of teething pain is to instruct the parents to: A. rub gums with aspirin to relieve inflammation. B. apply hydrogen peroxide to gums to relieve irritation. C. give child a frozen teething ring to relieve inflammation. D. have child chew on a warm teething ring to encourage tooth eruption.
C; give child a frozen teething ring to relieve inflammation.
The parent of a 12-month-old infant says to the nurse, "He pushes the teaspoon right out of my hand when I feed him. I can't let him feed himself; he makes too much of a mess." The nurse's BEST response is: A. "It's important not to give in to this kind of temper tantrum at this age. Simply ignore the behavior and the mess." B. "You need to try different types of utensils, bowls, and plates. Some are specifically designed for young children." C. "It's important to let him make a mess. Just try not to worry about it so much." D. "Feeding himself will help foster his growth and development. Perhaps we can discuss ways to make the messes more tolerable."
D; "Feeding himself will help foster his growth and development. Perhaps we can discuss ways to make the messes more tolerable."
The nurse expects which characteristic of fine motor skills in a 5-month-old infant? A. Strong grasp reflex B. Neat pincer grasp C. Able to build a tower of two cubes D. Able to grasp object voluntarily
D; Able to grasp object voluntarily
The parents of a 9-month-old infant tell the nurse that they are worried about their baby's thumb-sucking. What is the nurse's BEST reply? A. A pacifier should be substituted for the thumb. B. Thumb-sucking should be discouraged by age 12 months. C. Thumb-sucking should be discouraged when the teeth begin to erupt. D. There is no need to restrain non-nutritive sucking during infancy.
D; There is no need to restrain non-nutritive sucking during infancy.
A 3-month-old bottle-fed infant is allergic to cow's milk. The nurse's BEST option for a substitute is: A. goat's milk. B. soy-based formula. C. skim milk diluted with water. D. casein hydrolysate milk formula.
D; casein hydrolysate milk formula
The nurse is interviewing the parents of a 4-month-old male infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in his crib with a blanket over his head, lying face down in bloody fluid from his nose and mouth. They say he was "just fine" when they put him in his crib already asleep. The nurse should suspect his death was caused by: A. suffocation. B. child abuse. C. infantile apnea. D. sudden infant death syndrome (SIDS).
D; sudden infant death syndrome (SIDS)
In terms of fine motor development, the infant of 7 months should be able to: a. Transfer objects from one hand to the other. b. Use thumb and index finger in a crude pincer grasp. c. Hold a crayon and make a mark on paper. d. Release cubes into a cup.
a. Transfer objects from one hand to the other.
By what age does the posterior fontanel usually close? a. 6 to 8 weeks b. 10 to 12 weeks c. 4 to 6 months d. 8 to 10 months
a; 6 to 8 weeks
The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as: a. A normal finding. b. A questionable finding the infant should be rechecked in 1 month. c. An abnormal finding indicates the need for immediate referral to a practitioner. d. An abnormal finding indicates the need for developmental assessment.
a; A normal finding
The best play activity to provide tactile stimulation for a 6-month-old infant is to: a. Allow to splash in bath b. Give various colored block c. Playing music box, tapes or CDs d. Use infant swing or stroller
a; Allow to splash in bath
Clinical manifestations of failure to thrive caused by behavioral problems resulting in inadequate intake of calories include: a. Avoidance of eye contact. b. An associated malabsorption defect. c. Weight that falls below the 15th percentile. d. Normal achievement of developmental landmarks.
a; Avoidance of eye contact.
A parent of an infant with colic tells the nurse, All this baby does is scream at me; it is a constant worry. The nurses best action is: a. Encourage parent to verbalize feelings. b. Encourage parent not to worry so much. c. Assess parent for other signs of inadequate parenting. d. Reassure parent that colic rarely lasts past age 9 months.
a; Encourage parent to verbalize feelings.
Which is an important nursing consideration when caring for an infant with failure to thrive? a. Establish a structured routine and follow it consistently. b. Maintain a non-distracting environment by not speaking to the infant during feeding. c. Place the infant in an infant seat during feedings to prevent overstimulation. d. Limit sensory stimulation and play activities to alleviate fatigue.
a; Establish a structured routine and follow it consistently.
Which information could be given to the parents of a 12-month-old child regarding appropriate play activities for this age? a. Give large push-pull toys for kinesthetic stimulation. b. Place cradle gym across crib to facilitate fine motor skills. c. Provide child with finger paints to enhance fine motor skills. d. Provide stick horse to develop gross motor coordination.
a; Give large push-pull toys for kinesthetic stimulation.
Sara, age 4 months, was born at 35 weeks gestation. She seems to be developing normally, but her parents are concerned because she is a more difficult baby than their other child, who was term. The nurse should explain that: a. Infants temperaments are part of their unique characteristics. b. Infants become less difficult if they are not kept on scheduled feedings and structured routines. c. Sara's behavior is suggestive of failure to bond completely with her parents. d. Sara's difficult temperament is the result of painful experiences in the neonatal period.
a; Infants temperaments are part of their unique characteristics.
The nurse is interviewing the father of 10-month-old Megan. She is playing on the floor when she notices an electrical outlet and reaches up to touch it. Her father says No firmly and removes her from near the outlet. The nurse should use this opportunity to teach the father that Megan: a. Is old enough to understand the word No. b. Is too young to understand the word No. c. Should already know that electrical outlets are dangerous. d. Will learn safety issues better if she is spanked.
a; Is old enough to understand the word No.
The parents of a 4-month-old infant tell the nurse that they are getting a microwave oven and will be able to heat the baby's formula faster. The nurse should recommend: a. Never heating a bottle in a microwave oven. b. Heating only 10 ounces or more. c. Always leaving the bottle top uncovered to allow heat to escape. d. Shaking the bottle vigorously for at least 30 seconds after heating.
a; Never heating a bottle in a microwave
A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands; however, she will not voluntarily grasp it. The nurse should interpret this as: a. Normal development. b. Significant developmental lag. c. Slightly delayed development caused by prematurity. d. Suggestive of a neurologic disorder such as cerebral palsy.
a; Normal development
With the goal of preventing plagiocephaly, the nurse should teach new parents to: a. Place the infant prone for 30 to 60 minutes per day. b. Buy a soft mattress. c. Allow the infant to nap in the car safety seat. d. Have the infant sleep with the parents.
a; Place the infant prone for 30 to 60 minutes per day.
An appropriate play activity for a 7-month-old infant to encourage visual stimulation is: a. Playing peek-a-boo b. Playing pat-a-cake c. Imitating animal sounds d. Showing how to clap hands
a; Playing peek-a-boo
In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? a. Roll from abdomen to back b. Roll from back to abdomen c. Sit erect without support d. Move from prone to sitting position
a; Roll from abdomen to back
The nurse notices that a 10-month-old infant being seen in the clinic is wearing expensive, inflexible, high- top shoes. The nurse should explain that: a. Soft and flexible shoes are generally better. b. High-top shoes are necessary for support. c. Inflexible shoes are necessary to prevent in-toeing and out-toeing. d. This type of shoe will encourage the infant to walk sooner.
a; Soft and flexible shoes are generally better.
In terms of fine motor development, the infant of 7 months should be able to: a. Transfer objects from one hand to the other. b. Use thumb and index finger in a crude pincer grasp. c. Hold a crayon and make a mark on paper. d. Release cubes into a cup.
a; Transfer objects from one hand to the other.
The nurse is assessing a 6-month-old healthy infant who weighed 7 pounds at birth. The nurse should expect the infant to now weigh approximately: a. 10 pounds b. 15 pounds c. 20 pounds d. 25 pounds
b; 15 pounds
At what 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
b; 2 months
When is the best age for solid food to be introduced into the infants diet? a. 2 to 3 months b. 4 to 6 months c. When birth weight was tripled d. When tooth eruption has started
b; 4 to 6 months
A nurse is teaching parents about prevention and treatment of colic. Which should the nurse include in the teaching plan? a. Avoid use of pacifiers. b. Eliminate all secondhand smoke contact. c. Lay infant flat after feeding. d. Avoid swaddling the infant.
b; Eliminate all secondhand smoke contact.
The clinic is lending a federally approved car seat to an infants family. The nurse should explain that the safest place to put the car seat is: a. Front facing in back seat. b. Rear facing in back seat. c. Front facing in front seat if an air bag is on the passenger side. d. Rear facing in front seat if an air bag is on the passenger side.
b; Rear facing in back seat.
The nurse should teach parents that which age is safe to give infants whole milk instead of commercial infant formula? a. 6 months b. 9 months c. 12 months d. 18 months
c; 12 months
A parent asks the nurse At what age do most babies begin to fear strangers? The nurse responds that most infants begin to fear strangers at age: a. 2 months b. 4 months c. 6 months d. 12 months
c; 6 months
At which age can most infants sit steadily unsupported? a. 4 months b. 6 months c. 8 months d. 10 months
c; 8 months
By what age should the nurse expect that an infant will be able to pull to a standing position? a. 6 months b. 8 months c. 9 months d. 11 to 12 months
c; 9 months
Which behavior indicates that an infant has developed object permanence? a. Recognizes familiar face such as the mother b. Recognizes familiar object such as a bottle c. Actively searches for a hidden object d. Secures objects by pulling on a string
c; Actively searches for a hidden object
Which strategy might be recommended for an infant with failure-to-thrive to increase caloric intake? A. Using developmental stimulation by a specialist during feedings B. Avoiding solids until after the bottle is well accepted C. Being persistent through 10 to 15 minutes of food refusal D. Varying schedule of routine activities on a daily basis
c; Being persistent through 10 to 15 minutes of food refusal
Which statement best describes the infants physical development? a. Anterior fontanel closes by age 6 to 10 months. b. Binocularity is well established by 8 months. c. Birth weight doubles by age 5 months and triples by age 1 year. d. Maternal iron stores persist during the first 12 months of life.
c; Birth weight doubles by age 5 months and triples by age 1 year.
Parent guidelines for relieving colic in an infant include: a. Avoiding touching the abdomen. b. Avoiding using a pacifier. c. Changing the infants position frequently. d. Placing the infant where the family cannot hear the crying.
c; Changing the infants position frequently
A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. The nurse should recommend that the infant be given: a. Skim milk b. Whole cows milk c. Commercial iron-fortified formula d. Commercial formula without iron
c; Commercial iron-fortified formula
Latasha is a breastfed infant being seen in the clinic for her 6-month checkup. Her mother tells the nurse that Latasha recently began to suck her thumb. The best nursing intervention is to: a. Recommend that the mother substitute a pacifier for Latasha's thumb. b. Assess Latasha for other signs of sensory deprivation. c. Reassure the mother that this is very normal at this age. d. Suggest that the mother breastfeed Latasha more often to satisfy sucking needs.
c; Reassure the mother that this is very normal at this age
According to Piaget, the 6-month-old infant would be in what stage of the sensorimotor phase? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata
c; Secondary circular reactions
The parent of 2-week-old Sarah asks the nurse if Sarah needs fluoride supplements because she is exclusively breastfed. The nurses best response is: a. She needs to begin taking them now. b. They are not needed if you drink fluoridated water. c. She may need to begin taking them at age 6 months. d. She can have infant cereal mixed with fluoridated water instead of supplements.
c; She may need to begin taking them at age 6 months.
An infant experienced an apparent life-threatening event and is being placed on home apnea monitoring. The parents have understood the instructions for use of a home apnea monitor when they state: a. We can adjust the monitor to eliminate false alarms. b. We should sleep in the same bed as our monitored infant. c. We will check the monitor several times a day to be sure the alarm is working. d. We will place the monitor in the crib with our infant.
c; We will check the monitor several times a day to be sure the alarm is working.
An infant has been pronounced dead from sudden infant death syndrome (SIDS) in the emergency department. Which is an appropriate question to ask the parents? a. Did you hear the infant cry out? b. Why didnt you check on the infant earlier? c. What time did you find the infant? d. Was the head buried in a blanket?
c; What time did you find the infant?
A mother tells the nurse that she doesnt want her infant immunized because of the discomfort associated with injections. The nurse should explain that: a. This cannot be prevented. b. Infants do not feel pain as adults do. c. This is not a good reason for refusing immunizations. d. A topical anesthetic, eutectic mixture of local anesthetic (EMLA), can be applied before injections are given.
d; A topical anesthetic, eutectic mixture of local anesthetic (EMLA), can be applied before injections are given.
The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurses response should be based on knowledge that this is: a. Unacceptable because of the risk of sudden infant death syndrome (SIDS). b. Unacceptable because it does not encourage achievement of developmental milestones. c. Unacceptable to encourage fine motor development. d. Acceptable to encourage head control and turning over.
d; Acceptable to encourage head control and turning over.
Austin, age 6 months, has six teeth. The nurse should recognize that this is: a. Normal tooth eruption b. Delayed tooth eruption c. Unusual and dangerous d. Earlier-than-normal tooth eruption
d; Earlier-than-normal tooth eruption
Which is the most appropriate action when an infant becomes apneic? a. Shake vigorously. b. Roll head side to side. c. Hold by feet upside down with head supported. d. Gently stimulate trunk by patting or rubbing.
d; Gently stimulate trunk by patting or rubbing.
The parents of a 12-month-old child ask the nurse if the child can eat hot dogs. The nurses reply should be based on knowing that: 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.
d; Hot dogs must be cut into small, irregular pieces to prevent aspiration.
An important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS) is to: a. Explain how SIDS could have been predicted and prevented. b. Interview parents in depth concerning the circumstances surrounding the infants death. c. Discourage parents from making a last visit with the infant. d. Make a follow-up home visit to parents as soon as possible after the infants death.
d; Make a follow-up home visit to parents as soon as possible after the infants death.
A parent asks the nurse whether her infant is susceptible to pertussis. The nurses response should be based on which statement concerning susceptibility to pertussis? a. Neonates will be immune the first few months. b. If the mother has had the disease, the infant will receive passive immunity. c. Children younger than 1 year seldom contract this disease. d. Most children are highly susceptible from birth.
d; Most children are highly susceptible from birth.
A 9-month-old infant is seen in the emergency department after developing a urticaric rash with cough and wheezing. When collecting the history of events before the sudden onset of the rash with cough and wheezing, the mother states they were "feeding the baby new foods." Which food is the possible cause of this type of reaction in the infant? a. Potatoes b. Green beans c. Spinach d. Peanut butter
d; Peanut butter
A nurse is caring for a 2-month-old exclusively breastfed infant with an admitting diagnosis of colic. Based on the nurse's knowledge of breastfed infants, what type of stool is expected? a. Dark brown and small hard pebbles b. Loose with green mucus streaks c. Formed and with white mucus d. Semi-formed, seedy, yellow
d; Semi-formed, seedy, yellow
Parents tell the nurse that their 1-year-old son often sleeps with them. They seem unconcerned about this. The nurses response should be based on the knowledge that: a. Children should not sleep with their parents. b. Separation from parents should be completed by this age. c. Daytime attention should be increased. d. This is a common and accepted practice, especially in some cultural groups.
d; This is a common and accepted practice, especially in some cultural groups.
The parents of a 9-month-old infant tell the nurse that they have noticed foods such as peas and corn are not completely digested and can be seen in their infants stool. The nurse bases her explanation on knowing that: a. Children should not be given fibrous foods until the digestive tract matures at age 4 years. b. The infant should not be given any solid foods until this digestive problem is resolved. c. This is abnormal and requires further investigation. d. This is normal because of the immaturity of digestive processes at this age.
d; This is normal because of the immaturity of digestive processes at this age.
