Peds CH 15 ?'s

Which would be the best play activity for a 6-month-old infant to provide tactile stimulation? a. Allow to splash in bath. b. Give various colored blocks. c. Play music box, tapes, or CDs. d. Use infant swing or stroller.

ANS: A The feel of the water while the infant is splashing will provide tactile stimulation. Various colored blocks would provide visual stimulation for a 4- to 6-month-old infant. Music box, tapes, and CDs provide auditory stimulation. Swings and strollers provide kinesthetic stimulation. DIF: Cognitive Level: Apply REF: p. 309 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance

A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands, but 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 pals

ANS: A This indicates normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. No evidence of neurologic dysfunction is present.

The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. How should the nurse interpret this finding? a. Normal finding b. Finding requiring a referral c. Abnormal finding d. Normal finding, but requires rechecking in 1 month

ANS: A This is a normal finding. The anterior fontanel closes between ages 12 and 18 months. No further intervention is required. DIF: Cognitive Level: Apply REF: p. 301 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

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

ANS: B At age 2 months, the infant has a social, responsive smile. A reflex smile is usually present at age 1 month. The 3-month-old can recognize familiar faces. At age 4 months, the infant can enjoy social interactions. DIF: Cognitive Level: Understand REF: p. 314 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

The abnormal finding in an evaluation of growth and development for a 6-month-old infant would be: a. weight gain of 4 to 7 ounces per week. b. length increase of 1 inch in 2 months. c. head lag present. d. can sit alone for a few seconds.

ANS: C The infant should be holding the head up well by 5 months of age. If head lag is present at 6 months, the child should undergo further evaluation.

A nurse is conducting a teaching session for parents of infants. The nurse explains that which behavior indicates that an infant has developed object permanence? a. Recognizes familiar face, such as mother b. Recognizes familiar object, such as bottle c. Actively searches for a hidden object d. Secures objects by pulling on a string

ANS: C During the first 6 months of life, infants believe that objects exist only as long as they can see them. When infants search for an object that is out of sight, this signals the attainment of object permanence, whereby an infant knows an object exists even when it is not visible. Between ages 8 and 12 weeks, infants begin to respond differentially to the mother. They cry, smile, vocalize, and show distinct preference for the mother. This preference is one of the stages that influences the attachment process but is too early for object permanence. Recognizing familiar objects is an important transition for the infant, but it does not signal object permanence. The ability to understand cause and effect is part of secondary schemata development. DIF: Cognitive Level: Understand REF: p. 313 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

A mother tells the nurse that she is discontinuing breastfeeding her 5-month- old infant. What should the nurse recommend the infant be given? a. Skim milk b. Whole cow's milk c. Commercial iron-fortified formula d. Commercial formula without iron

ANS: C For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, then iron-fortified commercial formula should be used. Cow's milk should not be used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron-deficiency anemia. DIF: Cognitive Level: Apply REF: p. 319 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

A nurse is assessing a 12-month-old infant. Which statement best describes the infant's physical development a nurse should expect to find? a. Anterior fontanel closes by age 6 to 10 months. b. Binocularity is well established by age 8 months. c. Birth weight doubles by age 6 months and triples by age 1 year. d. Maternal iron stores persist during the first 12 months of life.

ANS: C Growth is very rapid during the first year of life. The birth weight has approximately doubled by age 5 to 6 months and triples by age 1 year. The anterior fontanel closes at age 12 to 18 months. Binocularity is not established until age 15 months. Maternal iron stores are usually depleted by age 6 months. DIF: Cognitive Level: Understand REF: p. 302 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

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

ANS: C The American Academy of Pediatrics does not recommend the use of cow's milk for children younger than 12 months. At 6 and 9 months, the infant should be receiving commercial infant formula or breast milk. At age 18 months, milk and formula are supplemented with solid foods, water, and some fruit juices. DIF: Cognitive Level: Understand REF: p. 318 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

At what age does an infant start to recognize familiar faces and objects, such as a feeding bottle? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: C The child can recognize familiar objects at approximately age 3 months. For the first 2 months of life, infants watch and observe their surroundings. The 4-month-old infant is able to anticipate feeding after seeing the bottle. DIF: Cognitive Level: Understand REF: p. 314 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

A maternity nurse is providing instruction to a new mother regarding the psychosocial development of the newborn infant. Using Erikson's psychosocial development theory, the nurse would instruct the mother to A) Allow the newborn infant to signal a need B) Anticipate all of the needs of the newborn infant C) Avoid the newborn infant during the first 10 minutes of crying D) Attend to the newborn infant immediately when crying

A) Allow the newborn infant to signal a need. Trust vs Mistrust stage-This will allow the infant opportunity to gain trust.

The statement made by a parent that indicates correct understanding of infant feeding is: a. "I've been mixing rice cereal and formula in the baby's bottle." b. "I switched the baby to low-fat milk at 9 months." c. "The baby really likes little pieces of chocolate." d. "I give the baby any new foods before he takes his bottle."

ANS: D New solid foods should be introduced before formula or breast milk to encourage the infant to try new fo

The nurse would advise a parent when introducing solid foods to: a. begin with one tablespoon of food. b. mix foods together. c. eliminate a refused food from the diet. d. introduce each new food 4 to 7 days apart.

ANS: D Only one new food is offered in a 4- to 7-day period to determine tolerance.

The nurse is caring for an infant who was born prematurely. After completing the assessment and discussing the infant's activities at home with her mother, it is clear that the child is not meeting her developmental milestones. When reporting this in the medical record, what term would be appropriate? A. Developmental delay B. failure to thrive

A

A parent asks the nurse "when will my infant start to teethe?" The nurse responds that the earliest age at which an infant begins teething with eruption of lower central incisors is _____ months. a. 4 b. 6 c. 8 d. 12

ANS: B Teething usually begins at age 6 months with the eruption of the lower central incisors; 4 months is too early for teething. By age 8 months, the infant has the upper and lower central incisors. At age 12 months, the infant has six to eight deciduous teeth. DIF: Cognitive Level: Apply REF: p. 317 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse explains that by the age of 6 months an iron-rich formula should be offered because the infant has: a. limited ability to produce red blood cells. b. ineffective digestive enzymes. c. exhausted maternal iron stores. d. need of the iron to support dentition.

c. exhausted maternal iron stores.

The nurse is examining an infant who is 4 days old. The nurse puts the infant in a semi-upright position and lets the head fall back (with immediate support). What infant reflex is the nurse testing for? a) Startle b) Moro c) Palmar grasp d) Babinski

B The moro reflex is stimulated when the infant is semi-upright and the head falls backward. When this happens, the infant responds with symmetrical abduction and extension of the arms, flexion of the thumb, and flexion of the upper limbs. This response should not persist after 4 months of age. The Babinski reflex is tested through stimulating the foot/toes, the palmar reflex through the hand/fingers, and the startle reflex through loud noises (e.g., clapping).

A 3-month-old boy was diagnosed with failure to thrive. What action will be most helpful in assisting the nurse to determine if there is an inorganic cause? a. reviewing the medical records for a history of prematurity or a congenital anomaly b. assessing for adequate calorie intake through recording ounces of formula consumed c. observing the mother-child interaction during feeding and hygiene activities d. observing the child's interest in and ability to feed

c. observing the mother-child interaction during feeding and hygiene activities Rationale: Observing the mother:child interaction during feeding and hygiene activities would disclose lack of knowledge of child care, poor feeding techniques, or inappropriate maternal bonding and interaction as inorganic causes or failure to thrive. The child's lack of interest in or inability to feed would indicate organic causes, as would determining that the child consumed adequate calories for age and finding a history of prematurity or congenital anomaly.

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: a) is a protective reflex and retained for life. b) should be pronounced and easy to elicit. c) should have disappeared. d) is expected to appear within 1 month.

C This primitive (not protective) reflex should be present at birth and disappear around age 4 months.

What should the teaching plan include about infant fall precautions? Select all that apply. a. Remove all unsteady furniture. b. Keep crib rails up and in locked position. c. Steady infant with hand when on changing table. d. Use tray attachment on high chair as restraint. e. Keep infant seat on the floor.

ANS: A, B, C, E The tray attachment to a high chair is an inadequate restraint. All other options are good precautions to prevent an infant from a fall.

The most appropriate activity to recommend to parents to promote sensorimotor stimulation for a 1-year-old would be to: a. ride a tricycle. b. spend time in an infant swing. c. play with push-pull toys. d. read large picture books.

ANS: C Push-pull toys are appropriate to promote sensorimotor stimulation for a 1-year-old child.

The nurse is aware that the earliest age at which the infant should be able to walk independently is _____ months. a. 8 to 10 b. 12 to 15 c. 15 to 18 d. 18 to 21

ANS: B For the majority of children, the milestone of walking alone is achieved between 12 and 15 months.

Which milestone is developmentally appropriate for a 2-month-old infant when the nurse pulls the infant to a sitting position? a. Head lag is present when the infant's trunk is lifted. b. The infant is able to support the head when the trunk is lifted. c. The infant is briefly able to hold the head erect. d. The infant is fully able to support and hold the head in a straight line.

C The infant is briefly able to hold the head erect. (A 2-month-old infant is able to hold the head erect only briefly and continues to have some head lag. It is not until 4 months of age that the infant can keep his or head in a straight line when pulled to a sitting position.)

A mother asks the nurse, "When should I begin to clean my baby's teeth?" What is the best response for the nurse? *a.* "You can begin when all her baby teeth are in." *b.* "You can easily begin now. Just put some toothpaste on a gauze pad to clean the teeth." *c.* "I don't think you have to worry about that until she can handle a toothbrush." *d.* "You can begin as soon as your child has a tooth. The easiest way is to take cotton swabs or a face cloth and just wipe the teeth. Toothpaste is not necessary."

*d.* "You can begin as soon as your child has a tooth. The easiest way is to take cotton swabs or a face cloth and just wipe the teeth. Toothpaste is not necessary." (An infant's teeth need to be cleaned as soon as they erupt. Cleaning the teeth with cotton swabs or a face cloth is appropriate. Waiting until all the baby teeth are in is inappropriate and prolongs cleaning until 2 years of age. Because toothpaste contains fluoride and infants will swallow the toothpaste, parents should avoid its use. Even when a child has the ability to hold a toothbrush, the parent should continue cleaning the child's teeth.)

Which statement concerning physiological factors of infancy is true? *a.* The infant has a slower metabolic rate than an adult. *b.* An infant is not able to digest protein and lactase. *c.* Infants have a slower circulatory response than adults. *d.* The kidneys of an infant are less efficient in concentrating urine than an adult's kidneys.

*d.* The kidneys of an infant are less efficient in concentrating urine than an adult's kidneys. (The infant's kidneys are not as effective at concentrating urine compared with an adult's kidneys because of immaturity of the renal system and a slower glomerular filtration rates. The infant's metabolic rate is faster, not slower, than an adult's. Although the newborn infant's gastrointestinal system is immature, it is capable of digesting protein and lactase, but the ability to digest and absorb fat does not reach adult levels until approximately 6 to 9 months of age.)

The nurse is assessing a newborn immediately after birth. Which findings indicate abnormality and need further investigation? Select all that apply. 1 BP is 80/70 mm Hg 2 Body weight is 3800 g 3 Body temperature is 97.0° F 4 Crown-to-rump length is 35 cm 5 Head circumference is 3 cm less than chest circumference

1. BP is 80/70 mm Hg 3. Body temperature is 97.0° F 5. Head circumference is 3 cm less than chest circumference The normal blood pressure of the newborn on the first day should be 65/45 mm Hg; a BP of 80/70 mm Hg is abnormal and needs further investigation. The normal body temperature of a newborn is usually between 97.7° F and 99.7° F. Therefore, a body temperature 97.0° F indicates hypothermia, and needs further investigation. Usually, the head circumference is about 2 to 3 cm (1 inch) greater than chest circumference; a head circumference less than 3 cm of chest circumference may indicate microcephaly. A body weight of 3800 g and a crown-to-rump length of 35 cm are normal and indicate normal growth and development.

Which immunoglobulins (Ig) are transferred from a mother to a fetus? 1. IgG 2. IgA 3. IgD 4. IgM

1. IgG Significant amounts of maternal IgG antibodies are passed on to a newborn and confer immunity against antigens. IgA is not present at birth but is found in saliva and tears by 2 to 5 weeks of age. The production of IgD is gradual, and increases progressively during childhood. Significant amounts of IgM are produced at birth, and adult levels are reached by 9 months of a

Which growth patterns does the nurse anticipate observing when providing care to a newborn? Select all that apply. 1. A 10% weight gain within the first few days of life 2. An average birth length of 48 to 53 cm (19 to 21 in) 3. An average birth weight of 2700 to 4000 g (6 to 9 lbs) 4. A positive Babinski reflex noted during admission assessment 5. An average head circumference of 33 to 35 cm (13 to 14 in)

2. An average birth length of 48 to 53 cm (19 to 21 in) 3. An average birth weight of 2700 to 4000 g (6 to 9 lbs) 5. An average head circumference of 33 to 35 cm (13 to 14 in) Growth patterns the nurse would expect for a newborn include an average birth length of 48 to 53 cm (19 to 21 in); an average birth weight of 2700 to 4000 g (6 to 9 lbs); and an average head circumference of 33 to 35 cm (13 to 14 in). The nurse would anticipate the newborn to lose, not gain, up to 10% of birth weight within the first few days of life. A positive Babinski reflex is an expected developmental finding, not a growth pattern.

The nurse has discussed with a mother the process of introducing solid foods to her 6-month-old infant. What statement by the mother leads the nurse to determine that learning has taken place? a. "I will give my infant rice cereal first." b. "I will give my infant yellow vegetables first." c. "I will give my infant egg yolks first." d. "I will give my infant fruits first."

ANS: A Solid foods are usually introduced at about 6 months of age, starting with rice cereal, which is the least allergenic.

The nurse is aware that the age at which the posterior fontanelle closes is _____ months. a. 2 to 3 b. 3 to 6 c. 6 to 9 d. 9 to 12

ANS: A The posterior fontanelle closes between 2 and 3 months of age.

The parent of a 3-month-old infant asks the nurse, "At what age do infants usually begin drinking from a cup?" The nurse would reply: a. 5 months. b. 9 months. c. 1 year. d. 2 years.

ANS: A The infant can usually drink from a cup when it is offered at about 5 months.

The parents of a newborn state, "We will probably not have our baby immunized because we are concerned about the risk of our child being injured." Which is the best response for the nurse to make? *a.* "It is your decision." *b.* "Have you talked with your parents about this? They can probably help you think about this decision." *c.* "The risks of not immunizing your baby are greater than the risks from the immunizations." *d.* "You are making a mistake."

*c.* "The risks of not immunizing your baby are greater than the risks from the immunizations." (Although immunizations have been documented to have a negative effect in a small number of cases, an unimmunized infant is at greater risk for development of complications from childhood diseases than from the vaccines. It is the parents' decision not to immunize the child; however, the nurse has a responsibility to inform parents about the risks to infants who are not immunized. Grandparents can be supportive but are not the primary decision makers for the infant. Telling parents that they are making a mistake is an inappropriate response.)

At ____ months of age, an infant should first be expected to locate an object hidden from view. *a.* 4. *b.* 6. *c.* 9. *d.* 20.

*c.* 9. (By 9 months of age an infant will actively search for an object that is out of sight. 4-month-old infants are not cognitively capable of searching out objects hidden from their view. Infants at this developmental level do not pursue hidden objects. 6-month-old infants have not developed the ability to perceive objects as permanent and do not search out objects hidden from their view. 20-month-old infants actively pursue objects not in their view and are capable of recalling the location of an object not in their view. They "first" look for hidden objects around the age of 9 months.)

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

ANS: A Because object permanence is a new achievement, peek-a-boo is an excellent activity to practice this new skill for visual stimulation. Pat-a-cake and showing how to clap hands will help with kinetic stimulation. Imitating animal sounds will help with auditory stimulation. DIF: Cognitive Level: Apply REF: p. 314 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse observes a 10-month-old infant using her index finger and thumb to pick up pieces of cereal. This behavior is evidence that the infant has developed: a. the pincer grasp. b. a grasp reflex. c. prehension ability. d. the parachute reflex.

ANS: A By 1 year, the pincer-grasp coordination of index finger and thumb is well established.

A clinic nurse assesses the communication patterns of a 5-month-old infant. The nurse determines that the infant is demonstrating the highest level of developmental achievement expected if the infant: A) Uses simple words such as "mama" B) Uses monosyllabic babbling C) Links syllables together D) Coos when comforted

B. Using monosyllabic babbling occurs between 3 and 6 months of age. Using simple words such as "mama" occurs between 9 and 12 months. Linking syllables together when communicating occurs between 6 and 9 months. Cooing begins at birth and continues until 2 months.

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. What should the nurse recommend? a. Never heat a bottle in a microwave oven. b. Heat only 10 ounces or more. c. Always leave bottle top uncovered to allow heat to escape. d. Shake bottle vigorously for at least 30 seconds after heating.

ANS: A Bottles cannot be heated safely in microwave ovens even if safe guidelines are followed and regardless of the amount to be heated due to uneven heating and possible burns. DIF: Cognitive Level: Apply REF: p. 319 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

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 crude pincer grasp. c. Hold crayon and make a mark on paper. d. Release cubes into a cup.

ANS: A By age 7 months infants can transfer objects from one hand to the other, crossing the midline. The crude pincer grasp is apparent at about age 9 months. The child can scribble spontaneously at age 15 months. At age 12 months the child can release cubes into a cup.

A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. How should the nurse interpret this action? a. Normal development b. Significant developmental lag c. Slightly delayed development due to prematurity d. Suggestive of a neurologic disorder such as cerebral palsy

ANS: A Holding a rattle but not voluntarily grasping it is indicative of normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. The infant is expected to be able to perform this task by age 3 months. If the child's age is corrected because of being 2 weeks preterm, the child is at the midpoint of the range for this developmental task and the behavior is age appropriate. No evidence of neurologic dysfunction is present. DIF: Cognitive Level: Apply REF: p. 306 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse is aware that the earliest age at which an infant is able to sit steadily alone is _____ months. a. 4 b. 5 c. 8 d. 15

ANS: C The infant can sit alone without support at about 8 months of age.

The parents of a 12-month-old child ask the nurse whether the child can eat hot dogs. The nurse's reply should be based on which statement? a. Child is too young to digest hot dogs. b. 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.

ANS: D Hot dogs are of a consistency, diameter, and round shape that may cause complete obstruction of the child's airway. If given to young children, the hot dog should be cut into small irregular pieces rather than served whole or in slices. The child's digestive system is mature enough to digest hot dogs. To eat the hot dog safely, the child should be sitting down, and the hot dog should be appropriately cut. DIF: Cognitive Level: Apply REF: p. 325 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Safe and Effective Care Environment: Safety and Infection Control (Injury Prevention)

At a well-baby visit, parents of a 6-month-old infant ask when to take the infant for the first dental visit. What is the nurse's best response? a. "If the teeth are brushed regularly, the child should see a dentist by 3 years of age." b. "The first dental visit should be arranged after the first tooth erupts." c. "The child should have a dental examination when all deciduous teeth have erupted." d. "A dental visit by 1 year of age is recommended by the American Academy of Pediatric Dentistry."

ANS: D The Academy of Pediatric Dentistry recommends that the first dental visit occur by 1 year of age.

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 infant's stools. The nurse's explanation of this is based on which statement? a. Child should not be given fibrous foods until digestive tract matures at age 4 years. b. Child 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.

ANS: D The immaturity of the digestive tract is evident in the appearance of the stools. Solid foods are passed incompletely broken down in the feces. An excess quantity of fiber predisposes the child to large, bulky stools. This is normal for the child and is a normal part of the maturational process; no further investigation is necessary. DIF: Cognitive Level: Apply REF: p. 306 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. What knowledge should the nurse's response should be based? a. Unacceptable because of the risk of sudden infant deat syndrome (SIDS) b. Unacceptable because it does not encourage achievement of developmental milestones c. Acceptable to encourage fine motor development d. Acceptable to encourage head control and turning over

ANS: D These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs and then be placed on their abdomens when awake to enhance development of milestones such as head control. The face-down position while awake and on the back for sleep are acceptable because they reduce risk of SIDS and allow achievement of developmental milestones. These position changes encourage gross motor, not fine motor, development. DIF: Cognitive Level: Analyze REF: p. 306 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

A nurse is assessing a 6-month-old infant. The nurse recognizes the posterior fontanel usually closes at which age? a. 6 to 8 weeks b. 10 to 12 weeks c. 4 to 6 months d. 8 to 10 months

ANS: A The bones surrounding the posterior fontanel fuse and close by age 6 to 8 weeks; 10 to 12 weeks, 4 to 6 months, and 8 to 10 months are too late. The posterior fontanel is usually closed by age 8 weeks. DIF: Cognitive Level: Remember REF: p. 301 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Which statement by a mother indicates that her 5-month-old infant is ready for solid food? *a.* "When I give my baby solid foods, she has difficulty getting it to the back of her throat to swallow." *b.* "She has just started to sit up without any support." *c.* "I am surprised that she only weighs 11 pounds. I expected her to have gained some weight." *d.* "I find that she really has to be encouraged to eat."

*b.* "She has just started to sit up without any support." (Sitting is a sign that the child is ready to begin with solid foods. Children who are ready to manage solid foods are able to move food to the back of their throats to swallow. Infants who weigh less than 13 pounds and demonstrate a lack of interest in eating are not ready to be started on solid foods. Infants who are difficult feeders and do not demonstrate an interest in sold foods are not ready to be started on them.)

A 6-month-old infant is admitted to the pediatric unit with a diagnosis of failure to thrive. The birthweight was 7 lb. Judging from growth and development charts, how many pounds does the nurse conclude that the infant should weigh? 1. 12 2. 14 3. 18 4. 22

2. 14 The average infant has doubled the birthweight at 6 months. Twelve pounds is too low; it may confirm a diagnosis of failure to thrive. Eighteen pounds is too high. Twenty-two pounds is too high; the average infant has tripled the birthweight at 1 year of age.

While assessing an infant, the nurse strokes the infant's cheek and the infant turns toward the nurse while making sucking sounds. What reflex did the nurse elicit? 1. Moro reflex 2. Rooting reflex 3. Babinski reflex 4. Tonic neck reflex

2. Rooting reflex The rooting reflex can be elicited by stroking an infant's cheek. In response, the infant turns toward the stimulated side and begins to suck. When eliciting the Moro reflex, the infant forms a C shape with thumb and index fingers while flexing the extremities in response to a jarring stimulus. The Babinksi reflex can be elicited by stroking from the heel upward to the toes. In response, the infant will hyperextend the toes. During elicitation of tonic neck reflex, the nurse turns the infant's head to one side. In response, the arm and leg flex in the direction of the infant's gaze and the opposite arm and leg extend.

Approximately what should a newborn weight at 1 year of age if the newborn's birth weight was 7 pounds 6 ounces? *a.* 14 3/4 pounds. *b.* 22 1/8 pounds. *c.* 29 1/2 pounds. *d.* Unable to estimate weight at 1 year.

*b.* 22 1/8 pounds. (An infant triples the birth weight by 1 year of age. An infant doubles the birth weight by 6 months of age. An infant quadruples the birth weight by 2 years of age. Weight at 6 months, 1 year, and 2 years of age can be estimated from birth weight.)

Which is a priority in counseling parents of a 6-month-old infant? *a.* Increased appetite from secondary growth spurt. *b.* Allowing the infant to self-feed. *c.* Securing a developmentally safe environment for the infant. *d.* Strategies to teach infants to sit up.

*c.* Securing a developmentally safe environment for the infant. (Safety is a primary concern as an infant becomes increasingly mobile. The infant's appetite and growth velocity decrease in the second half of infancy. Fine motor development, which is refined in the second half of infancy, is necessary before the infant can self-feed. Unless the infant has a neuromuscular deficit, strategies for teaching a normally developing infant to sit up are not necessary.)

The mother of a 10-month-old infant asks the nurse about beginning to wean her child from the bottle. Which statement by the mother suggests that the child is not ready to be weaned? *a.* "My son is frequently throwing his bottle down." *b.* "The baby takes a few ounces of formula from the bottle." *c.* "He is constantly chewing on the nipple. It concerns me." *d.* "He is consistently sucking."

*d.* "He is consistently sucking." (Consistent sucking is a sign that the child is not ready to be weaned. A decreased interest in the bottle starts between 6 and 12 months. Throwing the bottle down is a sign of decreased interest in the bottle. When the child is taking more fluids from a cup and decreasing amounts from the bottle, the child is demonstrating a readiness for weaning. Chewing on the nipple is another sign that the infant is ready to be weaned.)

The mother of a 9-month-old infant is concerned because the infant cries when she leaves him. Which is the best response for the nurse to make to the mother? *a.* "You could consider leaving the infant more often so he can adjust." *b.* "You might consider taking him to the doctor because he may be ill." *c.* "Have you noticed whether the baby is teething?" *d.* "This can be a healthy sign of attachment."

*d.* "This can be a healthy sign of attachment." (Healthy attachment is manifested by stranger anxiety in the late infancy. An infant who manifests stranger anxiety can be supported by the mother leaving the infant for only short periods of time. Assessing developmental needs is appropriate before taking an infant to a physician. Pain from teething expressed by the infant's cries would not occur only when the mother left the room.)

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.* "We will put plastic fillers in all electrical plugs." *c.* "We will place a gate at the top and bottom of stairways." *e.* "We will remove front knobs from the stove." (By the time babies reach 6 months of age, they begin to become much more active, curious, and mobile. Putting plastic filters on all electrical plugs can prevent an electrical shock. Putting gates at the top and bottom of stairways will prevent falls. Removing front knobs from the stove can prevent burns. Poisonous substances should be stored in a locked cabinet not in a cabinet that children can reach when they begin to climb. The household hot water heater should be turned down to 120 degrees or less.)

At a healthy 2-month-old infant's well-child clinic visit, the nurse should give which immunizations? *a.* DTaP, IPV, HepB, Hib, PCV, rotavirus. *b.* MMR, DTaP, PVC, and IPV. *c.* Hib, DTaP, rotavirus, and OPV. *d.* Hib and MMR, IPV, and rotavirus.

*a.* DTaP, IPV, HepB, Hib, PCV, rotavirus. (DTaP, IPV, HepB, Hib, PCV, and rotavirus are the appropriate sequence of immunizations for a healthy 2-month-old infant. MMR is given at or after 12 months of age. Oral polio vaccine (OPV) is no longer administered in the U.S.)

The mother of a 10-month-old infant tells the nurse that her infant "really likes cow's milk." Which is the best response to this mother? *a.* "Milk is good for him." *b.* "It is best to wait until he is a year old before giving him cow's milk." *c.* "Limit cow's milk to his bedtime bottle." *d.* "Mix his cereal with cow's milk and give him formula in a bottle."

*b.* "It is best to wait until he is a year old before giving him cow's milk." (It is best to wait until the infant is at least a year old before giving him cow's milk because of the risk of allergies and intestinal problems. Cow's milk protein intolerance is the most common food allergy during infancy. Although milk is a good source of calcium and protein for children after the first year of life, it is not the best source of calcium and protein for children after the first year of life, it is not the best source of nutrients for children younger than 1 year old. Bedtime bottles of formula or milk are contraindicated because of their high sugar content, which leads to dental decay in primary teeth. Cereal can be mixed with formula.)

Place in order the expected sequence of fine motor developmental milestones for an infant beginning with the first milestone achieved and ending with the last milestone achieved. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d, e). a. Voluntary palmar grasp b. Reflex palmar grasp c. Puts objects into a container d. Neat pincer grasp e. Builds a tower of two blocks, but fails

ANS: b, a, d, c, e Grasping occurs during the first 2 to 3 months as a reflex and gradually becomes voluntary. By 5 months, infants are able to voluntarily grasp objects. Gradually, the palmar grasp (using the whole hand) is replaced by a pincer grasp (using the thumb and index finger). By 8 to 10 months of age, infants use a crude pincer grasp, and by 11 months, they have progressed to a neat pincer grasp. By 11 months, they put objects into containers and like to remove them. By age 1 year, infants try to build towers of two blocks but fail. DIF: Cognitive Level: Analyze REF: p. 307 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Health Promotion and Maintenance

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.

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

Which is appropriate play for a 6-month-old infant? *a.* Pat-a-cake, peek-a-boo. *b.* Ball rolling, hid and seek game. *c.* Bright rattles and tactile toys. *d.* Push and pull toys.

*a.* Pat-a-cake, peek-a-boo. (6-month-old children enjoy playing pat-a-cake and peek-a-boo. 9-month-old infants enjoy rolling a ball and playing hide and seek games. 4-month-old infants enjoy bright rattles and tactile toys. 12-month-old infants enjoy playing with push and pull toys.)

During a well-baby clinic visit, the nurse finds that a 1-year-old infant says "ma" and "pa." The infant does not say anything else and uses gestures to communicate. What should the nurse infer from this finding? 1. The infant needs to spend more time with peers. 2. The infant exhibits normal language development. 3. The infant needs a consultation with the pediatrician. 4. The infant may have impaired cognitive development.

2. The infant exhibits normal language development. Infants usually use very few words to convey their needs, and rely mostly on gestures. Therefore, the infant has normal language development. The infant may enjoy spending time with peers, but it may not help in furthering language development. As the infant has normal growth and development, the infant does not need a consultation with the pediatrician. The normal language development indicates that the infant does not have cognitive impairment.

The nurse knows that an infant's birth weight should be tripled by: a. 9 months. b. 1 year. c. 18 months. d. 2 years.

ANS: B The infant usually triples his or her birth weight by about 12 months of age.

A parent brings a 6-month-old infant to the pediatric clinic for her well-baby examination. Her birth weight was 8 pounds, 2 ounces. The nurse weighing the infant today would expect her weight to be at least _____ pounds. a. 12 b. 16 c. 20 d. 24

ANS: B Birth weight is usually doubled by 6 months of age.

The nurse discusses child-proofing the home for safety with the mother of a 9-month-old. The statement made by the mother that indicates an unsafe behavior is: a. "I put covers on all of the electrical outlets." b. "In the car, she rides in a front-facing car seat." c. "There are locks on all of the cabinets in the house." d. "I have a gate at the top and bottom of the stairs."

ANS: B A rear-facing infant car seat should be used for infants younger than 1 year of age.

The clinic is lending a federally approved car seat to an infant's 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 with air bag on passenger side. d. rear facing in front seat if an air bag is on the passenger side.

ANS: B The rear-facing car seat provides the best protection for an infant's disproportionately heavy head and weak neck. The middle of the back seat is the safest position for the child. The infant must be rear facing to protect the head and neck in the event of an accident. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat. DIF: Cognitive Level: Understand REF: p. 325 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Safe and Effective Care Environment

A nurse is teaching a parent about introduction of solid foods into an infant's diet. Which should the nurse include in the teaching session? (Select all that apply.) a. Solid food introduction can be started at 2 months of age. b. Rice cereal is introduced first. c. Begin the introduction of solid foods by mixing with formula in the bottle. d. Introduce egg white in small quantities (1 tsp) toward the end of the first year. e. Introduce one food at a time, usually at intervals of 4 to 7 days.

ANS: B, D, E Rice cereal, because of its low allergenic potential, is the first solid food introduced to an infant at 4 to 6 months of age. Introduce one food at a time, usually at intervals of 4 to 7 days, to identify food allergies. Introduce egg white in small quantities (1 tsp) toward the end of the first year to detect an allergy. Solid food introduction should be started at 4 to 6 months of age. Never introduce foods by mixing them with the formula in a bottle. DIF: Cognitive Level: Apply REF: p. 319 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

The mother of a 7-month-old infant reports that the first lower central incisor has erupted. She asks the nurse, "How many teeth will he have by his first birthday?" The nurse explains that the infant will have how many teeth by 1 year of age? a. 2 b. 4 c. 6 d. 8

ANS: C The 1-year-old infant usually has about 6 teeth, 4 above and 2 below.

When assessing development in a 9-month-old infant, the nurse would expect to observe the infant: a. speaking in 2-word sentences. b. grasping objects with palmar grasp. c. creeping along the floor. d. beginning to use a spoon rather sloppily.

ANS: C The 9-month-old tries to creep, has developed pincer movement, and can grasp a spoon without keeping food on it.

The nurse advises the mother of a 3-month-old infant, exclusively breast-fed, to: *a.* start giving the infant a vitamin D-supplement. *b.* start using an infant feeder and add rice cereal to the formula. *c.* start feeding the infant rice cereal with a spoon at the evening feeding. *d.* continue breast-feeding without any supplements.

*a.* start giving the infant a vitamin D-supplement. (Breast mild does not provide an adequate amount of dietary vitamin D. Infants who are exclusively breast-fed need vitamin D supplements to prevent rickets. An infant feeder is an inappropriate method of providing the infant with caloric intake. Solid foods and rice cereal are not recommended for a 3-month-old infant. Solid feedings do not typically begin before 4 to 6 months of age. Because breast milk is not an adequate source of fluoride, infants need to be given a fluoride supplement.)

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 how many pounds? a. 10 b. 15 c. 20 d. 25

ANS: B Birth weight doubles at about age 5 to 6 months. At 6 months, a child who weighed 7 pounds at birth would weigh approximately 15 pounds; 10 pounds is too little. The infant would have gone from the 50th percentile at birth to below the 5th percentile; 20 to 25 pounds is too much. The infant would have tripled the birth weight at 6 months. DIF: Cognitive Level: Understand REF: p. 301 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

Which statement made by a parent would be consistent with a developmental delay? *a.* "I have noticed that my 9-month-old responds consistently to the sound of his name." *b.* "I have noticed that my 12-month-old does not get herself to a sitting position or pull to stand." *c.* "I am so happy when my 11/2-month-old infant smiles at me." *d.* "My 5-month-old infant is not rolling over in both directions yet."

*b.* "I have noticed that my 12-month-old does not get herself to a sitting position or pull to stand." (Critical developmental milestones for gross motor development in a 12-month-old include standing briefly without support, getting to a sitting position, and pulling to stand. If a 12-month-old child does not perform these activities, it may be indicative of a developmental delay. An infant who responds to his name at 9 months of age is demonstrating abilities to both hear and interpret sound. A social smile is present by 2 months of age. Rolling over in both directions is not a critical milestone for gross motor development until the child reaches 6 months of age.")

A 4-month-old was born at 35 weeks of 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. What should the nurse's explanation include? 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. The infant's behavior is suggestive of failure to bond completely with her parents. d. The infant's difficult temperament is the result of painful experiences in the neonatal period.

ANS: A Infant temperament has a strong biologic component. Together with interactions with the environment, primarily the family, the biologic component contributes to the infant's unique temperament. Children perceived as difficult may respond better to scheduled feedings and structured caregiving routines than to demand feedings and frequent changes in routines. The infant's temperament has been created by both biologic and environmental factors. The nurse should provide guidance in parenting techniques that are best suited to the infant's temperament. DIF: Cognitive Level: Understand REF: p. 314 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

In terms of gross motor development, which should 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. f. Adjust posture to reach an object.

ANS: A, B Rolling from abdomen and to back and placing the feet in the mouth when supine are developmentally appropriate for a 5-month-old infant. The ability to roll from back to abdomen usually occurs at 6 months old. Sitting erect without support is a developmental milestone usually achieved by 8 months. The 10-month-old infant can usually move from a prone to a sitting position. The 8-month-old infant adjusts posture to reach an object. DIF: Cognitive Level: Apply REF: p. 308 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse is discussing development and play activities with the parent of a 2-month-old. Recommendations should include giving a first rattle at about which age? a. 2 months b. 4 months c. 7 months d. 9 months

ANS: B It is recommended that a brightly colored toy or rattle be given to the child at age 4 months. Grasping has begun as a deliberate act, and the infant grasps, holds, and begins shaking to hear a noise; 2 months is too young. The infant still has primarily reflex grips; 7 to 9 months is too old for the first rattle. The child should be given toys that provide for further exploration. DIF: Cognitive Level: Apply REF: p. 314 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

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

ANS: B Most infants can pull themselves to a standing position at age 9 months. Infants who are notable to pull themselves to standing by age 11 to 12 months should be further evaluated for developmental dysplasia of the hip. At 6 months, infants have just obtained coordination of armsand legs. By age 8 months, infants can bear full weight on their legs. Any infant who cannot pullto a standing position by age 1 year should be referred for further evaluation.DIF_ Cognitive Level_ Understand REF_ p. 306TOP_ Integrated Process_ Nursing Process_ AssessmentMSC_ Area of Client Needs_ Health Promotion and Maintenance

Which information should the nurse give a mother regarding the introduction of solid foods during infancy? a. Solid foods should not be introduced until 8 to 10 months, when the extrusion reflex begins to disappear. b. Foods should be introduced one at a time, at intervals of 4 to 7 days. c. Solid foods can be mixed in a bottle to make the transition easier for the infant. d. Fruits and vegetables should be introduced into the diet first.

ANS: B One food item is introduced at intervals of 4 to 7 days to allow the identification of food allergies. Solid foods can be introduced earlier than 8 to 10 months. The extrusion reflex usually disappears by age 6 months. Mixing solid foods in a bottle has no effect on the transition to solid food. Iron-fortified cereal should be the first solid food introduced into the infant's diet. DIF: Cognitive Level: Apply REF: p. 319 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

What is the best age for solid food to be introduced into the infant's diet? a. 2 to 3 months b. 4 to 6 months c. When birth weight has tripled d. When tooth eruption has started

ANS: B Physiologically and developmentally, the 4- to 6-month-old infant is in a transition period. The extrusion reflex has disappeared, and swallowing is a more coordinated process. In addition, the gastrointestinal tract has matured sufficiently to handle more complex nutrients and is less sensitive to potentially allergenic food. Infants of this age will try to help during feeding; 2 to 3 months is too young. The extrusion reflex is strong, and the child will push food out with the tongue. Infant birth weight triples at 1 year. Solid foods can be started earlier. Tooth eruption can facilitate biting and chewing; most infant foods do not require this ability. DIF: Cognitive Level: Understand REF: p. 319 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse would expect a 4-month-old to be able to: a. hold a cup. b. stand with assistance. c. lift head and shoulders. d. sit with back straight.

ANS: C Because development is cephalocaudal, of these choices, lifting the head and shoulders is the one that the infant learns to do first. The infant can usually sit with support at about 5 months of age and can sit alone at about 8 months.

The mother of a 7-month-old infant states, "The baby is eating food now. Should I give him regular milk, too?" What is the nurse's best response? a. "You should give the baby low-fat milk." b. "Try the milk. See if he has any digestive problems." c. "Continue breast milk or iron-fortified formula until 1 year of age." d. "At this age, infants can tolerate lactose-free or soy-based milk."

ANS: C Whole milk should not be introduced before 1 year of age. Low-fat milk should not be introduced before 2 years of age.

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

ANS: C Infants are usually in the secondary circular reaction stage from ages 4 to 8 months. This stage is characterized by a continuation of the primary circular reaction for the response that results. Shaking is performed to hear the noise of the rattle, not just for shaking. The use of reflexes is primarily during the first month of life. Primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from ages 1 to 4 months. The fourth sensorimotor stage is coordination of secondary schemata. This is a transitional stage in which increasing motor skills enable greater exploration of the environment. DIF: Cognitive Level: Remember REF: p. 310 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

At what age can most infants sit steadily unsupported? a. 4 months b. 6 months c. 8 months d. 10 months

ANS: C Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months, an infant can sit with support. At age 6 months, the infant will maintain a sitting position if propped. By 10 months, the infant can maneuver from a prone to a sitting position. DIF: Cognitive Level: Understand REF: p. 306 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

A mother calls the pediatrician's office because her infant is "colicky." The helpful measure the nurse would suggest to the parent is to: a. sing songs to the infant in a soft voice. b. place the infant in a well-lit room. c. walk around and massage the infant's back. d. rock the fussy infant slowly and gently.

ANS: D One technique the nurse can offer parents of a fussy infant is to rock the infant gently and slowly while being careful to avoid sudden movements.

What type of development is the nurse assessing when an infant can lift his or her head before he or she can sit? a. Specific to general b. Proximodistal c. Cephalocaudal d. General to specific

ANS: C Cephalocaudal development proceeds from head to toe.

A parent asks the nurse "at what age do most infants begin to fear strangers?" The nurse should give which response? a. 2 months b. 4 months c. 6 months d. 12 months

ANS: C Between ages 6 and 8 months, fear of strangers and stranger anxiety become prominent and are related to the infant's ability to discriminate between familiar and unfamiliar people. At 2 months, infants are just beginning to respond differentially to the mother. At age 4 months, the infant is beginning the process of separation-individuation when the infant begins to recognize self and mother as separate beings. Twelve months is too late and requires referral for evaluation if the child does not fear strangers at this age. DIF: Cognitive Level: Understand REF: p. 313 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

Most infants begin to fear strangers at age: a. 2 months b. 4 months c. 6 months d. 12 months

ANS: C Between ages 6 and 8 months fear of strangers and stranger anxiety become prominent and are related to the infant's ability to discriminate between familiar and nonfamiliar people. At age 2 months infants are just beginning to respond differentially to the mother. At age 4 months the infant is beginning the process of separation individuation when the infant begins to recognize self and mother as separate beings. Twelve months is too late and requires referral for evaluation if the child does not fear strangers at this age.

A mother of a 2-month-old infant tells the nurse, "My child doesn't sleep as much as his older brother did at the same age." What is the best response for the nurse? *a.* "Have you tried to feed the baby more often?" *b.* "Infant sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time." *c.* "It is helpful to keep a record of your baby's eating, waking, sleeping, and elimination patterns and to come back in a week to discuss them." *d.* "This infant is difficult. It is important for you to identify what is bothering the baby."

*b.* "Infant sleep patterns very widely, with some infants sleeping only 2 to 3 hours at a time." (Newborn infants may sleep as much as 17 to 20 hours per day. Sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time. Infants typically do not need more caloric intake to improve sleep behaviors. Keeping intake, output, waking, and sleeping data is not typically helpful in discussing differences among infants' behaviors. Identifying an infant as difficult without identifying helpful actions is not a therapeutic response for a parent concerned about sleep.)

Which information could be given to the parents of a 12-month-old child regarding appropriate play activities? a. Give large push-pull toys for kinetic 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.

ANS: A The 12-month-old child is able to pull to standing and walk holding on or independently. Appropriate toys for a child this age include large pull toys for kinesthetic stimulation. A cradle gym should not be placed across the crib. Finger paints are appropriate for older children. A 12- month-old child does not have the stability to use a stick horse. DIF: Cognitive Level: Apply REF: p. 314 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development