Carman Essentials of Pediatric Nursing 3rd Ed - Ch. 3 Growth and Development of the Newborn and Infant

The mother of 1-week-old boy voices concerns about her baby's weight loss since birth. At birth the baby weighed 7 lb (3.2 kg); the baby currently weighs 6 lb 1 oz (2.8 kg). Which response by the nurse is most appropriate? a. "All babies lose a substantial amount of weight after birth." b. "Your baby has lost too much weight and may need to be hospitalized." c. "Your baby's weight loss is well within the expected range." d. "Your baby has lost a bit more than the normal amount."

Answer: d The normal newborn may lose up to 10% of their birth weight. The baby in question has lost just below this amount. This will likely not require hospitalization. Expressing to the mother that her baby will likely be hospitalized is rash and will most likely not occur.

The nurse is providing helpful feeding tips to the mother of a 2-week-old boy. Which recommendations will best help the child feed effectively? a. Maintain a feed-on-demand approach b. Apply warm compresses to the breast c. Encourage the infant to latch on properly d. Maintain adequate diet and fluid intake

Answer: a The best way to ensure effective feeding is by maintaining a feed-on-demand approach rather than a set schedule. Applying warm compresses to the breast helps engorgement. Encouraging the infant to latch on properly helps prevent sore nipples. Maintaining proper diet and fluid intake for the mother helps ensure an adequate milk supply.

The nurse is teaching the parents of a 6-month-old boy about proper child dental care. Which action will the nurse indicate as the most likely to cause dental caries? a. Not cleaning a baby's gums when he is done eating b. Putting the baby to bed with a bottle of milk or juice c. Using a cloth instead of a brush for cleaning teeth d. Failing to clean the teeth with fluoridated toothpaste

Answer: b The nurse will warn against putting the baby to bed with a bottle of milk or juice because this allows the sugar content of these fluids to pool around the baby's teeth at night. Not cleaning a baby's gums when he is done eating will have minimal impact on the development of dental caries, as will using a cloth instead of a brush for cleaning teeth when they erupt. Failure to clean the teeth with fluoridated toothpaste is not a problem if the water supply is fluoridated.

The nurse is educating the mother of a 6-month-old boy about the symptoms for teething. Which symptom would the nurse identify? a. Running a mild fever or vomiting b. Choosing soft foods over hard foods c. Increased biting and sucking d. Frequent loose stools

Answer: c The nurse would advise the mother to watch for increased biting and sucking. Mild fever, vomiting, and diarrhea are signs of infection. The child would more likely seek out hard foods or objects to bite on.

The nurse is assessing the oral cavity of a 4-month-old infant. Which finding is consistent with a child of this age? a. 1 to 3 natal teeth b. No teeth c. 1 to 2 lower teeth d. 1 upper tooth

Answer: b Normally infants are not born with teeth. Occasionally there are one or more teeth at birth. These are termed natal teeth and are often associated with anomalies. The first primary teeth typically erupt between the ages of 6 and 8 months.

The nurse is assessing an infant at his 4-month well-baby check-up. The nurse notes that at birth the baby weighed 8 lb (3.6 kg) and was 20 in (50.8 cm) in length. Which finding is most consistent with the normal infant growth and development? a. The baby weighs 21 lb (9.5 kg) and is 30 in (76.2 cm) in length b. The baby weighs 16 lb (7.3 kg) and is 26 in (66.0 cm) in length c. The baby weighs 15 lb (6.8 kg) and is 24 in (61.0 cm) in length d. The baby weighs 24 lb (10.9 kg) and is 26 in (66.0 cm) in length

Answer: b The average infant's weight doubles at 4 months and will triple at 1 year of life. The infant's length will increase by 50% by the first year.

The nurse is caring for the family with a 2-month-old boy with colic. The mother reports feeling very stressed by the baby's constant crying. Which intervention would provide the most help in the short term? a. Urging the baby's mother to take time for herself away from the child b. Educating the parents about when colic stops c. Assessing the parents' care and feeding skills d. Watching how the parents respond to the child

Answer: a Urging the parents to get time away from the child would be most helpful in the short term, particularly if the parents are stressed. Educating the parents about when colic stops would help them see an end to the stress. Observing how the parents respond to the child helps to determine if the parent-child relationship was altered. Assessing the parents' care and feeding skills may identify other causes for the crying.

The nurse is examining a 6-month-old girl who was born 8 weeks early. Which finding is cause for concern? a. The child measures 21 in (53 cm) in length b. The child exhibits palmar grasp reflex c. Head size has increased 5 in (12 cm) since birth d. The child weighs 10 lb 2 oz (4.6 kg)

Answer: c The child's head size is large for his adjusted age of 4 months, which would be cause for concern. Normal growth would be 3.6 in (9 cm). At 10 lb, 2 oz (12 cm), the child is the right weight for a 4-month-old adjusted age. Palmar grasp reflex disappears between 4 and 6 months adjusted age, so this would not be a concern yet. The child is of average weight for a 4-month-old adjusted age.

The mother of a 1-month-old infant voices concern about her baby's respirations. She states they are rapid and irregular. Which information should the nurse provide? a. The normal respiratory rate for an infant at this age is between 20 and 30 breaths per minute. b. The respirations of a 1-month-old infant are normally irregular and periodically pause. c. An infant at this age should have regular respirations. d. The irregularity of the infant's respirations are concerning; I will notify the physician.

Answer: b The normal respiratory rate for a 1-month-old infant is 30 to 60 breaths per minute. By 1 year of age the rate will be 20 to 30 breaths per minute. The respiratory patterns of the 1-month-old infant are irregular. There may normally be periodic pauses in the rhythm.

The nurse is observing a 6-month-old boy for developmental progress. For which typical milestone should the nurse look? a. Shifts a toy to his left hand and reaches for another b. Picks up an object using his thumb and finger tips c. Puts down a little ball to pick up a stuffed toy d. Enjoys hitting a plastic bowl with a large spoon

Answer: c At 6 months of age, the child is able to put down one toy to pick up another. He will be able to shift a toy to his left hand to reach for another with his right hand by 7 months. He will pick up an object with his thumb and finger tips at 8 months, and he will enjoy hitting a plastic bowl with a large spoon at 9 months.

The nurse is teaching healthy eating habits to the parents of a 7-month-old girl. Which recommendation is the most valuable advice? a. Let the child eat only the foods she prefers b. Actively urge the child to eat new foods c. Provide small portions that must be eaten d. Serve new foods several times

Answer: d When introducing a new food to an infant, it may take multiple attempts before the child will accept it. Parents must demonstrate patience. Letting the child eat only the foods she prefers, forcing her to eat foods she does not want, or actively urging the child to eat new foods can negatively affect eating patterns.

The nurse is assessing the sleeping practices of the parents of a 4-month-old girl who wakes repeatedly during the night. Which parent comment might reveal a cause for the night waking? a. They sing to her before she goes to sleep b. They put her to bed when she falls asleep c. If she is safe, they lie her down and leave d. The child has a regular, scheduled bedtime

Answer: b If the parents are keeping the child up until she falls asleep, they are not creating a bedtime routine for her. Infants need a transition to sleep at this age. If the parents are singing to her before she goes to bed, if she has a regular, scheduled bedtime, and if they check on her safety when she wakes at night, then lie her down and leave, they are using good sleep practices.

The nurse is educating the mother of a newborn about feeding practices. The nurse correctly advises the mother: a. the best feeding schedule offers food every 4 to 6 hours. b. most newborns need to eat about four times per day. c. the newborn's stomach can hold between one-half to one ounce. d. demand scheduled feeding is associated with increased difficulty getting the baby to sleep through the night

Answer: c The capacity of the normal newborn's stomach is between 1½ and 1 oz. The recommended feeding plan is to use a demand schedule. Newborns may eat as often as 1½ to 3 hours. Demand scheduled feedings are not associated with problems sleeping at night.