Development: Abnormal Development Practice Questions

During a developmental screening, the nurse finds that a 3-year-old child with cerebral palsy has arrested social and language development. The nurse tells the family: 1."This is a sign the cerebral palsy is progressing." 2."Your child has reached his maximum language abilities." 3."I need to refer you for more developmental testing." 4."We need to modify your therapy plan."

"3. It is important to identify primary developmental delays in children with cerebral palsy and to prevent secondary and tertiary delays. The arrested development is worrisome and requires further investigation. It is possible the lack of development indicates hearing loss or may be a sign of autism. The brain damage caused by cerebral palsy is not progressive. The brain of a young child is quite plastic; assuming the child's development has peaked at age 3 would be a serious mistake. The therapy plan will need to be modified, but a better understanding of the underlying problem will lead to the greatest chance of creating a successful therapy plan.

On the second postoperative day after repair of a cleft palate, which of the following should the nurse use to feed a toddler? 1.Cup. 2.Straw. 3.Rubber-tipped syringe. 4.Large-holed nipple.

1 A cup is the preferred drinking or eating utensil after repair of a cleft palate. At the age when repair is done, the child is ordinarily able to drink from a cup. Use of a cup avoids having to place a utensil in the mouth, which would increase the potential for injury to the suture lines.

A child born with Down syndrome should be evaluated for which associated cardiac manifestation? 1. Congenital heart defect (CHD). 2. Systemic hypertension. 3. Hyperlipidemia. 4. Cardiomyopathy

1 1. CHD is found often in children with Down syndrome. 2. This is not associated with Down syndrome. 3. This is not associated with Down syndrome. 4. This is not associated with Down syndrome.

The parents of a 12-month-old with cerebral palsy (CP) ask the nurse if they should teach their child sign language because he has not begun to vocalize. The nurse bases the response on the knowledge that sign language: 1. May be a very beneficial way to help children with CP communicate. 2. May cause confusion and further delay vocalization. 3. Is difficult to learn for most children with CP. 4. Is beneficial to learn, but it would be best to wait until the child is older

1 1. Sign language may help the child with CP communicate and ultimately decrease frustration. Children with CP may have difficulty verbalizing because of weak tongue and jaw muscles. They may be able to have sufficient motor skills to communicate with their hands. 2. Sign language does not cause confusion and may help reinforce vocabulary and vocalization. 3. CP is manifested differently in all children; therefore, generalizations cannot be made. 4. The earlier sign language is taught, the more it will be beneficial. TEST-TAKING HINT: The test taker can immediately eliminate answer 3 because it makes a generalization. All forms of language are beneficial and well tolerated by children, especially young children.

The parents of a child with cerebral palsy (CP) are learning how to feed their child and avoid aspiration. The nurse would question which of the following when reviewing the teaching plan? 1. Place the food on the tip of the tongue. 2. Place the child in an upright position during feedings. 3. Feed the child soft and blended foods. 4. Feed the child slowly.

1 1. The food should be placed far back in the mouth to avoid tongue thrust. 2. The child should be placed in an upright position. 3. Soft and blended foods minimize the risk of aspiration. 4. Allowing the child time to feed minimizes the risk of aspiration. TEST-TAKING HINT: The test taker should consider which methods will decrease the risk of aspiration. Answers 2, 3, and 4 all decrease the risk of choking and should be eliminated.

Which child is at increased risk for cerebral palsy (CP)? 1. An infant born at 34 weeks with an Apgar score of 6 at 5 minutes. 2. A 17-day-old infant with group B Streptococcus meningitis. 3. A 24-month-old child who has experienced a febrile seizure. 4. A 5-year-old with a closed-head injury after falling off a bike.

1 1. There is an increased incidence of CP when the infant has an Apgar score of 3 or less at 5 minutes. 2. Any infection of the central nervous system increases the infants risk of CP. 3. A febrile seizure does not increase the risk of CP. 4. Although head trauma can increase the risk of CP, the school-age child is not likely to develop CP from falling off a bike. TEST-TAKING HINT: The test taker should consider the risks for CP. Answers 3 and 4 should be eliminated because these symptoms are least likely to lead to CP.

Which should be included in the plan of care for a 14-month-old whose cleft palate was repaired 12 hours ago? Select all that apply. 1. Allow the infant to have familiar items of comfort such as a favorite stuffed animal and a "sippy" cup. 2. Once liquids have been tolerated, encourage a bland diet such as soup, Jell-O, and saltine crackers. 3. Administer pain medication on a regular schedule, as opposed to an as-needed schedule. 4. Use a Yankauer suction catheter on the infant's mouth to decrease the risk of aspiration of oral secretions. 5. When discharged, remove elbow restraints.

1, 3. 1. The child should not be allowed to use anything that creates suction in the mouth, such as pacifiers or straws. "Sippy" cups are acceptable. 2. The child should not have anything hard in the mouth, such as crackers, cookies, or a spoon. 3. Pain medication should be administered regularly to avoid crying, which places stress on the suture line. 4. A Yankauer suction should not be used in the mouth because it creates suction and is a hard instrument that could irritate the suture line. The child should be positioned to allow secretions to drain out of the child's mouth. Suction should be used only in the event of an emergency. 5. Elbow restraints are used until the repaired palate has healed. When at home, the parents need to monitor the child closely if restraints are removed to move the arms or for bathing. TEST-TAKING HINT: The child who has had a cleft palate repair should have nothing in the mouth that could irritate the suture line. Answers 2 and 4 can be eliminated.

Which of the following measures would be most effective in helping the infant with a cleft lip and palate to retain oral feedings? 1.Burp the infant at frequent intervals. 2.Feed the infant small amounts at one time. 3.Place the end of the nipple far to the back of the infant's tongue. 4.Maintain the infant in a lying position while feeding.

1. An infant with a cleft lip and palate typically swallows large amounts of air while being fed and therefore should be burped frequently. The soft palate defect allows air to be drawn into the pharynx with each swallow of formula. The stomach becomes distended with air, and regurgitation, possibly with aspiration, is likely if the infant is not burped frequently. Feeding frequently, even in small amounts, would not prevent swallowing of large amounts of air. A nipple placed in the back of the mouth is likely to cause the infant to gag and aspirate. Holding the infant in a lying position during feedings can also lead to regurgitation and aspiration of formula. The infant should be fed in an upright position

A primiparous client who had a vaginal birth 1 hour ago voices anxiety because she has a nephew with Down syndrome. After teaching the client about Down syndrome, which of the following client statements indicates the need for additional teaching? 1."Down syndrome is an abnormality that can result from a missing chromosome." 2."Down syndrome usually results in some degree of mental retardation." 3."There are several methods available to determine whether my baby has Down syndrome." 4."Older mothers are more likely to have a baby with chromosomal abnormalities."

1. Down's syndrome is a genetic abnormality that is caused by an extra chromosome that results in mental retardation. The degree of mental retardation is difficult to predict in a neonate, although most children born with Down's syndrome have some degree of mental retardation. Various methods can be used to determine whether a neonate has Down's syndrome, which is commonly manifested by hypotonia, poor Moro reflex, flat facial profile, upslanting palpebral fissures, epicanthal folds, and hyperflexible joints. Genetic studies can be indicative of this disorder. Mothers older than 35 years of age are at a higher risk for having a child with Down's syndrome. However, chromosomal abnormalities can occur regardless of the mother's age."

The nurse assesses the family's ability to cope with the child's cerebral palsy. Which action should alert the nurse to the possibility of their inability to cope with the disease? 1.Limiting interaction with extended family and friends. 2.Learning measures to meet the child's physical needs. 3.Requesting teaching about cerebral palsy in general. 4.Seeking advice on coping on social media."

1. Limited interaction or lack of interaction with friends and family may lead the nurse to suspect a possible problem with the family's ability to cope with others' reactions and responses to a child with cerebral palsy. Learning measures to meet the child's physical needs demonstrates some understanding and acceptance of the disease. Requesting teaching about the disease suggests curiosity or a desire for understanding, thus demonstrating the family dealing with the situation. Participating in social media may serve as a form of support and can be a healthy coping mechanism."

After teaching the parents of a neonate born with a cleft lip and cleft palate about appropriate feeding techniques, the nurse determines that the mother needs further instruction when the mother says which of the following? 1."I should clean her mouth with soapy water after feeding." 2."I should feed her in an upright position." 3."I need to remember to burp her often." 4."I may need to use a special nipple for feeding.

1. After feeding, the mouth should be cleaned with sterile water, not soapy water, to reduce the risk for aspiration. The cleft lip should be cleaned with sterile water to prevent crusting before surgical repair. The neonate needs to be fed in an upright position to prevent aspiration. The neonate with a cleft lip and palate commonly swallows large amounts of air during feeding. Therefore, the neonate needs to be burped frequently to help eliminate the air and decrease the risk for regurgitation. The neonate with a cleft lip and palate should be fed with a special soft nipple that fills the cleft and facilitates sucking.

After teaching the parent of an infant who has had a surgical repair for a cleft lip about the use of elbow restraints at home, the nurse determines that the teaching has been successful when the parent states which of the following? 1."We will keep the restraints on continuously except when checking the skin under them for redness." 2."We will keep the restraints on during the day while he is awake, but take them off when we put him to bed at night." 3."After we get home, we won't have to use the restraints because our child does not suck on his hands or fingers." 4."We will be sure to keep the restraints on all the time until we come to see the primary care provider for a follow-up visit."

1. To keep the infant from disturbing the suture line by placing fingers or other objects in the mouth, either intentionally or accidentally, the restraints should be in place at all times. They should be removed for a short period, however, so that the underlying skin can be checked for any redness or breakdown. While the restraints are removed, the parents should be instructed to manually restrain the hands and arms.

The nurse prepares baclofen for a child with cerebral palsy (CP) who just had her hamstrings surgically released. The child's parents ask what the medication is for. Select the nurse's best response. 1. "It is a medication that will help decrease the pain from her surgery." 2. "It is a medication that will prevent her from having seizures." 3. "It is a medication that will help control her spasms." 4. "It is a medication that will help with bladder control."

1. Baclofen is not given for postoperative pain control. 2. Baclofen is not given for seizures. 3. Baclofen is given to help control the spasms associated with CP. 4. Baclofen is not given for bladder control. TEST-TAKING HINT: The test taker needs to be familiar with the medication baclofen.

The nurse is caring for a newborn with a cleft lip and palate. The mother states, "I will not be able to breastfeed my baby." Which is the nurse ' s best response? 1. "It sounds like you are feeling discouraged. Would you like to talk about it?" 2. "Sometimes breastfeeding is still an option for babies with a cleft lip and palate. Would you like more information?" 3. "Although breastfeeding is not an option, you can pump your milk and then feed it to your baby with a special nipple." 4. "We usually discourage breastfeeding babies with cleft lip and palate as it puts them at an increased risk for aspiration."

1. Encouraging parents to express their feelings is important, but it is more appropriate to give the parents information on breastfeeding. 2. Some mothers are able to breastfeed their infants who have a cleft lip and palate. The breast can help fi ll in the cleft and help the infant create suction. 3. Breastfeeding is sometimes an option. 4. Breastfeeding does not increase the risk of aspiration among infants with a cleft lip and palate. TEST-TAKING HINT: The test taker should be led to select answer 2 because the breast can sometimes act to fi ll in the cleft.

The nurse is caring for a 4-month-old who has just had an isolated cleft lip repaired. Select the best position for the child in the immediate post-operative period. 1. Right side-lying. 2. Left side-lying. 3. Supine. 4. Prone.

1. The infant may rub the face on the bedding if positioned on the side. 2. The infant may rub the face on the bedding if positioned on the side. 3. The supine position is preferred because there is decreased risk of the infant rubbing the suture line. 4. The infant may rub the face on the bedding if positioned on the abdomen. TEST-TAKING HINT: The test taker should be led to answer 3 because it is the only option in which the suture line is not at increased risk for injury

Parents of a 2-year-old with Down syndrome are told the child should be screened for atlantoaxial instability. The nurse tells the parents that which of the following are symptoms of this instability? 1. Mental retardation. 2. Neck pain and torticollis. 3. Vision and hearing loss. 4. Early onset of puberty

2 1. All children with Down syndrome have mental retardation. 2. Atlantoaxial instability is ligamentous laxity of the atlantoaxial joint. The symptoms of neck pain, torticollis, and loss of bowel and bladder control indicate that instability is already present. The purpose of the x-rays is to prevent symptoms by limiting activities if instability is present. 3. Children with Down syndrome may have vision and hearing loss and should be screened before 2 years of age for both. 4. Children with Down syndrome attain puberty at the same age as do nondisabled children. TEST-TAKING HINT: Children with Down syndrome have hypotonia, and the more active they become, the more they are at risk for displacement of the atlantoaxial joint.

A child with cerebral palsy (CP) has been fitted for braces and is beginning physical therapy to assist with ambulation. The parents ask why he needs the braces when he was crawling without any assistive devices. Select the nurses best response. 1. "The CP has progressed, and he now needs more assistance to ambulate." 2. "As your child grows, different muscle groups may need more assistance." 3. "Most children with CP need braces to help with ambulation." 4. "We have found that when children with CP use braces, they are less likely to fall."

2 1. CP is a nonprogressive disorder. 2. CP can manifest in different ways as the child grows. It does not progress, but its clinical manifestations may change. 3. Children with CP have different abilities and needs. CP can result in mild to severe motor deficits; therefore, one treatment regimen cannot be used or recommended for all children. 4. Although braces may assist some children with ambulation, they will not be useful in all cases. TEST-TAKING HINT: The test taker can eliminate answers 3 and 4 because generalizations cannot be made regarding CP. Each child has different abilities and disabilities

Which medication is used for the treatment of spasticity in cerebral palsy (CP)? 1. Dexamethasone (Decadron). 2. Baclofen (Lioresal) 3. Diclofenac (Voltaren). 4. Carbamazepine (Tegretol).

2 1. Dexamethasone (Decadron) is a corticosteroid used to decrease infl ammation. Spinal cord-related spasms are not caused by infl ammation. 2. Baclofen (Lioresal) is used to treat the spasticity in cerebral palsy. It is a centrally acting muscle relaxant. 3. Diclofenac (Voltaren) is a nonsteroidal antiinfl ammatory drug. 4. Carbamazepine (Tegretol) is an antiepileptic used to treat seizures. TEST-TAKING HINT: Spasticity affects the muscles.

Parents confide to the nurse that their child, who is 35 months old, does not talk and spends hours sitting on the floor watching the ceiling fan go around. They are concerned their child may have autism. The nurse should ask the parents which question? 1. "Does your child have brothers or sisters?" 2. "Does your child seek you out for comfort and love?" 3. "Do you have trouble getting babysitters for your child?" 4. "Does your child receive speech therapy?"

2 1. It is important to discuss the findings that the parents have presented and not peripheral information that may or may not be necessary to their concern. 2. Children with autistic-like features lack many social skills, such as seeking reciprocity and comfort from parents and maintaining eye contact when someone is speaking with them. They have an inability to develop peer relationships. 3. It is important to discuss the findings that the parents have presented and not peripheral information that may or may not be necessary to their concern. 4. It is important to discuss the findings that the parents have presented and not peripheral information that may or may not be necessary to their concern. TEST-TAKING HINT: Autism is a complex developmental disorder that presents with behavioral and intellectual deficits. Language acquisition is an indicator of cognitive development

Which child requires continued follow-up because of behaviors suspicious of cerebral palsy (CP)? 1. A 1-month-old who demonstrates the startle reflex when a loud noise is heard. 2. A 6-month-old who always reaches for toys with the right hand. 3. A 14-month-old who has not begun to walk. 4. A 2-year-old who has not yet achieved bladder control during waking hours.

2 1. The startle reflex is expected in an infant 1-month-old. 2. The clinical characteristic of hemiplegia can be manifested by the early preference of one hand. This may be an early sign of CP. 3. Although many children walk before the age of 14 months, it is not considered a motor delay not to have achieved this milestone at this point. 4. Many 2-year-olds have not achieved bladder control. TEST-TAKING HINT: The test taker should be familiar with normal developmental milestones and eliminate answers 1, 3, and 4 because they are all developmentally appropriate

A child with spastic cerebral palsy is to begin botulinum toxin type A (Botox) injections. Which treatment goals should the health care team set for the child related to Botox? Select all that apply. 1.Improved nutritional status. 2.Decreased pain from spasticity. 3.Improved motor function. 4.Enhanced self-esteem. 5.Reduced caregiver strain and improved self-care. 6.Decreased speech impediments.

2,3,4,5. Botox injections can be used to improve many aspects of quality of life for the child with cerebral palsy. The injections can help decrease pain from spasticity. Injections improve motor status by reducing rigidity and allowing for more effective physical therapy to improve range of motion. Decreased spasms enhance self-esteem. Improved motor status facilitates the ability to provide some aspects of care, especially transfers. Botox does not significantly affect nutritional status or speech.

Which of the following nursing actions would support the best feeding practice for an infant with a cleft palate? 1.Use an appropriate nipple and bottle set. 2.Encourage the mother to breast-feed. 3.Assess daily weights and wet diapers to monitor intake. 4.Allow unlimited length of time for each feeding.

2. Breast-feeding is the method of choice for all neonates. Infant feeding is more difficult for infants with cleft palates because of the inability to create a seal around the nipple. Maternal nipples most readily conform to the palate and create an adequate seal. Secondarily utilizing a nipple especially made for the particular cleft facilitates the seal and encourages an easier suck and swallow. Assessing the infant's weight and wet diapers on a daily basis monitors the hydration and nutritional status. An unlimited length of time for each feeding can cause fatigue and poor weight gain.

The nurse is developing a plan of care for a child recently diagnosed with cerebral palsy (CP). Which should be the nurses priority goal? 1. Ensure the ingestion of sufficient calories for growth. 2. Decrease intracranial pressure. 3. Teach appropriate parenting strategies for a special-needs child. 4. Ensure that the child reaches full potential.

3 1. Adequate calories are an appropriate goal, but the priority for a special-needs child is that the child develop to full potential. 2. Children with CP do not have increased intracranial pressure. 3. Teaching appropriate parenting strategies for a special-needs child is important and is done so that the child can maximize her personal skills and minimize her limitation. 4. A child with CP needs a health-care team that can aid the family in helping them grow and develop to their full potential. The priority for all children is to develop to their full potential. TEST-TAKING HINT: All of these are important goals, but determining the priority goal for a special-needs child is the key.

The parents of a child with meningitis and multiple seizures ask if the child will likely develop cerebral palsy (CP). Select the nurse's best response. 1. "When your child is stable, she 'll undergo computed tomography (CT) and magnetic resolution imaging (MRI). The physicians will be able to let you know if she has CP." 2. "Most children do not develop CP at this late age." 3. "Your child will be closely monitored after discharge, and a developmental specialist will be able to make the diagnosis." 4. "Most children who have had complications following meningitis develop some amount of CP."

3 1. CP is diagnosed based on clinical characteristics and developmental findings. It is not diagnosed with any type of radiological examination. 2. Although most cases of CP occur in the neonatal period, some children can develop CP at a later age. 3. The child will be given a chance to recover and will be monitored closely before a diagnosis is made. 4. Although many children develop CP after having complications of meningitis, many do not. Although the parents should not be given false hope, they should not be led to lose hope for a complete recovery TEST-TAKING HINT: The test taker should be led to answer 3 because it explains the process and does not state that the child definitely will or will not develop CP.

The nurse is caring for a 2-month-old infant who is at risk for cerebral palsy (CP) due to extreme low birth weight and prematurity. His parents ask why a speech therapist is involved in his care. Select the nurses best response. 1. "Your baby is likely to have speech problems because of his early birth. Involving the speech therapist now will ensure vocalization at a developmentally appropriate age." 2. "The speech therapist will help with tongue and jaw movements to assist with babbling." 3. "The speech therapist will help with tongue and jaw movements to assist with feeding." 4."Many members of the health-care team are involved in your child ' s care so that we will know if there are any unmet needs."

3 1. The nurse cannot assume that the child will have speech difficulties. Speech therapy does not guarantee vocalization at a developmentally appropriate age. 2. Although speech therapy will assist with babbling at a later age, its primary purpose is to assist with feeding. 3. It is important to involve speech therapy to strengthen tongue and jaw movements to assist with feeding. The infant who is at risk for CP may have weakened and uncoordinated tongue and jaw movements. 4. Members of a multidisciplinary team become involved in a childs care based on specific needs, not hospital routine. TEST-TAKING HINT: The test taker should immediately eliminate answer 4 because it does not consider the child ' s individual needs

The mother asks the nurse whether her child with hemiparesis due to spastic cerebral palsy will be able to walk normally because he can pull himself to a standing position. Which of the following responses by the nurse would be most appropriate? 1."Ask the doctor what he thinks at your next appointment." 2."Maybe, maybe not. How old were you when you first walked?" 3."It's difficult to predict, but his ability to bear weight is a positive factor." 4."If he really wants to walk, and works hard, he probably will eventually."

3 The nurse needs to respond honestly to the mother. Most children with hemiparesis due to spastic cerebral palsy are able to walk because the motor deficit is usually greater in the upper extremity. There is no need to refer the mother to the primary health care provider. The age at which the mother walked may be important to elicit, but this does not influence when the child will walk. The will to walk is important, but without neurologic stability the child may be unable to do so.

The nurse judges that the mother understands the term cerebral palsy when she describes it as a term applied to impaired movement resulting from which of the following? 1.Injury to the cerebrum caused by viral infection. 2.Malformed blood vessels in the ventricles caused by inheritance. 3.Nonprogressive brain damage caused by injury. 4.Inflammatory brain disease caused by metabolic imbalances.

3 The term cerebral palsy (CP) refers to a group of nonprogressive disorders of upper motor neuron impairment that result in motor dysfunction due to injury. In addition, a child may have speech or ocular difficulties, seizures, hyperactivity, or cognitive impairment. The condition of congenital malformed blood vessels in the ventricles is known as arteriovenous malformations. Viral infection and metabolic imbalances do not cause CP.

When developing the plan of care for an infant with a cleft lip before corrective surgery is performed, which of the following should be a priority? 1.Maintaining skin integrity in the oral cavity. 2.Using techniques to minimize crying. 3.Altering the usual method of feeding. 4.Preventing the infant from putting fingers in the mouth.

3. Before corrective surgery for a cleft lip, the infant needs to consume formula or breast milk. Methods for feeding may need to be adjusted to fit the infant's needs, because the infant with a cleft lip experiences a decreased ability to suck, which interferes with the infant's ability to compress the nipple. A special feeder may be used to feed the infant to ensure adequate caloric intake. Problems with infection and skin integrity in the mouth are uncommon because the areas of the defect are not open areas. Although crying may cause the infant to swallow more air because of the defect, crying poses no harm to the infant. There is no need to keep the infant's fingers out of the mouth preoperatively. The fingers will not harm the defect or cause an infection.

The parent of an infant with a cleft lip and palate asks the nurse when the infant's cleft palate will be repaired. The nurse responds by stating that the first repair of a cleft palate is usually done at which of the following times? 1.Before the eruption of teeth. 2.When the child weighs approximately 10 kg (22 lb). 3.Before the development of speech. 4.After the child learns to drink from a cup.

3. The optimal time for cleft palate repair depends on many factors. However, it is best done before speech develops and the child learns faulty speech habits as a result of the defect, usually before 12 to 15 months of age. Tooth eruption usually begins at about 6 months of age. The child should weigh about 10 kg (22 lb) at 6 months, but the important consideration is to schedule surgery before speech patterns begin to develop. An infant may learn to start drinking from a cup as early as 6 to 7 months of age, possibly up to the first birthday.

The parent of a child with spastic cerebral palsy and a communication disorder tells the nurse, "He seems so restless. I think he is in pain." The nurse should: 1.Assess the child for pain using the Faces, Legs, Activity, Cry, Consolability (FLACC) scale. 2.Assess the child using the pediatric FACES scale. 3.Administer the pain medication that is prescribed to be given as needed and assess the response. 4.Notify the primary care provider of the change in behavior.

3. The parent is the child's primary care provider and may be very in tune to subtle changes in the child's behavior. If the parent thinks the child is in pain, it is very likely to be so. The nurse should administer the pain medication and evaluate if the medication affected the child's behavior. The FLACC scale may be difficult to interpret when the child has spasticity. The FACES scale requires self-report. The primary health care provider should be contacted regarding the change in behavior only if other available interventions are unsuccessful.

The nurse formulates the nursing diagnosis Imbalanced Nutrition: Less than body requirements related to negative feeding patterns for a 5-month-old infant diagnosed with failure to thrive. To meet the short-term outcomes of the infant's plan of care, the nurse should expect to do which of the following? 1.Instruct the parents in proper feeding techniques. 2.Give the infant high-calorie formula. 3.Provide consistent staff to care for the infant. 4.Allow the infant to sit in a high chair during feedings."

3. In the short-term care of this infant, it is important that the same person feed the infant at each meal and that this person be able to assess for negative feeding patterns and replace them with positive patterns. Once the infant is gaining weight and shows progress in the feeding patterns, the parents can be instructed in proper feeding techniques. This is a long-term outcome of nursing care. Because there is no organic reason for the failure to thrive, it should not be necessary to increase the formula calorie content. A 5-month-old infant is too young to be expected to sit in a high chair for feedings and should still be bottle-fed

A female neonate born vaginally at term with a cleft lip and cleft palate is admitted to the regular nursery. Which of the following actions should the nurse do the first time that the parents visit the neonate in the nursery? 1.Explain the surgical interventions that will be performed. 2.Stress that this defect is not life-threatening. 3.Emphasize the neonate's normal characteristics. 4.Reassure the parents about the success rate of the surgery

3. On the initial visit, the parents may be shocked, fearful, and anxious. Nursing care should include spending time with the parents to allow them to express their emotions. The nurse should initially emphasize the neonate's normal characteristics. After the parents have had sufficient time to adjust to the neonate's special needs, surgical interventions can be discussed. Telling the parents that this is not a life-threatening defect or that everything will be all right after the surgery is not helpful. Doing so discounts their feelings. Reassuring the parents about the success rate of the surgery can be done once the parents have had time to adjust to the neonate and express their emotions."

Which is the primary goal for a newborn with a cleft of the soft palate? 1. Prevent ear infections. 2. Help the mother bond with the baby. 3. Repair the cleft palate. 4. Establish feeding and sucking.

4 1. Infants with clefts of the palate are at greater risk for ear infections once they are eating and sucking on a breast or bottle. 2. It is important to help the mother bond with the baby, but nursing or sucking on the bottle helps to create positive feelings between the baby and the mother. 3. The cleft palate is not repaired until the baby is closer to 9 to 15 months of age when speech begins. 4. The primary goal of any newborn with a cleft palate is to establish feeding and sucking. TEST- TAKING HINT: Getting started with feeding and nursing is difficult for the newborn with a cleft palate.

The parents of a newborn diagnosed with a cleft lip and palate ask the nurse when their childs lip and palate will most likely be repaired. Which is the nurses best response? 1. "The palate and the lip are usually repaired in the first few weeks of life so that the baby can grow and gain weight." 2. "The palate and the lip are usually not repaired until the baby is approximately 6 months old so that the mouth has had enough time to grow." 3. "The lip is repaired in the first few months of life, but the palate is not usually repaired until the child is 3 years old." 4. "The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old."

4 1. The palate is not repaired until the child is approximately 18 months old to allow for facial growth. Waiting beyond 18 months may interfere with speech. 2. The lip is usually repaired in the first few weeks of life, and the palate is usually repaired at approximately 18 months. 3. The palate is repaired earlier than 3 years so that speech development is not impaired. 4. The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old. TEST-TAKING HINT: The test taker should consider the palate ' s involvement in the development of speech and therefore eliminate answer 3. The palate is usually given at least a year to grow sufficiently

When assessing the development of a 15-month-old child with cerebral palsy, which of the following milestones should the nurse expect a toddler of this age to have achieved? 1.Walking up steps. 2.Using a spoon. 3.Copying a circle. 4.Putting a block in cup.

4. Delay in achieving developmental milestones is a characteristic of children with cerebral palsy. Ninety percent of 15-month-old children can put a block in a cup. Walking up steps typically is accomplished at 18 to 24 months. A child usually is able to use a spoon at 18 months. The ability to copy a circle is achieved at approximately 3 to 4 years of age.

The health care team determines that the family of an infant with failure to thrive who is to be discharged will need follow-up care. Which of the following would be the most effective method of follow-up? 1.Daily phone calls from the hospital nurse. 2.Enrollment in community parenting classes. 3.Twice-weekly clinic appointments. 4.Weekly visits by a community health nurse.

4. The most effective follow-up care would occur in the home environment. The community health nurse can be supportive of the parents and will be able to observe parent-infant interactions in a natural environment. The community health nurse can evaluate the infant's progress in gaining weight, offer suggestions to the parents, and help the family solve problems as they arise.