NUR236 EXAM 1
The nurse is assessing an 6-month-old infant at a well-baby visit and is answering questions from the new mother. Which response should the nurse prioritize when addressing the mother's question concerning what the infant should be learning at this point in life? A. Trust B. Feel anger C. Love D. Fear
A
What is the correct amount of wet diapers a mature infant should produce each day? A. An infant should have 1 to 2 wet diapers/day. B. An infant should have 3 to 5 wet diapers/day. C. An infant should have 6 to 8 wet diapers/day. D. An infant should have 9 to 10 wet diapers/day.
C
A 12-month-old seen at a walk-in clinic weighed 8 pounds 4 ounces (3.75 kg) at birth. Weight now is 20 pounds 8 ounces (9.3 kg). The nurse determines: A. The child weighs less than expected for age. B. The child weighs more than expected for age. C. The child weighs the expected amount for age. D. The weight assessment is blatantly inaccurate.
A
A 5-month-old infant being assessed was born at 32 weeks. The nurse doing the well-child check-up should compare the baby to what norms? A. The development of a 3-month-old B. The development of a 10-week-old C. The growth of a 2-month-old D. The growth of a 5-month-old
A
The nurse is assessing development of a 4-month-old boy during a well-child visit. Which observation needs further investigation? A. The infant responds to his mother when he sees her but not at other times when she is near. B. The infant turns his head in the direction of a squeak toy. C. The infant shows interest in looking at near or high-contrast objects. D. The infant makes babbling sounds, coos, and smiles.
A
The nurse is assessing the 10-month-old infant. The nurse notes the anterior fontanel has closed. What initial action by the nurse is indicated? A. Document the findings as normal. B. Review the birth records of the infant to see if there were any other anomalies. C. Notify the infant's physician. D. Measure the infant's head circumference.
A
The student nurse is caring for a 2 1/2-week-old in the newborn intensive care unit. Which term is most accurate when discussing this client? A. Newborn B. Infant C. Child D. Baby
A
A mother calls the clinic nurse asking for recommendations on comfort measures for her infant who is teething. What recommendation should the nurse make? Select all that apply. A. teething rings B. over-the-counter numbing gel C. ice D. acetaminophen E. teething biscuits
AD
Anticipatory guidance for an infant for the 4th month should include the fact that the infant will be able to achieve which developmental milestone? A. develop a fear of strangers B. be able to turn over onto the back C. insist on things being done the infant's way D. have many "blue" or moody periods
B
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
B
During a well-baby visit the mother of a 3-month-old infant tells the nurse that she does not understand why her baby continues to spit out food during feeding of solid foods. What is the bestresponse by the nurse? A. "Maybe if you make your own baby food your infant will like it better." B. "I will make sure to let the physician know." C. "A lot of babies do this at first. Just give it some time and I'm sure your baby won't continue spitting out solid food." D. "Infants still have a tongue protrusion reflex until 4 to 6 months so they can't help but push out the solid food."
D
The mother of a 11-month-old has come to the clinic with concerns. She reports to the nurse that her baby's "soft spot in the front" is now gone. The nurse assesses the infant and notes the fontanel has closed. What response by the nurse is most appropriate? A. "The soft spot or fontanel has closed." B. "This closure of the fontanel is very premature and warrants some further testing." C. "This may signal your baby's calcium levels are elevated." D. "We will need to do additional neurological testing to make certain your infant is developing normally."
A
The nurse is conducting a physical examination of a 5-month-old boy. Which observation may be cause for concern about the infant's neurologic development? A. The infant displays an asymmetric tonic neck reflex (fencing reflex). B. The infant grasps a finger when it is placed in his palm. C. His toes hyperextend when the bottom of the foot is stroked. D. The anterior fontanel is open and easily palpated.
A
The nurse is making a home visit and observes the 7-month-old pulling the family dog's hair and ears. Which parenting skill does the nurse determine is most effective? A. The parent tells the child "no" with a stern voice and pulls the child's hand away from the dog B. The parent spanks the child while taking the child into another room away from the dog C. The parent allows the child to continue pulling at the dog and states, "If the dog bites her she will learn." D. The parent places the child in time-out and explains the reason for the time-out
A
The parent of an infant asks the nurse when to begin brushing the infant's teeth. What would be the nurse's best response? A. as soon as the first tooth erupts B. by 12 months of age C. when weaning is complete D. as soon as the infant begins to eat fruit
A
What information would the nurse include when teaching the parents of an infant about colic? A. Colic symptoms will probably fade at 3 months of age. B. The infant will need future follow-up for a "nervous" bowel. C. Formula intake should be doubled to keep the infant from losing weight. D. Symptoms will decrease if the infant is laid on the back after feedings.
A
When the nurse discharges a new mom and infant, the nurses notices that the car seat is in the front seat of the car. What is the appropriate response for the nurse to make regarding the car seat? A. "Let me go over car seat safety with you, so you can install your car seat properly." B. "You should never put the car seat in the front." C. "I see you have a car seat, that is great." D. "With the car seat in front, you can keep an eye on your baby."
A
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.
B
The nurse goes in to check on a new mother to see how breast-feeding is going with her new son. The nurse observes the infant is on the mother's lap with the blanket unwrapped, and the mother is washing his face, and gently stroking the baby. The mother has had trouble breastfeeding the last few times. What is the appropriate response from the nurse? A. "You will never get him to eat all unwrapped like that." B. "You are doing a wonderful job attempting to wake the baby." C. "That is not how you get him to eat." D. "Maybe you should watch the breastfeeding video again."
B
The nurse is admitting a 12-month-old to the medical unit. During the admission process the parents tell the nurse that their child is very advanced because he says "ball" when he picks up a football. How should the nurse respond? A. "He really isn't any more advanced than most 12-month-old children." B. "That is great that he is recognizing objects and is able to name them. He is right on target for language skills." C. "If he were advanced in language skills he would be putting several words together to form short sentences." D. "Parents usually think their child is far more advanced than other children."
B
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.
B
A newborn requires skin care that includes bathing. Besides hygiene, what is another reason for bathing the newborn? A. Bathing can prevent infection. B. Bathing is a great time to apply lotion. C. Bathing is a time for bonding with the parents. D. Bathing helps moisten the skin.
C
A parent asks the nurse if her 2-month-old could have bananas yet. The nurse would respond and educate the parent on the nutrition stages of infants by which of these responses? A. "Sure, if you feel she is ready to have bananas." B. "When did you feed your other child bananas? C. "In two months you can try bananas if you think she is ready." D. "In one month you can try bananas if you think she is ready."
C
A parent asks the nurse what symptoms to expect with normal teething in the infant. How should the nurse respond? A. The infant's gumline will be tender. B. The infant will not play or eat for 2 days. C. The infant will be constipated for 2 days. D. The infant's temperature may go as high as 102°F (38.9°C).
A
A teen mom asks the discharge nurse if it is okay to sleep in bed with her baby. She says her mom always did it with her siblings and it seemed okay. How should the nurse respond? A. "Baby can sleep in your room in an infant crib, but not in an adult bed." B. "Sure, you can do whatever you want, it is your baby." C. "Sure, you can, make sure you use a soft mattress for support." D. "Bed sharing is okay, just make sure the infant is between two people."
A
The father of a 6-week-old infant voices concerns about his son's stooling. He further shares that his son grunts and cries when having a bowel movement. What response by the nurse is most appropriate? A. "What does his stool look like?" B. "Grunting is normal with infant stool formation." C. "Is he in pain?" D. "We will need to collect a stool specimen for analysis."
A
The mother of a newborn reports she does not think her baby likes his formula since he spits up after only taking a small amount. Which response by the nurse is most appropriate? A. "Babies do not each much." B. "Your baby's stomach is small and can only hold about 1/2 to 1 ounce at birth." C. "You need to make certain to burp him more frequently." D. "It is too soon to determine a milk intolerance."
B
The mother of an infant is confused after being told by her dentist not to let her baby go to bed with a bottle of milk. She does not agree with that suggestion. Which response should the nurse prioritize when addressing this situation with the mother? A. "Giving a bottle of milk when the infant goes to bed can lead to obesity." B. "Bottles given at bedtime can cause erosion of the enamel on the teeth." C. "Giving your baby a pacifier at bedtime will satisfy the need to suck." D. "You could occasionally give your baby a bottle of water at bedtime."
B
The best way for an infant's parent to help the child complete the developmental task of the first year is to: A. expose the infant to many caregivers to help the infant learn variability. B. talk to the infant at a special time each day. C. respond to the infant consistently. D. keep the infant stimulated with many toys.
C
The nurse is assessing a 1-year-old at the well-child annual visit and notes the child is meeting the growth parameters. After noting the birth weight was 8 pounds (3.6 kg) and length was 20 inches (50.8 cm) long, which measurements would the nurse prepare to document for this visit? A. 16 pounds (7.2 kg) and grown 26 inches (65 cm) B. 20 pounds (9.1 kg) and 28 inches (70 cm) C. 24 pounds (10.8 kg) and 30 inches (75 cm) D. 28 pounds (12.7 kg) and 32 inches (80 cm)
C
The nurse is assessing the newborn. Which would the nurse assess to be an abnormal finding? A. The neck is short, thick and mobile B. The newborn startles to loud sounds C. Natal teeth noted in the mouth that are loose D. Gluteal folds are present and symmetrical
C
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
C
The clinic nurse is assessing a 9-month-old client. The parents state, "Our baby is having a really hard time teething." Which nursing action is appropriate? A. Encourage the parents feed the infant warmer foods while teething B. Have the parent's apply a topical numbing cream to the infant's gums hourly C. Tell the parents to give the infant acetaminophen every 4 hours D. Recommend the parents provide the infant a cold teething ring to chew
D