Pediatrics Chapter 3
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?
Urging the baby's mother to take time for herself away from the child
A new mother complains that she is exhausted and that the little sleep she gets is determined by her baby's daytime naps and the few hours the baby sleeps during the night. The nurse discusses with this mother the importance of helping the infant establish healthy sleeping patterns. Which of the following would be most helpful for this mother to do to encourage healthy sleeping patterns? The mother should
Use the crib for sleeping only, not for play activities
A teen mom asks the discharge nurse if it is okay to sleep in bed with the baby. She says her mom always did it with her siblings and it seemed okay. The nurse should respond how?
"Bed sharing has positive effects on babies, let me get you information."
At birth the newborn's head and chest circumference were measured. The nurse knows that the head should be about:
1 inch larger than the chest
The nurse is educating the mother of a 6-month-old boy about the symptoms for teething. Which symptom would the nurse identify?
Increased biting and sucking
A parent who is feeding his child formula prepared at home using evaporated milk is concerned about whether the child is receiving all necessary nutrients. Which of the following would be important for this parent to add to his child's diet to supplement the formula?
Iron
A 3-month-old still has a Moro reflex. Which statement is most true of this reflex?
Most 3-month-olds still have a Moro reflex.
A mother is discussing her 10-month old boy with the nurse. Which comment indicates a need for teaching?
"He loves being in his walker and 'zips' around the house."
Martha asks the nurse if her 2-month-old could have baby bananas yet. The nurse would respond and educate Martha on the nutrition stages of infants by which of these responses?
"In two months you can try bananas if you think she is ready." The age of 4 to 6 months is the age recommended to introduce solid foods.
A frustrated mother comes to a 9-month well-baby checkup complaining to you that her son is refusing all of the solid food she gives him. When talking with this mother, the nurse discovers that she has struggled all her life with a weight problem. She attributes this problem to being forced to eat all of the food she was served as a child, even when she was full. Because she doesn't want to cause the same problem in her child, she tells the nurse that each time her son pushes food away with his tongue she believes that he doesn't want it. Which of the following statements would be most appropriate for the nurse to say to this mother?
"The baby needs to learn how to move the food to the back of the mouth for swallowing, so catch the food and offer it again until the baby learns this."
A young breastfeeding mother calls the telephone nurse because she is concerned about her 3-month-old's stools. Which statement is of concern?
"The stools are foamy and smell terrible." This may indicate a digestive problem or illness
The infant weighs 7 lbs. 4 oz. at birth. If the infant is following a normal pattern of growth, which of the following would be an expected weight for this child at the age of 12 months?
21 lbs. 12 oz. By one year of age, the infant has tripled his or her birth weight and has grown 10 to 12 inches.
The infant measures 21 ½ inches at birth. If the infant is following a normal pattern of growth, which of the following would be an expected height for this child at the age of six months?
27 ½ inches
What is the correct amount of urine diapers a mature infant should have each day?
An infant should have 6 to 8 wet diapers/day.
The nurse is assessing the oral cavity of a 4-month-old infant. Which finding is consistent with a child of this age?
No teeth
While evaluating the development of 10-month-old boy, a nurse hides the boy's stuffed animal behind her back. The boy crawls around the examination table to look behind the nurse's back for the stuffed animal. Which of the following developmental phenomena has this infant demonstrated?
Object permanence
The nurse is caring for a 5-week-old infant who is spitting up "all the time." This is the mother's first child. Which of the following should be the priority nursing intervention?
Observe the mother while she feeds and burps her infant.
The nurse pulls the 5-month-old to sitting position from supine and notes head lag. The nurse's response is to:
Refer the infant for developmental and/or neurologic evaluation.
The nurse is teaching healthy eating habits to the parents of a 7-month-old girl. Which recommendation is the most valuable advice?
Serve new foods several times
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:
Should have disappeared
Which developmental milestone would the nurse expect an 11-month-old infant to have achieved?
Sitting independently Infants typically sit independently, without support, by age 8 months. Walking independently may be accomplished as late as age 15 months and still be within the normal range. Few infants walk independently by age 11 months. Building a tower of three or four blocks is a milestone of an 18-month-old. Turning a doorknob is a milestone of a 24-month-old. (less)
Which of the following milestones would you expect an infant to accomplish by 8 months of age?
Sitting without support
A father asks you what symptoms he can expect with normal teething in his infant. Which of the following would you tell him?
The child's gum line will be tender.
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?
The development of a 3-month-old This primitive (not protective) reflex should be present at birth and disappear around age 4 months.
The nurse is reviewing topics to be discussed with caregivers related to caring for infants. Which of the following statements would be the most appropriate statement for the nurse to make to this group of caregivers?
The infant sleeps 10-12 hours at night and take 2-3 naps during the day
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?
The respirations of a 1-month-old infant are normally irregular and periodically pause.
The best way for an infant's father to help his child complete the developmental task of the first year is to
respond to her consistently.
A staff nurse is talking about Piaget's theory with a nursing student. Infants are in the sensorimotor stage of cognitive development during which object permanence is mastered. An example of an infant displaying this ability is:
Looking for a toy in her crib at the last place she saw it
An infant is breastfed. When assessing her stools, which of the following data would be typical?
Breastfed infants are less likely to be constipated than bottle-fed infants.
Lea is 3 months old. At what age would it be okay for Lea's mother to introduce carrots to her for dinner?
Solid food can be introduced at 4 to 6 months of age.
In working with the infant age child, the nurse recognizes which of the following as a characteristic of the infant.
The child grows and develops skills more rapidly than at any other time in their life
Infant development is best described by which of the following statements?
Development proceeds cephalocaudally.
The nurse is reinforcing teaching related to the nutritional needs of the infant with a group of caregivers. One caregiver asks why her 6-month-old infant needs to have solid foods when breast milk is such a good source of nutrition. Which of the following would be the best response by the nurse?
"Milk does not provide adequate amounts of iron which are found in solid foods."
The nurse comes into infant Lucy's room on the pediatric floor. She is going to try and feed her for the first time since her surgery. How does the nurse know what infant state Lucy is in by what Mom says and that it is okay to try and feed Lucy?
"Lucy has been a chatterbox and smiles just like her brother."
Parents complain of being "worn out" at their child's 6-month check-up because their boy awakens each night and cries. The nurse suggests which measures?
• Establish a quieting ritual before bed. • During night awakening, keep interactions minimal.
The infant weighs 6 lbs. 8 oz. at birth. If the infant is following a normal pattern of growth, which of the following would be an expected weight for this child at the age of four months?
13 lbs. Most infants double their birthweight by 4 months of age and triple their birthweight by the time they are 1 year old.
A 6-month-old arrives for a well-baby visit with a case of diaper rash. The baby's mother tells the nurse she is not concerned and believes this to be normal. She reports that she changes the baby's diaper when he wakes up and before she puts him in his crib for naps or bedtime. It would be important to teach this mother that she should start checking his diaper to see if it needs changing every
2-4 hours
A new mother asks for advice from the nurse about bathing her infant. Which of the following should the nurse tell her?
Be sure to wash the infant's face, hands, and diaper area daily
The nurse is examining a 6-month-old girl who was born 8 weeks early. Which finding is cause for concern?
Favoring one hand over the other may be a warning sign that proper motor development is not occurring in the other arm or hand.
The nurse is examining a 6-month-old girl who was born 8 weeks early. Which finding is cause for concern?
Head size has increased 5 in (12 cm) since birth.
The mother of a 3-month-old is concerned because her daughter does not yet sit by herself. Which of the following statements best reflects average sitting ability?
Most babies do not sit steadily until 8 months; she is normal.
A nurse is preparing discharge teaching for a client being discharged with her newborn baby. What is the highest priority item that must be included in the teaching plan?
Restrain the baby in a car seat.
A new mother, when asked by a nurse, explains that her 4-month-old infant has been nursing regularly every 3 to 4 hours but seems satisfied. However, the mother recently introduced solid food in the form of unbuttered popcorn to the baby as a supplement, to "get her used to eating solid food." She felt that the popcorn would be safe because it is soft on the baby's gums. Which of the following should be the primary nursing diagnosis in this situation?
Risk for aspiration related to feeding the infant an inappropriate food
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:
The child weighs less than expected for age.
The nurse is conducting a physical examination of a 5-month-old boy. Which of the following observations may be cause for concern about the infant's neurologic development?
The infant displays an asymmetric tonic neck reflex (fencing reflex). The tonic neck reflex normally disappears by age 4 months, the palmar grasp reflex by age 6 months, and the Babinski reflex (fanning of toes when sole of foot stroked) by 12 months.
The nurse is assessing development of a 4-month-old boy during a well-child visit. Which of the following observations needs further investigation?
The infant responds to his mother when he sees her but not at other times when she is near.
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?
They put her to bed when she falls asleep.
When teaching an infant's mother about bathing her, it would be important to instruct her that
bath time provides an opportunity for play.
Anticipatory guidance for an infant for the 4th month should include the fact that she probably will
be able to turn over onto the back.
The nurse is educating the mother of a newborn about feeding practices. The nurse correctly advises the mother:
the newborn's stomach can hold between one-half to 1 ounce.
A nurse places a toy car in front of a 6-month-old girl. She swats at it, and the car flies across the examination table and lands on the floor. She squeals with surprise and delight. When the nurse puts the toy car in front of her again, she immediately swats it again and laughs as it rolls across the table and falls to the floor again. Which of the following has the girl just demonstrated?
Secondary circular reaction By the third month of life, a child enters a cognitive stage identified by Piaget as primary circular reaction. During this time, the infant explores objects by grasping them with the hands or by mouthing them. Infants appear to be unaware of what actions they can cause or what actions occur independently, however. At about 6 months of age infants pass into a stage Piaget called secondary circular reaction. Now when infants reach for an object, hit it, and watch it move, they realize it was their hand that initiated the motion, and so they hit it again. By 10 months, infants discover object permanence. Infants are ready for peek-a-boo once they have gained this concept. They know their parent still exists even when hiding behind a hand or blanket and wait excitedly for the parent to reappear. Binocular vision, which is the ability to fuse two images into one, is demonstrated by 2-month-olds when the follow moving objects with their eyes, although not past the midline