PEDS: Chapter 23: Growth and Development of the Infant

Which measures should receive priority in the care plan for an infant client who has sensitive skin? • Use only cloth diapers • Change diapers frequently • Use scented wipes with stool • Use baby power with each change

• Change diapers frequently Explanation: The infant should be changed every 2-4 hours. It is best to use unscented wipes or clear water to clean the infant with each change. Baby power should never be used as it is an aspiration risk. Question 19

The mother of a 4-month-old infant is working with the nurse to schedule well-child visits for her son. The mother would expect to schedule the next visit for her son at which age? • 8 months • 6 months • 12 months • 9 months

• 6 months Explanation: The routine schedule for newborn visits within the first year of life is 1 week, 1, 2 ,4, 6, 9, 12 months of age. The above infant should be seen at 6 months of age for follow up care and instructions.

The nurse is teaching the parents of an infant about bathing. The nurse will inform the parents to set the home hot water heater to which temperature? • 115°F (46.1℃) • 130°F (54.4℃) • 135°F (57.2℃) • 125°F (51.6℃)

• 115°F (46.1℃) Explanation: Water safety also includes ensuring the home hot water heater temperature is set to less than 120°F (48.9°C) to prevent burns and scalding of the infant while bathing.

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. • should be pronounced and easy to elicit. • is a protective reflex and retained for life. • is expected to appear within 1 month.

• should have disappeared. Explanation: This primitive (not protective) reflex should be present at birth and disappear around age 4 months. Question 5

The nurse is assessing Julie, a 3-month-old infant. Which developmental milestone would the nurse expect? • Julie loves to play "pat-a-cake". • Julie can grasp a toy at will. • Julie can hold her head erect and steady. • Julie can sit by herself.

Correct response: • Julie can hold her head erect and steady. Explanation: When an infant matures and grows they move through different developmental milestones. A 3-month-old rolls over from back to side and holds the head erect and steady and begins to replace the reflex grasp with voluntary grasping. Grasping a toy at will occurs at about 6- to 7-months of age. Sitting without support occurs around 6 months. Playing pat-a-cake is characteristic of an 8- to 9-month-old. Question 5

In observing an infant who is 6 months of age, which fine motor skill would the infant have most recently attained? • The infant has developed the pincer grasp. • The infant can hold a bottle. • The infant has a strong grasp reflex. • The infant can hold a cup.

• The infant can hold a bottle. Explanation: By the age of 24 weeks, the infant holds a bottle fairly well. Question 2

A new mother asks the nurse what she should look for when the baby starts to teethe. What should the nurse explain to the mother? • The child will have a high temperature. • The child's gum line will be tender. • The child will not play or eat for 2 days. • The child will be constipated for 2 days.

Correct response: • The child's gum line will be tender. Explanation: Gums are sore and tender before a new tooth breaks the surface. As soon as the tooth is through, the tenderness passes. A high temperature is not a normal expectation with teething and should be reported to the health care provider. The child may resist chewing because of the sore gum; however, it may not last for 2 days. Playing may or may not be affected. Constipation is not an expectation with teething.

The nurse is providing anticipatory guidance to a mother of a 5-month-old boy about introducing solid foods. Which statement by the mother indicates that effective teaching has occurred? • "I'll start with baby oatmeal cereal mixed with low-fat milk." • "Once he gets used to the cereal, then we'll try giving him a cup." • "The cereal should be a fairly thin consistency at first." • "I can puree the meat that we are eating to give to my baby." SUBMIT ANSWER

• "The cereal should be a fairly thin consistency at first." Explanation: Iron-fortified rice cereal mixed with a small amount of formula or breast milk to a fairly thin consistency is typically the first solid food used. As the infant gets older, a thicker consistency is appropriate. Strained, pureed, or mashed meats may be introduced at 10 to 12 months of age. A cup is typically introduced at 6 to 8 months of age regardless of what or how much solid food is being consumed. Question 9

A nurse is educating a client being discharged with her newborn baby. What is the highestpriority item that must be included in the teaching plan? • Lock all cabinets that contain cleaning supplies. • Restrain the baby in a car seat. • Give warm bottles of formula to the baby. • Keep all pots and pans in lower cabinets.

• Restrain the baby in a car seat. Explanation: The client should restrain the baby in a car seat when driving. Infants are especially vulnerable to injuries resulting from falls from changing tables or being unrestrained in automobiles. Locking the cabinets and giving warm bottles of formula to the baby are secondary teachings.

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? • "Sure, you can do whatever you want, it is your baby." • "Bed sharing is okay, just make sure the infant is between two people." • "Baby can sleep in your room in an infant crib, but not in an adult bed." • "Sure, you can, make sure you use a soft mattress for support."

• "Baby can sleep in your room in an infant crib, but not in an adult bed." Explanation: According to the 2016 recommendation by the American Academy of Pediatrics, infants should sleep in the same bedroom as the parents, but on a separate firm surface, such as a crib or bassinet, and never on a couch, armchair or adult bed, to decrease the risks of sleep-related deaths. Question 20

The parent of an infant asks the nurse when to begin brushing the infant's teeth. What would be the nurse's best response? • as soon as the infant begins to eat fruit • when weaning is complete • as soon as the first tooth erupts • by 12 months of age

• as soon as the first tooth erupts Explanation: Before tooth eruption occurs, parents should clean the infant's gums after feeding with a damp wash cloth. After the first tooth erupts, parents can use a soft bristle tooth brush. Dental hygiene should be part of the infant's everyday care. The American and Canadian Dental Associations recommend the first dental checkup to occur around 1 year of age. Infants should not go to bed with bottles or sippy cups to prevent dental caries. Question 6

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? • "You should never put the car seat in the front." • "Let me go over car seat safety with you, so you can install your car seat properly." • "With the car seat in front, you can keep an eye on your baby." • "I see you have a car seat, that is great."

Correct response: • "Let me go over car seat safety with you, so you can install your car seat properly." Explanation: The nurse should notice this is not the proper place for a car seat. The car seat should be rear facing and in the center of the back seat of the car. The nurse would review car seat safety with the mother and have her install the seat properly. The nurse should provide written materials if available. The other responses are not appropriate and do not ensure that proper installation will occur and that infant safety will be maintained.

In working with infants, the nurse would expect the posterior fontanel to be closed in an infant who is which age? • 3 months • 3 weeks • 6 weeks • 1 month

Correct response: • 3 months Explanation: The posterior fontanel is usually closed by the second or third month of life. Question 3

The nurse is visiting a mother who has a 3-month-old infant. Which anticipatory guidance information should the nurse provide to the mother at this time? • The child will experience many moody periods. • The child will have a fear of strangers. • The child will expect things to be done a certain way. • The child should be able to turn over onto the back at age 4 months.

• The child should be able to turn over onto the back at age 4 months. Explanation: Infants typically turn over from the front to back at age 4 months. Fear of strangers will not occur until 7 months. The nurse has no way of knowing the infant's temperament to determine that the child will be moody or when the child will expect things to be done a certain way. Question 4

Estimating illness in an infant is difficult. To help an infant's parents do this, which of the following would you instruct them to use? • Take her temperature about once a week. • Use her interest in eating as a good gauge. • Call if the infant's stools are yellow. • Call if she spits up any formula.

• Use her interest in eating as a good gauge. Explanation: A healthy infant eats well, voids adequately, and gains weight. Question 7

If the infant is following a normal pattern of dentition, the child would most likely have how many teeth by the age of 14 months? • 14 to 18 teeth • Four teeth • 24 teeth • Six to 12 teeth

Correct response: • Six to 12 teeth Explanation: The central incisors erupt between 6 and 12 months of age and lateral incisors erupt between 9 and 13 months. The other lateral incisors erupt between 10 and 16 months, so by age 14 months the infant could have up to 12 teeth. Question 5

A nurse is talking to and making facial expressions at a 9-month-old baby girl during a routine office visit. What is the most advanced milestone of language development that the nurse should expect to see in this child? • The infant squeals with pleasure • The infant says "da-da" when looking at her father • The infant imitates her father's cough • The infant coos, babbles, and gurgles

Correct response: • The infant says "da-da" when looking at her father Explanation: By 9 months, an infant usually speaks a first word: "da-da" or "ba-ba." The other answers refer to earlier milestones in language development. In response to a nodding, smiling face, or a friendly tone of voice, a 3-month-old infant will squeal with pleasure or laugh out loud. By 4 months, infants are very "talkative," cooing, babbling, and gurgling when spoken to. At 6 months, infants learn the art of imitating. They may imitate a parent's cough, for example, or say "Oh!" as a way of attracting attention. Question 4

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 more than expected for age. • The child weighs the expected amount for age. • The child weighs less than expected for age. • The weight assessment is blatantly inaccurate.

• The child weighs less than expected for age. Explanation: Birth weight should triple by 12 months. The child should weigh near 24 pounds 12 ounces (11.25 kg). The child is underweight for age. Question 5

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? • The infant displays an asymmetric tonic neck reflex (fencing reflex). • The anterior fontanel is open and easily palpated. • The infant grasps a finger when it is placed in his palm. • His toes hyperextend when the bottom of the foot is stroked.

• The infant displays an asymmetric tonic neck reflex (fencing reflex). Explanation: 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. Retaining these primitive reflexes may indicate a neurologic abnormality. The anterior fontanel, which remains open for brain growth, closes between 12 and 18 months of age. Question 4

The nurse in a community clinic is assessing a 4-week-old infant. The mother asks if the infant is developing normally. The nurse refers to which finding as suggestive of normal development in infants from birth to 4 weeks of age? • The infant frowns and tears are produced. • The infant raises head and chest while on stomach • The infant pulls self with arms. • The infant makes babbling sounds.

• The infant raises head and chest while on stomach Explanation: Infants have gained some neck control and can independently raise head and chest by 4 weeks of age. Appearance of tears, pulling themselves with their arms, and making babbling sounds are appropriate developmental milestones after 6 weeks of age.

A home visit nurse is providing health promotion on safety to a family of a 1-week-old infant. Which of the following statements by the parents indicates the need for further teaching? • "We will give our son a pacifier before placing him in his crib." • "We will place our infant in a rear-facing car seat in the back seat of the car." • "We will swaddle our son to keep him quiet and warm to sleep." • "We will position our infant on his side for sleeping."

Correct response: • "We will position our infant on his side for sleeping." Explanation: Infants should be placed on their backs for sleeping to reduce the risk of SIDS. All other choices are safe infant practices.

A mother takes her 4-month-old to the doctor for a visit. She asks the nurse what type of baby cereal she should buy now that her child is starting solid foods. How should the nurse respond? • "You should buy oat cereal." • "You should buy barley cereal." • "You should buy wheat cereal." • "You should buy rice cereal."

Correct response: • "You should buy rice cereal." Explanation: The rice cereal should be first. The infant should be monitored for food allergies by following the rice cereal with oats, barley, and wheat. Wheat has the highest allergy reaction in infants. Question 2

The nurse is assessing development of a 4-month-old boy during a well-child visit. Which observation needs further investigation? • The infant turns his head in the direction of a squeak toy. • The infant shows interest in looking at near or high-contrast objects. • The infant makes babbling sounds, coos, and smiles. • The infant responds to his mother when he sees her but not at other times when she is near.

• The infant responds to his mother when he sees her but not at other times when she is near. Explanation: If the infant does not respond to his mother's voice, it could indicate hearing loss. Infants recognize parents' voices from 1 month of age. It is normal for the infant to turn his head in the direction of a squeak toy, to focus visually on near or high-contrast objects, and to make babbling sounds but no words by this age. Infants develop a social smile at 2 months. Question 3

The nurse is assessing a 4-month-old infant during a scheduled visit. Which findings might suggest a developmental problem? • The child does not say dada or mama. • The child does not vocally respond to voices. • The child never squeals or yells. • The child does not babble.

Correct response: • The child does not vocally respond to voices. Explanation: The fact that the child does not vocally respond to voices might suggest a developmental problem. At 4 to 5 months of age most children are making simple vowel sounds, laughing aloud, doing raspberries, and vocalizing in response to voices. The child is too young to babble, squeal, yell, or say dada or mama. Question 4

A parent asks the nurse what symptoms to expect with normal teething in the infant. How should the nurse respond? • The infant's temperature may go as high as 102°F (38.9°C). • The infant's gumline will be tender. • The infant will be constipated for 2 days. • The infant will not play or eat for 2 days.

Correct response: • The infant's gumline will be tender. Explanation: Infants experience discomfort as the tooth emerges through the peridontal membrane and from inflammation. When teething some infants become irritable, have excessive drooling and like to bite on hard surfaces. To relieve discomfort the parent can apply ice to the gums or use an over-the-counter topical anesthetic for infants. Some infatns will refuse to eat or have poor sleeping due to the pain in the gums. There is not a definitive timeframe for this to occur, and it does not happen in all infants. Fever, diarrhea, and vomiting are signs of illness, not teething.

The mother of a 16-month-old infant comes into the clinic and asks the nurse, "When will my baby play with toys by moving them from one hand to the other?" The nurse's response is based on knowledge that transferring objects from one hand to the other is normally accomplished by what age? • 36 weeks • 48 weeks • 28 weeks • 17 weeks • 20 weeks

• 28 weeks Explanation: Infants usually transfer objects from one hand to the other by age 28 weeks.

Which milestone would the nurse expect an infant to accomplish by 8 months of age? • Sitting without support • Creeping on all fours • Being able to sit from a standing position • Pulling self to a standing position

• Sitting without support Explanation: Physical development of infants occurs in a cephalocaudal fashion. That means they must learn to control and lift their heads first. This is followed by the ability to turn over. Once this occurs the remainder of development occurse quickly. Most infants are able to sit unsupported by 8 months. They are able to creep at 9 months and pull to a standing position by 10 months. At 12 months the infant is able to sit from a standing position and is learning to walk. Question 3

The nurse observes a new mother bathing her 9-month-old baby. Which observation indicates that the experience is positive for both mother and infant? • The baby is crying and screaming. • The baby is reaching for the mother. • The baby is trying to keep the legs from touching the water. • The baby is moving the arms and hand and smiling.

• The baby is moving the arms and hand and smiling. Explanation: Bath time should be fun for an infant and can serve many functions. Especially during the second half of the first year, a child enjoys poking at soap bubbles on the surface of the water or playing with bath toys. Bath time also helps an infant learn different textures and sensations and provides an opportunity to exercise and kick as well as a good opportunity for a parent to touch and communicate with the child. Crying, screaming, reaching for the mother, and trying to avoid touching the water indicates that the bath experience is not positive for the baby or the mother. Question 15

An infant who is 4 months old continues to be seen at doctor visits for illness prevention. What would be the next scheduled appointment that this infant should attend to be evaluated? • The next visit would be at 6 months. • The next visit would be in 3 months. • The next visit would be at 9 months. • The next visit would be in 1 month.

• The next visit would be at 6 months. Explanation: The routine schedule for newborn visits within the first year of life is at 1 week, and then at 1, 2, 4, 6, 9, and 12 months of age. The above infant should be seen at 6 months of age for follow-up care and instructions. Question 3

The mother of a 3-month-old infant expresses concern that her infant's head is misshapen. Which would be the most appropriate question by the nurse? • "Have you thought of using a helmet?" • "Do you use "tummy time" with the infant?" • "Is the infant rolling over yet?" • "Does the infant sleep on its side?"

• "Do you use "tummy time" with the infant?" Explanation: The appropriate question would be for the nurse to assess whether the mother is placing the infant in the prone position during supervised period of time. This allows for the infant to increase head and neck muscle strength and development of rolling over. It also aids in evening out misshapen or flat heads.

A nurse is conducting a class for new mothers about infants and nutrition. One of the women asks, "What is the best nutrition for my 3-month-old infant?" Which response by the nurse would be most appropriate? • "Iron fortified formula is necessary for the infant's growth" • "Experts recommend soy milk as the preferred food.". • "Human milk is the best nutrition for your child" • "Rice cereal is the best because allergy risk is low. "

• "Human milk is the best nutrition for your child" Explanation: Human milk provides optimal nutritional support for a newborn and has recognized prebiotic and anti-inflammatory effects that enhance biological wellness for the child. Ingestion of human milk is known to aid the newborn's immature immune system. Breastfeeding is the feeding method most encouraged by health care providers today, resulting from the nutritional composition of the milk, the additional immunity it provides the infant in the form of antibodies, and the fact that it has the most easily digestible form of protein. Human milk is readily available, inexpensive, and encourages bonding between the mother and infant. The AAP (2005a) recommends breastfeeding exclusively (no supplemental formulas or baby foods) for approximately the first 6 months and supports continuing breastfeeding after foods are introduced to serve as the child's milk source for the entire first year as long as it is mutually desired by the infant and the mother. Parents should not offer low-iron milks (e.g., cow, goat, soy) to their child until the child is at least 12 months old. Cow's or goat's milk can contributeto anemia because both are deficient in iron. Infants should also never receive low-fat or nonfat milk because these milks do not have the fat, calories, or ironneeded to support the rapid growth and development that occurs at this age.

A nurse is providing health promotion education to a family of an 11-month-old infant who is eating "finger foods." The nurse knows the parents understand the risk of infant choking when they state which response below? • "I can feed our baby popcorn." • "I can feed our baby Cheerios." • "I can feed our baby raisins." • "I can feed our baby lollipops."

• "I can feed our baby Cheerios." Explanation: Cheerios are a good choice for finger-foods to promote finger-grasp fine motor coordination and self-feeding. Ten to 12 months is a good age to promote self-eating as infants move into mostly solid foods. Popcorn, raisins, and lollipops are choking hazard foods for infants at this age. Question 16

A nurse is providing health promotion education to a family of an infant at the family birth center. The nurse knows the parents need more education when they state which response? • "I will give my infant a drinking cup gradually around 5 months." • "I will introduce soft foods for my infant around 5 months of age." • "I will introduce new foods one at a time." • "I will switch to whole milk when my baby is around 6 months of age."

• "I will switch to whole milk when my baby is around 6 months of age." Explanation: An infant can be introduced to whole milk at about 1 year of age. At this stage infants' intestinal tracts should be mature enough for whole mile, and they will be less likely to have allergic reactions. Soft food, a drinking cup, and introducing foods one at a time are all correctly stated for developmental age. Question 5

After the nurse provides education to new parents about appropriate sleeping habits for infants, which statement by a parent would indicate to the nurse that teaching needs to reoccur? • "By keeping the room at a neutral temperature, I do not have to use blankets." • "I have a crib in my room so that I can breastfeed my baby." • "I will place my infant on the back to sleep every night." • "My husband gave the baby a special bear that I will place in the crib."

• "My husband gave the baby a special bear that I will place in the crib." Explanation: The nurse should reinforce that stuffed animals, blankets, pillows, and soft mattresses are suffocation hazards for infants. Question 17

A new mother shows the nurse that her baby grasps her finger when she touches the baby's palm. How might the nurse respond to this information? • "This is a protective reflex known as rooting." • "This is a protective reflex known as the Moro reflex." • "This is a primitive reflex known as the plantar grasp." • "This is a primitive reflex known as the palmar grasp."

• "This is a primitive reflex known as the palmar grasp." Explanation: Primitive reflexes are subcortical and involve a whole-body response. Selected primitive reflexes present at birth include Moro, root, suck, asymmetric tonic neck, plantar and palmar grasp, step, and Babinski. During the palmar grasp, the infant reflexively grasps when the palm is touched. The plantar grasp occurs when the infant reflexively grasps with the bottom of the foot when pressure is applied to the plantar surface. The root reflex occurs when the infant's cheek is stroked and the infant turns to that side, searching with mouth. The Moro reflex is displayed when with sudden extension of the head, the arms abduct and move upward and the hands form a "C." Question 8

The infant weighs 6 lb 8 oz (2,912 g) at birth. If the infant is following a normal pattern of growth, what would be an expected weight for this child at the age of 4 months? • 16 lb (7.26 kg) • 13 lb (5.9 kg) • 10 lb 8 oz (4.76 kg) • 15 lb 4 oz (6.92 kg)

• 13 lb (5.9 kg) Explanation: The average newborn weighs 7.5 pounds. They loose 10% of their birthweight over the first week of life but regain it in about 10-14 days. Most infants double their birth weight by 4 months of age and triple their birth weight by the time they are 1 year old.If the baby weighed 6lb 8 oz at birth and doubled that weight at 4 months the infant should weigh 13 lb (6 1/2 X 2= 13). Question 3

The infant weighs 7 lb 4 oz (3,248 g) at birth. If the infant is following a normal pattern of growth, what would be the expected weight for this child at the age of 12 months? • 25 lb (11.3 kg) • 21 lb 12 oz (9.9 kg) • 14 lb 8 oz (6.6 kg) • 28 lb 4 oz (12.8 kg)

• 21 lb 12 oz (9.9 kg) Explanation: The average weight of a newborn is 7.5 pounds. The infant gains about 30g each day. By four months of age they have doubled their birthweight. By 1 year of age they have tripled their birth weight and have grown 10 to 12 inches. 7lb 4 oz X 3= 21 lb 12 oz Question 2

The infant measures 21.5 in. (54.6 cm) at birth. If the infant is following a normal pattern of growth, what would be an expected height for this child at the age of 6 months? • 32 in. (81.3 cm) • 29 in. (73.7 cm) • 30.5 in. (77.5 cm) • 27.5 in. (69.9 cm)

• 27.5 in. (69.9 cm) Explanation: Infants gain about 1/2 to 1 inch in length for the first 6 months of life. Therefore, a 21.5 inch baby adding 6 inches of growth would be 27.5 inches. Babies grow the fastest during the first 6 months of life and slow down the second 6 months. By 12 months of age, the infant's length has increased by 50 percent, making this child 32.25 inches at 1 year old. Question 3

An infant is being introduced to drinking fluids from a cup. The nurse instructs the mother that fruit juice can now be added. Which of the following would the nurse suggest the mother try first? Select all that apply. • Pineapple • White grape juice • Apple • Grapefruit • Orange

• Apple • White grape juice Explanation: Juice is introduced when a cup is introduced to an infant. Usually 4-6 ounces of juice is recommended. Juices that have low-acidity like apple and white grape juice are appropriate. These juices may be diluted to half-strength with water. Orange, grapefruit and pineapple juice are to be avoided. Question 12

When a cup is introduced to infants, the introduction of fruit juice may follow. What type of juice would be appropriate for an infant? • Grapefruit juice • Pineapple juice • Apple juice • Orange juice

• Apple juice Explanation: Juice is introduced when a cup is introduced to an infant. Usually 4 to 6 ounces of juice is recommended. Juices that have low acidity like apple and white grape juice are appropriate. These juices may be diluted to half-strength with water. Question 2

The nruse is providing client education to the parent about bathing the infant. What would be important to instruct the parent? • Infants need a daily bath • Soap lubricates and oils an infant's skin • Never use soap on an infant's hair • Bath time provides an opportunity for play

• Bath time provides an opportunity for play Explanation: The work of children is play. Play provides a natural way for the infant to learn. In early infancy infants prefer their parents rather than toys. Parents can talk and sing to infants during feeding, bathing, and changing diapers. Infants do not need a daily bath as long as the diaper area is washed with diaper changes. Soap is actually drying to an infant's skin. Washing the hair with soap can help remove excess oil. Question 4

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 give the baby a complete bath every day • Be sure to oil the scalp with mineral oil and leave it on overnight before bathing the infant the next day • Be sure to brush the scalp with a soft toothbrush during the bath to prevent seborrhea • Be sure to wash the infant's face, hands, and diaper area daily

• Be sure to wash the infant's face, hands, and diaper area daily Explanation: Except in very hot weather, an infant does not need a bath every day. If a parent is tired and would not enjoy bath time or if some days are just too rushed, a complete bath can be omitted, with only the infant's face, hands, and diaper area washed. Some infants do need their head and scalp washed frequently (every day or every other day) to prevent seborrhea, a scaly scalp condition often called cradle cap. If seborrhea lesions do develop, they adhere to the scalp in yellow, crusty patches. The skin beneath them may be slightly erythematous. The patches can be softened by oiling the scalp with mineral oil or petroleum jelly and leaving it on overnight. The crusts can then be removed by shampooing the hair the next morning. A soft toothbrush or fine-toothed comb can be used to help remove them. Question 11

A mother calls the clinic every couple of weeks concerned that her infant is not developing appropriately. What would be an appropriate nursing diagnosis for the nurse to assign to this client? • Ineffective role performance related to new responsibilities • Social isolation related to lack of adequate social support • Deficient knowledge related to normal infant growth and development • Health seeking behaviors related to adjusting to parenthood

• Deficient knowledge related to normal infant growth and development Explanation: The client is demonstrating deficient knowledge related to normal growth and development of her infant. The nurse should plan interventions that include teaching of expected outcomes of growth and development. Question 18

The nurse is promoting a healthy diet to guide a mother when feeding her 2-week-old girl. Which is the most effective anticipatory guidance? • Advocating iron supplements with bottle-feeding • Advising fluid intake per feeding of 5 or 6 ounces • Discouraging the addition of fruit juice to the diet • Substituting cow's milk if breast milk is not available

• Discouraging the addition of fruit juice to the diet Explanation: Discouraging the addition of fruit juice to the child's diet is the most effective anticipatory guidance. Fruit juice can displace important nutrients from breast milk or formula. Cow's milk is likely to result in an allergic reaction. If breast milk is not available, infant formula may be substituted. Advising fluid intake per feeding of 5 or 6 ounces is too much for this neonate, but is typical for an infant 4 to 6 months of age. Advocating iron supplements with bottle-feeding is unnecessary so long as the formula is fortified with iron.

A 6-month-old girl weighs 14.7 pounds (6.7 kg) during a scheduled check-up. Her birth weight was 8 pounds (3.6 kg). What is the priority nursing intervention? • Discussing the child's feeding patterns • Talking about solid food consumption • Increasing the number of breast-feedings • Discouraging daily fruit juice intake

• Discussing the child's feeding patterns Explanation: Assessing the current feeding pattern and daily intake is the priority intervention. Talking about solid food consumption may not be appropriate for this child yet. Discouraging daily fruit juice intake or increasing the number of breastfeedings may not be necessary until the situation is assessed. Question 4

The nurse is providing anticipatory guidance to the mother of a 2-month-old in relation to interpersonal development. Which behavior is most likely to occur over the next 8 weeks? • Participating in a game of peek-a-boo • Mimicking mother's facial expressions • Becoming clingy around strangers • Crying when the mother is out of sight

• Mimicking mother's facial expressions Explanation: Infants will mimic the facial expressions of their parents when they are 3 to 4 months old. Becoming clingy around strangers probably won't occur until the child reaches 6 months. Engaging in peek-a-boo becomes fun between 6 and 8 months. Crying when the mother is out of sight indicates separation anxiety and is common after 6 to 8 months of age.

A 3-month-old infant has a Moro reflex. Which statement is most true of this reflex? • Most 3-month-old infants still have a Moro reflex. • It is not important how long the reflex persists, only that it is present at birth. • A Moro reflex normally lasts until 9 months. • A Moro reflex present at 3 months of age requires referral for a neurologic exam.

• Most 3-month-old infants still have a Moro reflex. Explanation: The Moro reflex is seen in the infant as a sudden extension of the head with the arms abducted and moving upward. In this position the hands for the letter "C". This reflex is present at birth and disappears around 4 months of age. This reflex is known as the startle reflex because the baby looks startled when this is seen. It is a normal reflex and there is no need for medical intervention. Question 3

During an assessment, the nurse determines that a 3-month-old baby has a Moro reflex. What does this finding indicate to the nurse? • Most 3-month-olds still have a Moro reflex. • It will persist until the age of 1 year. • It usually lasts until 9 months. • If present at 3 months of age, a neurologic exam is needed.

• Most 3-month-olds still have a Moro reflex. Explanation: The Moro reflex will begin to fade at age 5 months and disappear by age 6 months. A Moro reflex at age 9 months or 1 year indicates the need for a neurologic examination. Question 4

The mother of a 3-month-old baby is concerned because the child is not able to sit independently. How should the nurse respond to this mother's concern? • Most babies sit steadily at 3 months. • Most babies sit steadily at 4 months. • Most babies do not sit steadily until 8 months. • Sitting ability and the age of first tooth eruption are correlated.

• Most babies do not sit steadily until 8 months. Explanation: An 8-month-old child can sit securely without any additional support. Babies are not able to sit steadily at age 3 or 4 months. Sitting ability does not correspond with tooth eruption. Question 13

The parent of a 3-month-old infant is concerned because the infant does not yet sit by oneself. Which statement best reflects average sitting ability? • Most infants sit steadily at 4 months; this infant is normal. • Most infants sit steadily at 3 months; this infant is slightly delayed. • Sitting ability and the age of first tooth eruption are correlated. • Most infants do not sit steadily until 8 months; this infant is normal.

• Most infants do not sit steadily until 8 months; this infant is normal. Explanation: At 3 months of age the infant should be able to raise the head about 45 degrees when in the prone position. The infant does yet have the developmental skills for sitting. Most infants are unable to sit steadily until 8 months of age. Gross motor skill development does not correlate with tooth eruption. The nurse should reassure the parent that this infant is on tract developmentally. Question 3

A nurse is educating a client being discharged with her newborn baby. What is the highestpriority item that must be included in the teaching plan? • Keep all pots and pans in lower cabinets. • Lock all cabinets that contain cleaning supplies. • Restrain the baby in a car seat. • Give warm bottles of formula to the baby.

• Restrain the baby in a car seat. Explanation: The client should restrain the baby in a car seat when driving. Infants are especially vulnerable to injuries resulting from falls from changing tables or being unrestrained in automobiles. Locking the cabinets and giving warm bottles of formula to the baby are secondary teachings. Question 10

The nurse is visiting a mother who has a 3-month-old infant who has been hospitalized for cardiac problems. Which nursing diagnosis should the nurse use to guide care for this family at this time? • Disturbed maternal sleep pattern related to infant's feeding schedule • Risk for impaired parenting related to hospitalization of infant • Deficient knowledge related to normal infant growth and development • Health-seeking behaviors related to adjusting to parenthood

• Risk for impaired parenting related to hospitalization of infant Explanation: The diagnosis appropriate for the family whose infant has been hospitalized would be risk for impaired parenting related to hospitalization. There is no evidence to suggest that the mother is not adjusting to parenthood. There is no information about the infant's feeding schedule. There is no information to suggest the mother has a knowledge deficit regarding normal infant growth and development. Question 14

Anticipatory guidance for an infant for the 4th month should include the fact that the infant will be able to achieve which developmental milestone? • have many "blue" or moody periods • develop a fear of strangers • insist on things being done the infant's way • be able to turn over onto the back

• be able to turn over onto the back Explanation: At four months of age, the infant is able to lift the head and look around. The infant can roll from prone to supine. When being pulled up, the head leads. The 4-month-old infant can make simple vowel sounds, laugh aloud, and vocalize in reponse to voices. A fear of strangers does not occur until the child is older and a 4-month-old infant has not developed emotionally to have "moody" periods and is dependent on parental care. Question 5

The best way for an infant's parent to help the child complete the developmental task of the first year is to: • expose the infant to many caregivers to help the infant learn variability. • talk to the infant at a special time each day. • keep the infant stimulated with many toys. • respond to the infant consistently.

• respond to the infant consistently. Explanation: The developmental task of an infant is gaining a sense of trust. The infant develops this sense from the caretakers who respond to the child's needs, such as feeding, changing diapers, being held. It is a continuous process. A sense of trust is difficult to learn if things are constantly changing. Consistently responding to an infant's needs helps to build a sense of trust. An infant is too young to have variability in caretakers. This causes mistrust. The parents or caretakers do not need a special time to talk to the infant each day. It should be done with each interaction. Providing too much stimulus before the infant develops gross motor skills causes frustration from the child and not enjoyment. Question 4