chapter 10, 11 health promotion/problems of the infant

d. Commercial iron-fortified formula For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, then iron-fortified commercial formula should be used. Cow's milk should not be used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron-deficiency anemia.

A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. What does the nurse recommend based on the American Academy of Pediatrics? a. Skim milk b. Whole cow's milk c. Commercial formula without iron d. Commercial iron-fortified formula

a. A Vitamin A deficiency contributes to increased morbidity in measles, diarrhea, and infections. The American Academy of Pediatrics recommends that supplementation be considered in children with measles and related disorders. No correlation exists between vitamin C, niacin, and folic acid and increased morbidity and mortality with measles.

Deficiency of what vitamin correlates with increased morbidity and mortality in children with measles and increased complications from diarrhea and infections? a. A b. C c. Niacin d. Folic acid

b. Infants become less difficult if they are kept on scheduled feedings and structured routines. Children perceived as difficult may respond better to scheduled feedings and structured caregiving routines than to demand feedings and frequent changes in routines. Infant temperament has a strong biologic component. Together with interactions with the environment, primarily the family, the biologic component contributes to the infant's unique temperament. Sara's temperament has been created by both biologic and environmental factors. The nurse should provide guidance in parenting techniques that are best suited to Sara's temperament.

Sara, age 4 months, was born at 35 weeks of gestation. She appears to be developing normally, but her parents are concerned because she is a "more difficult" baby than their other child, who was full term. What response by the nurse is appropriate? a. Infants tend to become more difficult over time. b. Infants become less difficult if they are kept on scheduled feedings and structured routines. c. Behavior is suggestive of failure to completely bond with her parents. d. Difficult temperament is the result of painful experiences in the neonatal period.

b. Middle of the back seat facing rearward. The rear-facing car seat provides the best protection for an infant's disproportionately heavy head and weak neck in the event of an accident. The middle of the back seat is the safest position for the child. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat.

The clinic is loaning a federally approved car seat to a 4.5-kg (10-pounds) infant's family. Where does the nurse teach the family is the most appropriate location to place the infant car seat? a. Back seat facing forward. b. Middle of the back seat facing rearward. c. Front seat with air bags on passenger side. d. Front seat if there is no air bag on the passenger side.

b. 6.3 Birth weight doubles at about ages 5 to 6 months. At 6 months, a child who weighed 3.2 kg at birth would weigh approximately 6.3 kg. The infant would have gone from the 50th percentile at birth to below the 5th percentile; 5.2 kg is too little. The infant would have tripled the birth weight by 6 months; 8.7 kg to 9.6 kg is too much.

The nurse is assessing a 6-month-old healthy infant who weighed 3.2 kg at birth. The nurse would expect the infant to now weigh approximately how many kilograms? a. 5.2 b. 6.3 c. 8.7 d. 9.6

c. Developmental, neurologic evaluation referral Most infants have only slight head lag when pulled from a lying to a sitting position at 4 months of age. By 6 months, head control should be well established. Developmental neurologic evaluation is indicated to determine why the child is not achieving an expected milestone. The head lag is suggestive of a developmental delay. It does not provide information about cognitive status. As part of normal development, interventions cannot be done until a cause is identified.

The nurse is assessing a 6-month-old infant who is noted to have head lag. What is the appropriate response documentation in the chart related to this finding? a. Normal development b. Cognitive impairment noted, follow-up in 1 month c. Developmental, neurologic evaluation referral d. Teach parents to practice exercises with infant

a. Transfer objects from one hand to the other. The ability to transfer objects from one hand to another occurs at about age 7 months. The infant can use one hand for grasping and hold a cube in the other at the same time. A crude pincer grasp develops by ages 8 to 9 months. The ability to hold a crayon and mark on a piece of paper develops between ages 12 and 15 months. Infants can release a cube into a cup at ages 9 to 12 months.

The nurse is assessing a 7-month old infant during a well baby exam. What does the nurse anticipate for fine motor development for this infant? a. Transfer objects from one hand to the other. b. Use the thumb and index finger in crude pincer grasp. c. Hold a crayon and make a mark on paper. d. Release cubes into a cup.

a. Health practices of the facility Health practices should be most important. With the need for diaper changes and assistance with feeding, young children are at increased risk when hand washing and other hygienic measures are not consistently used. A structured learning environment is not the highest priority for a child this age. The socioeconomic status of the children should have little effect on the choice of facility. Cultural similarities may be important to some families, but the facility's health care practices are more important.

The nurse is providing information to parents asking about selecting a daycare facility for their child. What does the nurse instruct the parents as important to consider when making the selection? a. Health practices of the facility b. Structured learning environment c. Socioeconomic status of the children d. Cultural similarities of the children

d. Reassure the parent that periods of "unexplained fussiness" can be normal. A crying infant can be a source of great distress for parents. There is great variability in the amount of crying that can be expected from an infant. Parents should be reassured that some crying without apparent cause is normal. Persistent and inconsolable crying may need further attention. Reassuring the parent that nothing is wrong negates the parent's concern about the child. The parent is responding to cues from the infant by feeding and changing diapers. There is no evidence that an attachment issue exists. The parent is seeking information about how to care for the infant.

The parent of a 10-week-old infant tells the nurse, "She cries sometimes when nothing is wrong—for example, when she is dry and has recently been fed." What is the appropriate response by the nurse? a. Reassure the parent that nothing is wrong. b. Explain how to better interpret infant cues. c. Evaluate for failure of the parent to bond with the infant. d. Reassure the parent that periods of "unexplained fussiness" can be normal.

c. Start putting her to bed while still awake and while the parent is present. Current research suggests that parents be present at bedtime until the child is drowsy. The child should then be allowed to fall asleep alone. This encourages self-soothing behaviors. Children who learn to fall asleep on their own have longer sustained sleep periods than those who fall asleep with parents present. Letting the child cry herself back to sleep is difficult to implement for many parents. Co-bedding could be unsafe at this age. The type of feeding will not affect the child's sleep pattern.

The parents of a 3-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hr during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. What would the nurse suggest to help them deal with this problem? a. Let her cry herself back to sleep. b. Put her in parents' bed to cuddle. c. Start putting her to bed while still awake and while the parent is present. d. Give her a bottle of formula instead of breastfeeding her so often at night.

c. Eggs, cow's milk, and peanuts Milk products, eggs, and peanuts are three of the most common food allergens. Ingestion of these products can cause sensitization and, with subsequent exposure, an allergic reaction. Eggs are a common allergen but not fruit or rice. Wheat is a common allergen but not fruit and vegetables. Cow's milk is a common allergen but not green vegetables.

What are the most common food allergens that need to be considered when educating parents of an infant? a. Fruit, eggs, and rice b. Fruit, vegetables, and wheat c. Eggs, cow's milk, and peanuts d. Cow's milk and green vegetables

b. Actively searches for a hidden object. During the first 6 months of life, infants believe that objects exist only as long as they can see them. When infants search for an object that is out of sight, this signals the attainment of object permanence, whereby an infant knows an object exists even when it is not visible. The ability to understand cause and effect is part of secondary schema development, which is a later developmental task. Between ages 8 and 12 weeks, infants begin to respond differentially to their mothers. They cry, smile, vocalize, and show distinct preference for the mother. This preference is one of the stages that influences the attachment process but is too early for object permanence. Recognizing familiar objects is an important transition for the infant, but it does not signal object permanence.

What behavior indicates that an infant has developed object permanence? a. Secures objects by pulling on a string. b. Actively searches for a hidden object. c. Recognizes familiar face, such as mother. d. Recognizes familiar object, such as bottle.

c. Preventing infection of lesions The lesions of atopic dermatitis are itchy. New lesions develop when the skin is scratched. This cycle leads to the possibility of infection. Although keeping the baby content and maintaining adequate nutrition are important, decreasing the amount of scratching is a primary aim. Antibiotics are not the primary treatment of atopic dermatitis.

What consideration is important in educating parents of an infant with atopic dermatitis (eczema)? a. Keeping the baby content b. Maintaining adequate nutrition c. Preventing infection of lesions d. Applying antibiotics to lesions

d. Families using yogurt as primary source of milk Yogurt does not contain adequate amounts of vitamins A and D. Commercial formulas have recommended amounts of vitamin D. Lack of sunlight is a causative factor. Individuals who follow a lacto-ovovegetarian diet use dairy products and can obtain sufficient vitamin D.

What dietary concerns place infants at risk for developing vitamin D-deficiency rickets? a. Exclusively formula fed b. Exposure to daily sunlight c. Mothers who are lacto-ovovegetarians d. Families using yogurt as primary source of milk

a. Grains and legumes Eating grains (cereal, rice, and pasta) and legumes (beans, peas, lentils, and peanuts) at the same meal provides the appropriate amount of essential amino acids. Grains and vegetables, legumes and vegetables, and milk products and fruit are combinations that do not provide the appropriate amounts of essential amino acids.

What food combinations will generally provide the appropriate amounts of essential amino acids for someone who is a vegetarian? a. Grains and legumes b. Grains and vegetables c. Legumes and vegetables d. Milk products and fruit

c. Change the infant's position frequently. Changing the infant's position frequently may be beneficial. The parent can walk holding the child face down and with the child's abdomen across the parent's arm. The parent's hand can support the child's abdomen, applying gentle pressure. Pacifiers can be used for meeting additional sucking needs. Gently massaging the abdomen is effective in some children. The child should not be placed where he or she cannot be monitored. The child can be placed in the crib and allowed to cry. Periodically, the child should be picked up and comforted.

What information on relieving colic would a nurse include in teaching a parents of an infant with the diagnosis? a. Avoid using a pacifier. b. Avoid touching the abdomen. c. Change the infant's position frequently. d. Place the infant where the family cannot hear the crying.

b. Foods should be introduced one at a time at intervals of 5 to 7 days. One food item is introduced at intervals of 5 to 7 days to allow the identification of food allergies. Iron-fortified cereal should be the first solid food introduced into the infant's diet. Mixing solid foods in a bottle has no effect on the transition to solid food. Solid foods can be introduced earlier than 8 to 10 months. The extrusion reflex usually disappears by age 6 months.

What information would the nurse give a mother regarding the introduction of solid foods during infancy? a. Fruits and vegetables should be introduced into the diet first. b. Foods should be introduced one at a time at intervals of 5 to 7 days. c. Solid foods can be mixed in a bottle to make the transition easier for the infant. d. Solid foods should not be introduced until 8 to 10 months when the extrusion reflex begins to disappear.

b. Having the infant sleep in the supine position The supine position is recommended for all infants while sleeping. Smoking in the infant's environment increases the infant's risk for SIDS by 1.9%. There is a positive association between bed sharing with parents and SIDS. Thermal stress or overheating is associated with an increased risk of SIDS.

What intervention lowers the risk of sudden infant death syndrome (SIDS)? a. Smoking near the infant b. Having the infant sleep in the supine position c. Having the infant sleep with the parents instead of alone in a crib d. Making certain the infant is kept very warm while sleeping

a. Establish a structured routine, which is followed consistently. An infant with failure to thrive should have a structured routine that is followed consistently. Disruptions in other activities of daily living can have a great impact on feeding behaviors. Bathing, sleeping, dressing, playing, and feeding are structured. The child can engage in sensory and play activities at times other than mealtimes. Young children should be held while being fed, and older children can sit at a feeding table. The child should be fed in the same manner at each meal. The nurse should talk to the child by giving directions about eating. This will help the child maintain focus.

What is an important nursing consideration when caring for an infant with failure to thrive? a. Establish a structured routine, which is followed consistently. b. Limit sensory stimulation and play activities to alleviate fatigue. c. Place the child in an infant's seat during feedings to prevent overstimulation. d. Maintain a nondistracting environment by not speaking to the child during feeding.

a. Has a multifactorial etiology. Current evidence suggests a multifactorial causation, including cultural, psychologic, and infective factors that interact to place the child at risk. Kwashiorkor appears in infants after being weaned from the breast after the birth of another child. No correlation exists between vitamin K and kwashiorkor. Protein deficiency exists in children with kwashiorkor.

What is most descriptive of kwashiorkor? a. Has a multifactorial etiology. b. Occurs primarily in breastfed infants. c. Results from excessive amounts of vitamin K. d. Is related to inadequate calories but adequate protein.

a. Trust During the first year of life, the infant focuses on the task of developing a sense of trust of self, of others, and of the world. This presents challenges for infants who are separated from parents or consistent caregivers. Industry is the focus of school-age children. Preschoolers are engaged in acquiring initiative. Autonomy is a developmental task during the toddler years.

What is the primary task of development in infancy, according to Erikson's stages? a. Trust b. Industry c. Initiative d. Autonomy

b. Parachute The parachute reflex appears at 7 to 9 months of age and persists indefinitely. The Moro reflex is one of the primitive reflexes present at birth. Neck righting appears at 3 months of age and persists until 24 to 36 months. Labyrinth righting appears at 2 months and is strongest at 10 months.

What reflexes appear at about 7 to 9 months of age? a. Moro b. Parachute c. Neck righting d. Labyrinth righting

b. C Vitamin C increases the absorption of iron for hemoglobin formation. No correlation exists between vitamins B12, D, and biotin and iron absorption.

What vitamin increases the absorption of iron? a. B12 b. C c. D d. Biotin