Chapter 9 Health Promotion of the Infant and Family

A nurse is caring for a 5-month-old infant. When the infant is pulled to a sitting position the nurse notes an absence of head lag. What should the nurse understand about this finding? (p. 303) 1 This is a normal finding. 2 The infant may have a cognitive delay. 3 The infant is developmentally delayed. 4 This finding is evidence of child abuse.

1 Absence of head lag at 5 months of age is a normal finding. It is not indicative of developmental or cognitive delay, nor is it evidence of child abuse.

The nurse recognizes that growth and development of children is subject to progressive maturation. How can the nurse describe growth during the first year of life? (p. 301) 1 Growth is especially rapid during the first 6 months of the first year of life. 2 Growth is especially rapid during the final 3 months of the first year of life. 3 Height slows during the first 6 months of life and increases during second 6 months. 4 Head circumference increases by approximately 2 cm during the first 6 months of life.

1 Growth is especially rapid during the first 6 months of the first year of life. Growth slows a little during the second 6 months of the first year of life. Height slows during the initial 6 months of life and increases during second 6 months. Head circumference increases by about 1.5 cm, rather than 2 cm, during the first 6 months of life.

A 6-month-old infant has been recently diagnosed with iron deficiency anemia and is treated with iron supplements. After 2 days the parent of the infant complains of black stools in the infant and is very worried about it. What advice should be given to the parent? (p. 318) 1 Black stools are one of the common side effects of iron supplements; hence there is no need to worry. 2 Iron supplements should be stopped immediately, and the health care provider should be consulted. 3 Iron supplements may cause bleeding in the upper GI tract and should be investigated further. 4 Iron supplements may cause bleeding in the lower GI tract and should be investigated further.

1 Parents of the child should be informed about common side effects of iron supplements. One of them is the stools turning black or tarry green. When this occurs, parents need not worry, and they can continue giving iron supplements. The iron supplement should not be stopped, because the child has iron deficiency anemia. Black stools are not indicative of upper or lower GI bleeding when the iron supplements are administered.

Which intervention lowers the risk of sudden infant death syndrome (SIDS)? (p. 308) 1 Placing the infant in the supine position to sleep 2 Making certain that the infant is kept very warm while sleeping 3 Keeping the window open when anyone is smoking near the infant 4 Letting the infant sleep with the parents instead of alone in the crib

1 The Back to Sleep Campaign is credited with reducing the rate of sudden infant death syndrome (SIDS) in the United States, and states that placing the infant in the supine position can help reduce its incidence. Overheating also increases the risk of SIDS. Smoking increases the risk of SIDS because the infant is exposed to pulmonary irritants. Having the infant sleep with the parents (co-sleeping) increases the risk of SIDS.

The mother of a 3-month-old breastfed infant asks about giving the baby water because it is summer and very warm. What should the nurse tell the mother? (p. 319) 1 Fluids in addition to breast milk are not needed. 2 Water should be given if the infant seems to nurse longer than usual. 3 Clear juice is better than water for promoting adequate fluid intake. 4 Water once or twice a day will make up for losses due to environmental temperature.

1 The child will nurse according to his or her needs. Additional fluids are not necessary for a breastfed baby. Water is not a replacement for breast milk. Infants should take as much breast milk as they desire; this will meet their fluid requirements. Breast milk will provide the fluids that the infant requires. Supplementation with water is not necessary. Clear juices should not be given to a 3-month-old infant. Breast milk will provide the necessary calories and fluid intake that an infant requires, even in the warm summer months.

According to Erikson, infancy is concerned with acquiring a sense of what? (p. 309) 1 Trust 2 Industry 3 Initiative 4 Separation

1 The task of infancy is the development of trust. If the infant is not successful with this task, then mistrust develops. Industry versus inferiority is the developmental task of school-age children. Initiative versus guilt is the developmental task of preschoolers. Separation occurs during the sensorimotor stage, as described by Piaget.

The nurse is assessing a healthy 6-month-old infant who weighed 3.5 kg at birth. Approximately how many kilograms does the nurse expect the infant to weigh now? (p. 301) 1 5.5 2 7.0 3 8.8 4 9.8

2 Birth weight doubles around 5 to 6 months of age. At 6 months a child who weighed 3.5 kg at birth should weight approximately 7.0 kg. Five-and-a-half kilograms is too little weight gain for this infant. A weight of either 8.8 kg or 9.8 kg at the 6-month visit would represent a tripling of the birth weight, which is too much.

A parent works the night shift and keeps the expressed breast milk in the freezer at the office and brings frozen milk home to feed the baby. What is the best way to warm the frozen milk before feeding the baby? (p. 319) 1 Place the container with frozen expressed milk in a microwave to warm it. 2 Place the container with frozen milk in a lukewarm water bath to warm it. 3 Place the expressed milk in refrigerator overnight and heat it on stove next day. 4 Place the expressed milk in refrigerator overnight and warm it in microwave.

2 Frozen milk should be warmed slowly and evenly by placing the container in a lukewarm water bath.

A parent of an 8-month-old infant expressed that the infant cannot walk even a few steps and is unable to sit without support. The nurse gave a toy to the infant and found that the infant was able to transfer the toy between the hands. What should be the most appropriate response of the nurse to the parent? (p. 304) 1 "I'm sorry to hear about the developmental delay in your baby." 2 "At this age the babies do not walk; they may walk after a few months more." 3 "I understand your concern; we will make your child walk very soon." 4 "At this age infants are expected to play comfortably with strangers."

2 The parent should be informed that an 8-month-old baby cannot walk without support. However the baby may be able to sit without support and transfer objects between the hands. Because the baby's development is normal, the nurse should not say that the baby has developmental delay. The nurse should not give false assurance, because it is impossible to make the 8-month-old baby walk without support. Children between the ages of 6 to 8 months do not like to play with strangers.

A 4-month-old baby sustained minor oral burns from drinking hot milk. The nurse learns that the parent had warmed the expressed breast milk in a microwave for 3 minutes before giving it to the baby. What should the nurse advise the parent? (p. 319) 1 Warm the expressed milk in the microwave only for 1 minute. 2 Never use a microwave for warming the expressed breast milk. 3 Warm the expressed milk in the microwave for 30 seconds only. 4 Provide only chilled milk to the baby to avoid oral burns.

2 (I put 4) Parents should be advised that they should never thaw or rewarm expressed milk in a microwave because it can cause uneven warming of milk and result in oral burns. They should be advised to thaw the frozen milk by either placing it in lukewarm water.

A mother expresses concern because her 6-month-old daughter has been drooling, sucking more often on her fingers, and biting on objects. What are these behaviors most likely associated with? (p. 317) 1 Illness 2 Cavities 3 Teething 4 Viral disease

3 A 6-month-old infant who is drooling, sucking on her fingers, and biting on toys and other objects is most likely teething. Illness generally manifests as vomiting, fever, or diarrhea. Cavities are not typically a problem for 6-month-old infants. Viral disease is generally marked by signs and symptoms of vomiting, rash, fever, or diarrhea.

The nurse in a well baby clinic finds that a 2-month-old baby is not gaining weight. The nurse learns that the mother, who is working, gives expressed breast milk to the baby. The mother works for 8 hours and expresses milk once during this time. What should the nurse advise the mother? 1 Instruct the mother to quit job and breastfeed the baby. 2 Instruct the mother to take the baby along to the office. 3 Instruct the mother to express milk at least every 3 to 4 hours. 4 Advise the mother to switch to infant formula milk for the baby.

3 Employed mothers should be encouraged to continue breastfeeding with appropriate guidance. At home they can breastfeed on demand. But when at the workplace, they should express their milk at least every 3 to 4 hours to maintain adequate milk supply. This milk can be stored in the refrigerator at the workplace and can be fed to the baby. The mother should not be advised to quit the job or take the baby along to the office, because these actions are not feasible. The mother should not be advised to switch to infant formula milk, because breast milk is the best source of nutrition.

The mother of a 12-month-old boy tells the nurse that she is very concerned because her child is still sucking his thumb. She asks the nurse how she can get her child to stop this "annoying behavior." Before giving advice, what should the nurse do? 1 Report the mother's concerns to the proper authorities. 2 Ignore the mother's concerns because the behavior is normal. 3 Investigate the mother's feelings regarding her son's behavior. 4 Assure that the mother that her son's thumb-sucking is not her fault.

3 It is important for the nurse to examine the mother's feelings and then base advice on the information that the parent has provided. It is not necessary to report the mother's concerns to the proper authorities, and ignoring the mother's concerns is inappropriate. It is not helpful to assure the mother that her son's thumb-sucking is not her fault.

The parent of a 10-month-old infant tells the nurse that the baby cries and screams whenever being left with the grandparents. What is the nurse's best response? (p. 314) 1 The infant is most likely spoiled. 2 The grandparents are not responsive to the infant. 3 Stranger anxiety is common for an infant of this age. 4 Separation anxiety should have disappeared between 4 and 8 months of age.

3 The infant is experiencing stranger anxiety, which is expected for an infant of this age. Stranger anxiety usually develops by between 6 and 8 months of age and begins to disappear at about 1 year of age. The behavior the infant is exhibiting is normal and not indicative of a spoiled child. Separation anxiety is common between 6 and 8 months of age. There are no data to support the conclusion that the grandparents are not responsive to the infant.

The nurse, while performing an assessment of a 12-month-old infant, discovers that the infant cannot pull himself to a standing position. For what should the infant be further evaluated? (p. 309) 1 Lordosis 2 Kyphosis 3 Osteogenesis imperfecta 4 Developmental dysplasia of the hip

4 An infant who does not pull to a standing position by 11 to 12 months of age should be further evaluated for developmental dysplasia of the hip. Lordosis and kyphosis do not affect the infant's ability to pull to a standing position. Osteogenesis imperfecta is a rare heterogeneous autosomal dominant disorder characterized by fractures and bone deformity.

The mother of a 6-month old infant tells the nurse she is concerned about her son's nutrition because he pushes the spoonful of baby food away as soon as she brings it to his mouth. What is the most appropriate response to the mother's concern? (p. 320) 1 "It's important not to give into this kind of controlling behavior at this age." 2 "He's old enough to feed himself. Just hand him the spoon and let him try." 3 "Maybe you need to try a different type of spoon designed for infants." 4 "Just keep presenting the spoon to him even though he pushes it away."

4 (I put 3) When the spoon is first introduced, around 6 months of age, the infant often pushes it away and appears dissatisfied. The behavior is not controlling; rather, it is developmentally appropriate. This child is not old enough to feed himself. The infant does not typically need a different spoon; this behavior is developmentally appropriate.