Infant development and safety
At which age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? a. 1 month b. 2 months c. 3 months d. 4 months
ANS: B At age 2 months, the infant has a social, responsive smile. A reflex smile is usually present at age 1 month. A 3-month-old infant can recognize familiar faces. At age 4 months, infants can enjoy social interactions.
The nurse notices a baby in the waiting room. The baby is sitting on the mother's lap and picking up small green peas out of a bowl with a true pincer grasp and eating them unassisted. The nurse knows that this baby is at least how many months old? a. 4 to 6 b. 7 to 9 c. 10 to 12 d. 13 to 15
C Correct. By 10 months of age, the infant's pincer grasp is more refined and reflected in the ability to grasp small finger foods such as green peas.
At which age can most infants sit steadily unsupported? a. 4 months b. 6 months c. 8 months d. 12 months
ANS: C Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months, an infant can sit with support. At age 6 months, the infant will maintain a sitting position if propped. By 10 months, the infant can maneuver from a prone to a sitting position.
At which age does an infant start to recognize familiar faces and objects, such as his or her own hand? a. 1 month b. 2 months c. 3 months d. 4 months
ANS: C The child can recognize familiar objects at approximately age 3 months. For the first 2 months of life, infants watch and observe their surroundings. The 4-month-old infant is beginning to develop hand-eye coordination.
According to Erikson, the psychosocial development of an infant is centered around the concept of: a. trust versus mistrust b. pleasure versus pain c. growth versus failure to grow d. love versus hate
A Correct. Erikson's psychosocial development of an infant is centered around the concept of trust versus mistrust.
2. A 5 day old infant comes in for a newborn checkup. On assessment of the newborn, you note that the skin is jaundice in color. The anterior fontanel is slightly sunken. Per mom, the infant has only had 2 diapers today. The infant is strictly breastfed and this is mom's first child. She states baby is having trouble latching on. A bilirubin level is sent and comes back at 18. You identify this newborn to be dehydrated and is most likely to have breast milk jaundice. Which nursing intervention(s) will be required for this baby? 1. Phototherapy 2. Providing support and education for the lactating mother 3. Strict monitoring of intake and output 4. All of the above
ANS 4 Feedback 1. Phototherapy will be required to help decrease the level of bilirubin. 2. It is important to provide the mother with support and education and offer a lactation specialist. 3. This infant is dehydrated so it will be necessary to monitor strict I & O's. 4. Breast Milk Jaundice occurs in 1-2% of breastfed babies. At early onset there are poor feeding patterns and bilirubin levels may spike to 19. It is important to provide the mother with support and education and offer a lactation specialist. This infant is dehydrated so it will be necessary to monitor strict I & O's. Phototherapy will be required to help decrease the level of bilirubin.
A mother is concerned that every time she leaves the hospital room to take a break, her 8 month old cries. The nurse explains to the mother that this is normal behavior and that her infant is experiencing 1. Safety issues 2. Separation anxiety 3. Irritability 4. Colic
ANS: 2 Feedback 1. The child is too young to know about safety issues 2. Between the ages of 6 and 9 months, infants suffer from separation anxiety and can be sensitive to caregiver cues 3. The child only cries when the mother leaves, if irritable the child would cry more often 4. The child is past the age of colic occurring
A part of injury prevention is making and keeping infant appointments. The required checkups and vaccinations are at: 1. 3 months, 6 months, 9 months 2. 2 months, 4 months, 6 months and 1 year 3. 2 months, 4 months, 6 month, 9 months and 1 year 4. 2 months, 4 months, 9 months and 1 year
ANS: 3 Feedback 1. It is recommended that a routine check-up with vaccinations be done at 2 months, 4 months, 6 months, 9 months and 1 year of age. 2. It is recommended that a routine check-up with vaccinations be done at 2 months, 4 months, 6 months, 9 months and 1 year of age. 3. It is recommended that a routine check-up with vaccinations be done at 2 months, 4 months, 6 months, 9 months and 1 year of age. 4. It is recommended that a routine check-up with vaccinations be done at 2 months, 4 months, 6 months, 9 months and 1 year of age.
1. A mother brings her 9 month infant in for a routine visit. What milestone would be appropriate for the doctor to ask if the infant is meeting? 1. Walking 2. Speaking in two word phrases 3. Rolls back to stomach and stomach to back 4. All of the above
ANS: 3 Feedback 1. Between 10-12 months of age, an infant can walk 2. Between 14-16 months of age, an infant can speak two word phrases 3. Between 6 and 9 months of age, an infant can roll from back to stomach and stomach to back. 4. Many infants will not be walking at this age. It is too soon for word phrases to be developed. The child should be rolling.
On assessment of a 6 month old infant you note that the anterior fontanel is flat and soft and the posterior fontanel is no longer palpable. This is an appropriate finding because the posterior fontanel closes at: 1. 6 months 2. 4 months 3. 2 months 4. 5 months
ANS: 3 The posterior fontanel is triangular in shape, 1-2 cm and closes in the 2nd month.
Highlights in education for promoting safety in infants involves 1. Burns and car seat safety 2. Preventing choking and poisoning 3. Safe Sleep 4. All the above
ANS: 4 Feedback These 5 topics are important for parents and caregivers to be aware of when it comes to infant safety. It is helpful to provide anticipatory guidance to parents at time of discharge so that they can prepare for their child's growth.
In teaching parents about appropriate pacifier selection, the nurse should recommend which characteristic? a. Easily grasped handle b. Detachable shield for cleaning c. Soft, pliable material d. Ribbon or string to secure to clothing
ANS: A A good pacifier should be easily grasped by the infant. One-piece construction is necessary to avoid having the nipple and guard separate, posing a risk for aspiration. The material should be sturdy and flexible. If the pacifier is too pliable, it may be aspirated. No ribbon or string should be attached. This poses additional risks.
An infant, age 5 months, is brought to the clinic by his parents for a well-baby checkup. What is the best advice that the nurse should include at this time about injury prevention? a. "Keep buttons, beads, and other small objects out of his reach." b. "Do not permit him to chew paint from window ledges because he might absorb too much lead." c. "When he learns to roll over, you must supervise him whenever he is on a surface from which he might fall." d. "Lock the crib sides securely because he may stand and lean against them and fall out of bed."
ANS: A Aspiration of foreign objects is a great risk at this age. Parents are instructed to keep small objects out of the infant's reach. At this age, the child is not mobile enough to reach window sills. If window sills have cracked or chipped paint, it needs to be removed before he is a toddler. This child should already be rolling over. This information is reinforced but should have been taught earlier. Pulling to a stand occurs between 8 and 12 months of age.
The nurse advises the mother of a 3-month-old exclusively breastfed infant to a. Start giving the infant a vitamin D supplement. b. Start using an infant feeder and add rice cereal to the formula. c. Start feeding the infant rice cereal with a spoon at the evening feeding. d. Continue breastfeeding without any supplements.
ANS: A Feedback A Breast milk does not provide an adequate amount of dietary vitamin D. Infants who are exclusively breastfed need vitamin D supplements to prevent rickets. B An infant feeder is an inappropriate method of providing the infant with caloric intake. Solid foods are not recommended for a 3-month-old infant. C Rice cereal and other solid foods are contraindicated in a 3-month-old infant. Solid feedings do not typically begin before 4 to 6 months of age. D Because breast milk is not an adequate source of fluoride, infants need to be given a fluoride supplement in addition to a vitamin D supplement.
In terms of fine motor development, what should the 7-month-old infant be able to do? a. Transfer objects from one hand to the other. b. Use thumb and index finger in crude pincer grasp. c. Hold crayon and make a mark on paper. d. Release cubes into a cup.
ANS: A Feedback A-By age 7 months, infants can transfer objects from one hand to the other, crossing the midline. B-The crude pincer grasp is apparent at approximately age 9 months. C-The child can scribble spontaneously at age 15 months. D-At age 12 months, the child can release cubes into a cup.
In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? a. Roll from abdomen to back. b. Roll from back to abdomen. c. Sit erect without support. d. Move from prone to sitting position
ANS: A Feedback A-Rolling from abdomen to back is developmentally appropriate for a 5-month-old infant. B-The ability to roll from back to abdomen usually occurs at 6 months old. C-Sitting erect without support is a developmental milestone usually achieved by 8 months. D-The 10-month-old infant can usually move from a prone to a sitting position.
Which is appropriate play for a 6-month-old infant? a. Pat-a-cake, peek-a-boo b. Ball rolling, hide-and-seek game c. Bright rattles and tactile toys d. Push and pull toys
ANS: A Feedback A-Six-month-old children enjoy playing pat-a-cake and peek-a-boo. B-Nine-month-old infants enjoy rolling a ball and playing hide-and-seek games. C-Four-month-old infants enjoy bright rattles and tactile toys. D-Twelve-month-old infants enjoy playing with push and pull toys.
A 3-month-old infant born at 38 weeks of gestation will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. The nurse should interpret this as a. Normal development b. Significant developmental lag c. Slightly delayed development as a result of prematurity d. Suggestive of a neurologic disorder such as cerebral palsy
ANS: A Feedback A-This is indicative of normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. B-The infant is expected to be able to perform this task by age 3 months. If the child's age is corrected because of being 2 weeks preterm, the child is at the midpoint of the range for this developmental task. C-The infant is expected to be able to perform this task by age 3 months. If the child's age is corrected because of being 2 weeks preterm, the child is at the midpoint of the range for this developmental task. D-The child is age-appropriate. No evidence of neurologic dysfunction is present.
What activity would the nurse choose to meet Erikson's developmental task of industry when caring for a 7-year-old? a. Completing a 50-piece jigsaw puzzle b. Looking at a comic book c. Playing a game of "I Spy" with the nurse d. Coloring a picture in a coloring book
ANS: A In the developmental period of late childhood, children are striving to develop a sense of industry. The completion of a jigsaw puzzle is industrious play.
The nurse is assessing a 1-year-old infant in the pediatric office. What finding should the nurse report to the physician immediately? a. Respiratory rate of 60 breaths per minute b. Pulse rate of 100 beats per minute c. Minimal verbalization d. Fussy behavior
ANS: A Respirations of a 1-year-old should be 20 to 40 breaths per minute. Increased respiratory rate can lead to distress and should be reported immediately. Pulse rate of 100 to 140 beats/minute is normal. Minimal verbalization and fussy behavior are not emergency situations or abnormal for this age.
The parent of a 3-month-old infant asks the nurse, "At what age do infants usually begin drinking from a cup?" What is the nurse's most accurate response? a. 5 months b. 9 months c. 1 year d. 2 years
ANS: A The infant can usually drink from a cup when it is offered at about 5 months.
What should the teaching plan include about infant fall precautions? (Select all that apply.) a. Remove all unsteady furniture. b. Keep crib rails up and in locked position. c. Steady infant with hand when on changing table. d. Use tray attachment on high chair as restraint. e. Keep infant seat on the floor.
ANS: A, B, C, E The tray attachment to a high chair is an inadequate restraint. All other options are good precautions to prevent an infant from a fall.
The nurse is preparing to outline principles of discipline for parents of an infant. What information should the nurse include? (Select all that apply.) a. Firmly say "No." b. Distract the child to another activity. c. Bribe the child with a sweet treat. d. Remain consistent. e. Ignore the child until behavior improves.
ANS: A, B, D Parental approval is important to the infant, and setting limits early is important (Anderson, 2008). Principles of discipline for an infant include lowering the voice to say "no" firmly, removing the child from the situation, distraction, and consistency.
The nurse is evaluating a 7-month-old infant's cognitive development. Which behaviors should the nurse anticipate evaluating? (Select all that apply.) a. Imitates sounds b. Shows interest in a mirror image c. Comprehends simple commands d. Actively searches for a hidden object e. Attracts attention by methods other than crying
ANS: A, B, E A 7-month-old infant is in the secondary circular reactions (4-8 months) stage of cognitive development. Behaviors in this stage include imitating sounds, showing interest in a mirror image, and attracting attention by methods other than crying. Comprehending simple commands and actively searching for a hidden object are behaviors seen in the coordination of secondary schemas (9-12 months).
Parents attending a well visit for their 11-year-old son verbalize concern over his computer use. When asked about it, the boy states, "I play games on my computer for 1 hour a day." The nurse knows that computer games can provide what opportunities to childhood development? (Select all that apply.) a. Problem-solving skills b. Gross motor development c. Manipulative skills d. Learning opportunities e. Increased self-worth
ANS: A, C, D Computer programs are popular with all age groups, providing problem-solving skills, manipulative skills, and opportunities for new learning.
A nurse has completed a teaching session for parents about "baby-proofing" the home. Which statements made by the parents indicate an understanding of the teaching? Select all that apply. a. "We will put plastic fillers in all electrical plugs." b. "We will place poisonous substances in a high cupboard." c. "We will place a gate at the top and bottom of stairways." d. "We will keep our household hot water heater at 130 degrees." e. "We will remove front knobs from the stove.
ANS: A, C, E Feedback Correct By the time babies reach 6 months of age, they begin to become much more active, curious, and mobile. Putting plastic fillers on all electrical plugs can prevent an electrical shock. Putting gates at the top and bottom of stairways will prevent falls. Removing front knobs form the stove can prevent burns. Incorrect Poisonous substances should be stored in a locked cabinet not in a cabinet that children can reach when they begin to climb. The household hot water heater should be turned down to 120 degrees or less.
The nurse is discussing development and play activities with the parent of a 2-month-old boy. Which statement by the parent would indicate a correct understanding of the teaching? a. "I can give my baby a ball of yarn to pull apart or different textured fabrics to feel." b. "I can use a music box and soft mobiles as appropriate play activities for my baby." c. "I should introduce a cup and spoon or push-pull toys for my baby at this age." d. "I do not have to worry about appropriate play activities at this age."
ANS: B Music boxes and soft mobiles are appropriate play activities for a 2-month-old infant. A ball of yarn to pull apart or different textured fabrics are appropriate for an infant at 6 to 9 months. A cup and spoon or push-pull toys are appropriate for an older infant. Infants of all ages should be exposed to appropriate types of stimulation.
The nurse discusses child-proofing the home for safety with the mother of a 9-month-old. Which statement made by the mother would indicate an unsafe behavior? a. "I put covers on all of the electrical outlets." b. "In the car, she rides in a front-facing car seat." c. "There are locks on all of the cabinets in the house." d. "I have a gate at the top and bottom of the stairs."
ANS: B A rear-facing infant car seat should be used for infants younger than 1 year of age.
A parent brings a 6-month-old infant to the pediatric clinic for her well-baby examination. Her birth weight was 8 pounds, 2 ounces. What will the nurse weighing the infant today would expect her weight to be? a. At least 12 pounds b. At least 16 pounds c. At least 20 pounds d. At least 24 pounds
ANS: B Birth weight is usually doubled by 6 months of age.
Which statement made by a mother is consistent with a developmental delay? a. "I have noticed that my 9-month-old infant responds consistently to the sound of his name." b. "I have noticed that my 12-month-old child does not get herself to a sitting position or pull to stand." c. "I am so happy when my 1 1/2-month-old infant smiles at me." d. "My 5-month-old infant is not rolling over in both directions yet."
ANS: B Feedback A-An infant who responds to his name at 9 months of age is demonstrating abilities to both hear and interpret sound. B-Critical developmental milestones for gross motor development in a 12-month-old include standing briefly without support, getting to a sitting position, and pulling to stand. If a 12-month-old child does not perform these activities, it may be indicative of a developmental delay. C-A social smile is present by 2 months of age. D-Rolling over in both directions is not a critical milestone for gross motor development until the child reaches 6 months of age.
What is the earliest age at which the infant should be able to walk independently? a. 8 to 10 months b. 12 to 15 months c. 15 to 18 months d. 18 to 21 months
ANS: B For the majority of children, the milestone of walking alone is achieved between 12 and 15 months.
In terms of gross motor development, what should the nurse expect an infant age 5 months to do? a. Sit erect without support. b. Roll from the back to the abdomen. c. Turn from the abdomen to the back. d. Move from a prone to a sitting position.
ANS: C Rolling from the abdomen to the back is developmentally appropriate for a 5-month-old infant. The ability to roll from the back to the abdomen is developmentally appropriate for an infant at age 6 months. Sitting erect without support is a developmental milestone usually achieved by 8 months. A 10-month-old infant can usually move from a prone to a sitting position.
During the 2-month well-child checkup, the nurse expects the infant to respond to sound in which manner? a. Respond to name. b. React to loud noise with Moro reflex. c. Turn his or her head to side when sound is at ear level. d. Locate sound by turning his or her head in a curving arc.
ANS: C At 2 months of age, an infant should turn his or her head to the side when a noise is made at ear level. At birth, infants respond to sound with a startle or Moro reflex. An infant responds to his or her name and locates sounds by turning his or her head in a curving arc at age 6 to 9 months.
At which age should the nurse expect most infants to begin to say "mama" and "dada" with meaning? a. 4 months b. 6 months c. 10 months d. 14 months
ANS: C Beginning at about age 10 months, an infant is able to ascribe meaning to the words "mama" and "dada." Four to 6 months is too young for this behavior to develop. At 14 months, the child should be able to attach meaning to these words. By age 1 year, the child can say three to five words with meaning and understand as many as 100 words.
By which age should the nurse expect that an infant will be able to pull to a standing position? a. 5 to 6 months b. 7 to 8 months c. 11 to 12 months d. 14 to 15 months
ANS: C Most infants can pull themselves to a standing position at age 9 months. Infants who are not able to pull themselves to standing by age 11 to 12 months should be further evaluated for developmental dysplasia of the hip. At 6 months, infants have just obtained coordination of arms and legs. By age 8 months, infants can bear full weight on their legs.
Which milestone is developmentally appropriate for a 2-month-old infant? a. Pulled to a sitting position, head lag is absent. b. Pulled to a sitting position, the infant is able to support the head when the trunk is lifted. c. The infant can lift his or her head from the prone position and briefly hold the head erect. d. In the prone position, the infant is fully able to support and hold the head in a straight line.
ANS: C A - A 2-month-old infant's neck muscles are stronger than those of a newborn; however, head lag is present when pulled to a sitting position. B - A 2-month-old infant continues to have some head lag when pulled to a sitting position. C - A 2-month-old infant is able to briefly hold the head erect when in a prone position. If a parent were holding the infant against the parent's shoulder, the infant would be able to lift his or her head briefly. D - It is not until 4 months of age that the infant can easily lift his or her head and hold it steadily erect when in the prone position.
What toy is developmentally appropriate for the nurse to suggest to entertain a 5-year-old child? a. Jack-in-the-box b. Book of nursery rhymes c. Model airport with toy planes d. Model car construction kit
ANS: C At this age children are into creative play. The model airport with toy planes is the most developmentally appropriate.
What would the nurse expect a 4-month-old to be able to accomplish? a. Hold a cup. b. Stand with assistance. c. Lift head and shoulders. d. Sit with back straight.
ANS: C Because development is cephalocaudal, of these choices, lifting the head and shoulders is the one that the infant learns to do first. The infant can usually sit with support at about 5 months of age and can sit alone at about 8 months.
At what age is an infant first expected to locate an object hidden from view? a. 4 months of age b. 6 months of age c. 9 months of age d. 20 months of age
ANS: C Feedback A Four-month-old infants are not cognitively capable of searching out objects hidden from their view. Infants at this developmental level do not pursue hidden objects. B Six-month-old infants have not developed the ability to perceive objects as permanent and do not search out objects hidden from their view. C By 9 months of age, an infant will actively search for an object that is out of sight. D Twenty-month-old infants actively pursue objects not in their view and are capable of recalling the location of an object not in their view. They first look for hidden objects around age 9 months.
What is the most appropriate activity to recommend to parents to promote sensorimotor stimulation for a 1-year-old? a. Ride a tricycle. b. Spend time in an infant swing. c. Play with push-pull toys. d. Read large picture books.
ANS: C Push-pull toys are appropriate to promote sensorimotor stimulation for a 1-year-old child.
The mother of a 7-year-old pediatric patient asks the nurse about her child's sleep requirement. What is the most accurate response by the nurse? a. "7 to 10 hours a night" b. "5 to 7 hours a night with one daytime nap" c. "11 to 13 hours a night" d. "4 to 6 hours a night with two daytime naps"
ANS: C Sleep patterns vary with age. The neonate sleeps 8 to 9 hours per night and naps an equal amount of time during the day. The 2-year-old may sleep 10 hours during the night and have only one short daytime nap. The 7-year-old usually requires 11 to 13 hours of sleep and rarely has a daytime nap. These patterns may be altered by cultural practices.
The nurse is assessing development in a 9-month-old infant. What would the nurse expect to observe? a. Speaking in 2-word sentences b. Grasping objects with palmar grasp c. Creeping along the floor d. Beginning to use a spoon rather sloppily
ANS: C The 9-month-old tries to creep, has developed pincer movement, and can grasp a spoon without keeping food on it.
What is the earliest age at which an infant is able to sit steadily alone? a. 4 months b. 5 months c. 8 months d. 15 months
ANS: C The infant can sit alone without support at about 8 months of age.
What is an abnormal finding in an evaluation of growth and development for a 6-month-old infant? a. Weight gain of 4 to 7 ounces per week b. Length increase of 1 inch in 2 months c. Head lag present d. Can sit alone for a few seconds
ANS: C The infant should be holding the head up well by 5 months of age. If head lag is present at 6 months, the child should undergo further evaluation.
Which characteristic best describes the fine motor skills of an infant at age 5 months? a. Neat pincer grasp b. Strong grasp reflex c. Builds a tower of two cubes d. Able to grasp object voluntarily
ANS: D At age 5 months, the infant should be able to voluntarily grasp an object. The grasp reflex is present in the first 2 to 3 months of life. Gradually, the reflex becomes voluntary. The neat pincer grasp is not achieved until age 11 months. At age 12 months, an infant will attempt to build a tower of two cubes but will most likely be unsuccessful.
At an 8-month-old well-baby visit, the parent tells the nurse that her infant falls asleep at night during the last bottle feeding but wakes up when moved to the infant's crib. What is the most appropriate response for the nurse to make? a. "You should put your baby to sleep 1 hour earlier without the nighttime feeding but with a pacifier for soothing." b. "You could place rice cereal in the last bottle feeding of the day to ensure a longer sleep pattern." c."You should have your partner give the last bottle of the day and observe whether your infant stays awake for your partner." d. "You could increase daytime feeding intervals to every 4 hours and put your baby in the crib while the baby is still awake."
ANS: D Increasing the daytime intervals to 4 hours and placing the baby in the crib while still awake are interventions for nighttime sleeping problems. Putting the baby to bed 1 hour earlier with a pacifier will not stop the need for the bedtime bottle; there is no research that rice cereal in the bottle helps to satisfy the baby longer at night, and switching partners does not guarantee that the baby will go to sleep better.
An infant, age 6 months, has six teeth. The nurse should recognize that this is what? a. Normal tooth eruption b. Delayed tooth eruption c. Unusual and dangerous d. Earlier than expected tooth eruption
ANS: D Six months is earlier than expected to have six teeth. At age 6 months, most infants have two teeth. Although unusual, having six teeth at 6 months is not dangerous.
The parents of a 12-month-old child ask the nurse if the child can eat hot dogs as do their other children. The nurse's reply should be based on what? a. The child is too young to digest hot dogs. b. The child is too young to eat hot dogs safely. c. Hot dogs must be sliced into sections to prevent aspiration. d. Hot dogs must be cut into small, irregular pieces to prevent aspiration.
ANS: D To eat a hot dog safely, the child should be sitting down, and the hot dog should be cut into small, irregular pieces rather than served whole or in slices. The child's digestive system is mature enough to digest hot dogs. Hot dogs are of a consistency, diameter, and shape that may cause complete obstruction of the child's airway if not cut into irregular, small pieces.
What statement made by a parent indicates correct understanding of infant feeding? a. "I've been mixing rice cereal and formula in the baby's bottle." b. "I switched the baby to low-fat milk at 9 months." c. "The baby really likes little pieces of chocolate." d. "I give the baby any new foods before he takes his bottle."
ANS: D New solid foods should be introduced before formula or breast milk to encourage the infant to try new foods.
A mother is concerned because her 10-month-old is lethargic. What is the best action the nurse can advise this mother to implement? a. Keep the infant's room well lit. b. Rub the infant's soles vigorously. c. Offer the infant a pacifier. d. Handle the infant slowly and gently.
ANS: D Some infants respond to stimulating environments by shutting down. Move and handle infants slowly and gently.