NURS 299 Nutrition EXAM 3

Failure to Thrive (FTT)

a condition in which infants become malnourished and fail to grow or gain weight for no obvious medical reason alternative definition for weight for length measurement less than the fifth percentile of weight for age below the third percentile

Teratogens

agents, such as chemicals and viruses, that can reach the embryo or fetus during prenatal development and cause harm unique during pregnancy HIV Hypertension diabetes phenylketonuria

The hemodilution

an increase in blood plasma, resulting in a dilution of the blood's cellular contents

maternal age

best outcomes associated with maternal age 20 to 35 years older woman are at risk for nutrition related complication such as gestational diabetes

premature

born before the 37th week of pregnancy

contraindications to breastfeeding

- active tuberculosis - HIV/AIDS - herpes simplex lesions on the maternal breast - maternal alcoholism - drug addiction - malaria - maternal chicken pox ( first 3 weeks post-partum only) - breast cancer - mother with hepatitis C should not breastfeed

weight gain in pregnancy

- maternal body composition changes, including increased blood and extracellular fluid volume - the maternal supportive tissue , such as the great size of the uterus and breast - the product of conception, including the fetus and the placenta

anatomical and physiological changes during pregnancy

- plasma volume during the second trimester - cardiac hypertrophy - glomerular filtration rate (GFR) increases - small quantities of glucose, amino acids, and water-soluble vitamins may appeared in the urine - preeclampsia / pregnancy-induced hypertension (excretion large amount of proteins in the urine)

progesteron

- promotes the development of the endometrium - relaxes muscle cells of the uterus - causes increased renal sodium excretion during pregnancy - lobules or alveoli in the breast increase in size and number

estrogen

- promotes the growth of the uterus and breast during pregnancy - renders the connective tissues in the pelvic region more flexible in preparation for birth - stimulates proliferation of the breast ductal system

Calcium AI during pregnancy

1000 mg/day for women 1300 mg/day for adolescents

Iron RDA during pregnancy

27 mg/day all women should take a 30 mg ferrous iron supplement daily beginning in the second trimester to prevent iron deficiency anemia anemia can impair oxygen delivery to the fetus in the last trimester, the fetus stores iron in its liver to use during the first 4 months pica is associated with iron deficiency, which is characterized by a hunger an appetite for nonfood substances, including ice, corn starch, clay, and even dirt.

requirements for milk production

500 to 800 kcal/day protein RDA 71 grams/day Energy intake at least 1800 kcal/day

Folate DRI during pregnancy

600 mcg per day for prevention of neural tube defect (NTDs) such as spina bifida and anencephaly, one of the most common congenital malformation in the US

protein recommended dietary allowance RDA - pregnancy

71 grams per day for adolescents and adults

The nurse assesses the newborn 1 minute after delivery and documents the following data: Body pink, extremities blue Heart rate is 120 beats/min Weak cry, hypoventilation Some flexion of extremities Grimace The nurse documents the 1 minute Apgar score as: A. 6. B. 8. C. 9. D. 10.

A. 6. The nurse determines the Apgar score at 1 and 5 minutes after birth. It is based on five signs noted in the newborn. The nurse evaluates the newborn for these five signs and then totals the numbers for the total score. The score is from 0 to 10. The higher the score, the better; the newborn is adapting to the extrauterine environment.

What are the roles of the nurse in caring for the patient in the laboring process? (select all that apply) A. Assess labor discomfort every 20 to 30 minutes. B. Implement nursing interventions to deal with labor discomfort as needed. C. Prepare the client for epidural anesthesia. D. Assess cultural beliefs during labor and delivery management. E. Provide teaching about the labor and delivery process. F. Monitor the fetal response to administration of systemic analgesia.

A. Assess labor discomfort every 20 to 30 minutes. B. Implement nursing interventions to deal with labor discomfort as needed. D. Assess cultural beliefs during labor and delivery management. E. Provide teaching about the labor and delivery process. Options 1, 2, 4, and 5 are all interventions that will assist the labor client to cope with her contractions during labor. Preparing the client for an epidural will eliminate the pain of contractions but is not the priority nursing intervention for ineffective coping during active labor. Administration of systemic analgesia and monitoring is an important assessment to be performed during labor but does not directly address the client's needs or ineffective coping. Reference: p. 384

Cognitive-behavioral therapy (CBT ) is a stress management intervention that can be utilized. Which of the following statements are true about CBT? (select all that apply) A. CBT is effective with many stress-related and mental health disorders. B. CBT is a long-term intervention. C. CBT helps people evaluate their thoughts, challenge them, and replace them with more rational cognitive and behavioral responses. D. CBT can be utilized by any therapist. E. Cognitive-behavioral restructuring teaches people that negative thinking often causes emotional distress.

A. CBT is effective with many stress-related and mental health disorders. C. CBT helps people evaluate their thoughts, challenge them, and replace them with more rational cognitive and behavioral responses. E. Cognitive-behavioral restructuring teaches people that negative thinking often causes emotional distress. Cognitive-behavioral therapy (CBT) is a conceptually based short-term intervention to modify negative or catastrophic thinking and related behaviors, and thereby reduce stress. It is a technique or series of strategies that help people evaluate their thoughts, challenge them, and replace them with more rational cognitive and behavioral responses. Although advanced training is needed, nurses can safely and effectively use basic strategies. Cognitive-behavioral restructuring teaches people that negative thinking often causes emotional distress. This recognition will alter the negative thinking and reduce the negative consequences of stress. Reference: p. 309

Which entities recommend that health practitioners within the United States use growth charts for children from birth to 24 months? (select two that apply) A. Centers for Disease Control and Prevention B. World Health Organization C. The Joint Commission D. Healthy People 2020

A. Centers for Disease Control and Prevention B. World Health Organization Growth is one of the most important indications of a child's overall health and well-being. Based on input from an expert panel, the Centers for Disease Control and Prevention (CDC) recommended that health practitioners within the United States use the 2006 WHO international growth charts for children from birth to 24 months, and continue to use the revised 2000 CDC growth charts (including the BMI and the 3rd and 97th percentile) for children aged 2 to 20 years. This recommendation was based on the fact that WHO growth charts were compiled from healthy breastfed infants living in optimal conditions—achieving the greatest potential of growth possible, which was recognized as the desired standard against which to compare the growth of all other infants (CDC, 2010). Reference: p. 343

The nurse caring for the infant in the community setting observes for which of the following passive manifestations of abuse? (select all that apply) A. Poor nutrition B. Neglected visits to primary care providers C. Soft tissue injuries D. Fractures in varying stages of healing E. Emotional neglect

A. Poor nutrition B. Neglected visits to primary care providers E. Emotional neglect The child-abuse syndrome is a clinical condition in infants who have suffered serious active or passive abuse at the hands of their parents or other caregivers. Physical trauma is not the only indicator that nurses should observe for. Passive manifestations of abuse include: poor nutrition, failure to thrive, severe malnutrition, poor physical condition, lack of medical attention, and emotional and moral neglect. Active manifestations of abuse include the presence of brain injuries, fractures, and sexual abuse. Reference: p. 406

Which of the following stressors are examples of intrinsic factors? (select all that apply) A. Poor time management B. A traffic jam C. Social interactions D. Poor communication E. Catastrophic negative thinking

A. Poor time management D. Poor communication E. Catastrophic negative thinking Intrinsic factors that create stress for an individual are those that are created or exacerbated by poor time management, procrastination, poor communication, catastrophic negative thinking (expecting the worst), or struggling with self-defeating behaviors. A traffic jam is an example of an extrinsic factor, which is something that a person has no control over. Stressors that individuals can modify include changing their environment and social interactions or behaviors. Reference: p. 298

Which of the following techniques will help the infant development of trust vs. mistrust? (select all that apply) A. Respond to the infant in a consistent manner. B. Allow the infant to cry to avoid spoiling the child, particularly if the infant has just been fed and diapered. C. Respond to the infant in a prompt manner even if the child has physical needs met. D. Use a pacifier to soothe the infant when crying. E. Provide the infant with predictable and organized routines.

A. Respond to the infant in a consistent manner. C. Respond to the infant in a prompt manner even if the child has physical needs met. E. Provide the infant with predictable and organized routines. Erikson's psychosocial developmental theory is concerned primarily with a series of tasks or crises that each individual must resolve before encountering the next one. The central task during infancy is the development of a sense of trust versus mistrust. Establishing this basic trust or mistrust determines the manner in which the infant approaches all future stages of growth. The infant first develops a sense of trust in the mother (or other caretaker) and then in other significant people. Trust influences the infant's future relationships, allowing for deeper commitment and intimacy. To develop trust the infant requires maximal gratification and minimal frustration to experience a healthy balance between inner needs and outer satisfaction. If the mother or caretaker is consistently responsive to the infant, meeting physical and psychological needs, the infant will likely learn to trust his or her caretaker; view the world as a safe place; and grow up to be secure, self-reliant, trusting, cooperative, and helpful towards others. Prompt, skillful, and consistent response to the infant's needs helps foster security and trust because it enables the infant to predict what will happen within the environment. Reference: p. 392

Which physical growth and development change in toddlers places them at risk for airway obstruction? A. The diameter of the upper respiratory tract is small. B. The respiratory rate decreases to 25 breaths per minute. C. All 20 primary or deciduous teeth erupt be the end of toddlerhood. D. The swallowing pattern using the tongue is fully developed.

A. The diameter of the upper respiratory tract is small. As the toddler grows, the respiratory rate decreases for a mean of 30 breaths per minute at 1 year of age to 25 breaths per minute at 3 years of age. The diameter of the toddler's upper respiratory tract is small when compared with an older child. This small diameter, coupled with the toddler's exploratory nature and lack of judgment in deciding what to place in the mouth, can result in airway obstruction. All 20 primary teeth erupt at the end of toddlerhood, but it is extremely rare that one of these teeth becomes loose. A mature swallowing pattern, using the tongue rather than the cheeks, has not yet developed, and toddlers continue to be at risk for choking. Reference: p. 429

Which theory of development asserts that learning precedes development? A. Vygotsky's theory of cognitive development B. Piaget's theory of cognitive development C. Erikson's theory of psychosocial development D. Kohlberg's theory of moral development

A. Vygotsky's theory of cognitive development Vygotsky proposed that learning precedes development. One of the significant differences between the cognitive theories of Piaget and Vygotsky is that Piaget believed that development preceded learning. Piaget proposed that a level of cognitive development must be reached before learning could take place. Vygotsky thought that by viewing development and learning in this way, that adults would teach to the lowest ability, aiming instruction at those mental functions or intellectual operations that had already matured in the child Reference: pp. 346-347

Major goals in assessing each person's functional pattern are to determine: (select all that apply) A. ability to manage health-promoting activities. B. herbal medications that promote health. C. knowledge of health promotion. D. the need for physician referral for illness care. E. the value that the person ascribes to health promotion.

A. ability to manage health-promoting activities. C. knowledge of health promotion. E. the value that the person ascribes to health promotion. A major goal in assessing each pattern is to determine the individual's knowledge of health promotion, the ability to manage health-promoting activities, and the value that the individual ascribes to health promotion. The assessment of herbal medications is important to determine potential for interactions with other prescribed medications, and adverse effects produced by the herbal medications. Referral to the physician for illness care would not be part of the assessment of functional health patterns. Reference: p. 130

The nurse offers interventions to parents to enhance toddlers' nutritional pattern by telling the parents to (select all that apply) A. avoid foods that may cause choking. B. serve the toddlers' favorite foods when he or she refuses to eat. C. send the toddler to bed if he or she does not want to eat. D. do not use food to bribe, reward, or punish the toddler. E. serve small portions, and let the toddler ask for more. F. serve single foods as mixtures of foods.

A. avoid foods that may cause choking. D. do not use food to bribe, reward, or punish the toddler. E. serve small portions, and let the toddler ask for more. Nursing interventions to assist parents to meet nutritional needs of toddlers include the following: Offer simple, single foods because mixtures of foods are often rejected. Serve the toddler's favorite foods along with the new ones. It may take several times before the toddler accepts a new food. Encourage the use of utensils, but accept that toddlers still often need to use their fingers. Routines are important to toddlers. Serve scheduled meals and snacks. Mealtime should be a relaxed and pleasant time, free of distractions. Do not use food to bribe, reward, or punish the toddler. Schedule meals and sleep periods such that the child is awake and alert during mealtimes. Serve small portions and let the toddler ask for more. Avoid foods that may cause choking. Drinking more than 2 cups of milk per day can reduce the child's appetite for other healthy foods. Reference: p. 434

The nurse teaches the expectant client about interventions that decrease sibling rivalry after birth. These instructions would include: A. encouraging the sibling to participate in decisions such as selecting toys for the newborn. B. disciplining the sibling when negative comments are made about the baby. C. instructing the sibling to "be careful" and "be quiet" around the newborn. D. requesting the grandparents care for the sibling during prenatal visits.

A. encouraging the sibling to participate in decisions such as selecting toys for the newborn. The older sibling must be involved in the pregnancy and birth experience according to his or her growth and development. After delivery, involving the sibling in choosing toys and clothes for the new baby will decrease sibling rivalry. The sibling may make negative comments, as he or she now must share time with the parents and the baby. Explanations and planning separate time for the sibling should be the intervention and not discipline. The sibling may also be admonished to "be careful" and "be quiet," and the child may not accept the baby with open arms. Involving the sibling during prenatal visits helps set the stage for the arrival of the new baby. It provides an extended time for the sibling to begin to understand the additional of a new baby to his or her family. Reference: p. 371

The nurse is teaching a group of mothers about toddlers and their play activities by explaining that toddlers: A. participate in parallel play. B. demonstrate skill in sharing and cooperative play. C. enjoy playing together with a group of toddlers. D. learn best with intensive drill during play.

A. participate in parallel play. Most toddlers are interested in other children. However, this interest is limited, because toddlers, though ready to be with other children, are not ready to share. Successful social encounters with toddlers are best described as parallel play, where children play side by side, doing similar things with similar toys, but each working independently. Sharing and cooperative play will not develop until well into the preschool years. Reference: p. 435

The nurse suggests stimulating experiences for development of their infant to the parents of a 6-month-old infant. These experiences would include: A. singing lullabies to the baby. B. inviting another infant over to play. C. keeping the top of the crib free of hanging mobiles. D. providing a toy that emits animal sounds when the buttons are pushed.

A. singing lullabies to the baby. The infant's first play is an exercise of the senses, and the toys are visual in nature. The infant needs experiences that involve sight, sound, and touch. Singing to the infant will stimulate the development of sound. The parents should hang a mobile over the crib to stimulate the infant's development of sight. During infancy, the baby's play is solitary and repetitious. The 6-month-old infant does not possess the fine motor skills to push a button on a toy. Reference: p. 401

Any psychological, social, environmental, physiological, or spiritual stimulus that disrupts homeostasis requiring change or adaptation is a: A. stressor. B. trigger. C. distress. D. cognitive restructuring

A. stressor. A stressor is any psychological, social, environmental, physiological, or spiritual stimulus that disrupts homeostasis requiring change or adaptation. Stress is a state of threatened homeostasis that triggers various adaptive changes in order to handle the event. Stress can be situational or maturational. One's coping strategies and resources will determine the outcomes of each crisis experience. Reference: p. 298

Research has demonstrated the role of stress-hardy characteristics of individuals in promoting better health. These characteristics of stress hardiness include: A. viewing stress as a challenge rather than a threat. B. feeling as though one does not have internal control over stressful situations. C. having to focus commitment on primarily one component (home or work) in life. D. reporting more physical symptoms related to the degree of stress.

A. viewing stress as a challenge rather than a threat. Individuals who possess characteristics of stress-hardiness are shown to be less vulnerable to stress-related symptoms and disease. The characteristics of stress hardiness are control, challenge, and commitment. For stress-hardy individuals, stress is viewed as a challenge rather than a threat; they feel in control of situations in their lives; and they are committed to, rather than alienated from, work, home, and family. Reference: p. 302

Vitamin D AI and UL during pregnancy

AI 5 mcg per day; UL 50 mcg per day

preeclampsia

AKA pregnancy induced hypertension, is considered hypertension with poteinuria after 20 week gestation it is one of the leading causes of prematurity and maternal and fetal death may progress to eclampsia (cause is unknown - no screening test)(results in seizures that can be fatal) Low vitamin D is a factor of preeclampsia

When assessing the older adult for sleep quality, the nurse expects to find that the person will state: A. "I continue to be a night owl." B. "I experience difficulty returning to sleep." C. "I experience a night of deep sleep." D. "I rarely wake up during the night."

B. "I experience difficulty returning to sleep." Most difficulties associated with sleep are amenable to nursing therapies. Frequent awakenings do not necessarily imply sleep interruption. Many individuals may awaken numerous times during the night but return to sleep within seconds. This may be especially true of older adults who generally spend most of the night in stages of light sleep. Their normal developmental pattern does not include deep sleep; therefore, awakenings may not affect the sleep cycles and resultant feelings after awakening in the morning. More commonly, older adult individuals experience difficulty returning to sleep because they experience discomfort, fears, or other variables. Reference: p. 137

The nurse is preparing education on prevention of urinary tract infections. A principle emphasized in the teaching plan would be: A. Decreasing oral intake facilitates urinary dilution. B. Empty the bladder at the first sensation of fullness. C. Frequency is a common symptom that can be ignored. D. Increasing time between urinations decreases the risk of infection.

B. Empty the bladder at the first sensation of fullness. The nurse uses evidence-based practice to guide his or her practice. Emptying the bladder as soon as bladder sensation of fullness occurs is a practice that decreases the time the urine remains in the bladder, thus decreasing the chance for bacterial growth to occur. Decreasing oral intake will cause the urine to become concentrated. Urinary frequency is a symptom seen with urinary tract infections. Research indicates that delayed time between urinations is associated with increased incidence of urinary tract infection. Reference: p. 134

The nurse is providing suggestions to individuals with sleep disturbances resulting from stress-related issues. The nurse recommends which of the following? (select all that apply) A. Have a glass of wine right before bedtime. B. Establish a regular sleep-wake schedule, even on weekends. C. Limit naps during the day to 45 minutes. D. Exercise within 1 hour of bedtime. E. Take a hot bath 2 hours before bedtime. F. Sleep in a warm room.

B. Establish a regular sleep-wake schedule, even on weekends. C. Limit naps during the day to 45 minutes. E. Take a hot bath 2 hours before bedtime. The nurse can provide suggestions to clients with stress-related sleep disturbances using the following strategies: Keep a sleep diary, which helps determine sleep patterns. Reduce consumption of alcohol and caffeine. Have a regular sleep-wake schedule, even on weekends. If unable to fall asleep within 20 to 30 minutes or if waking up and unable to fall back to sleep within that time, get out of bed and do something until groggy and sleepy again. Use a relaxation tape or practice diaphragmatic breathing to help release tension and calm down. Limit naps during the day to 45 minutes. Exercise within 3 to 6 hours of bedtime. Take a hot bath 2 hours before bedtime. Sleep in a cool room.

Which theorist developed his ideas based on interviews that focused on hypothetical moral dilemmas? A. Gilligan B. Kohlberg C. Piaget D. Erikson

B. Kohlberg Lawrence Kohlberg's theory of moral development is based on interviews that focused on hypothetical moral dilemmas such as: Should a man steal an expensive drug that would save his dying wife? Carol Gilligan's theory of moral development (1982; 1988) suggests that there is a different process of moral development in women in society. She did research with Lawrence Kohlberg and discovered that his research was conducted using men only, and developed her own research with females. Jean Piaget's theory of cognitive development is concerned primarily with structure rather than content, with how the mind works rather than with what it does. Erik Erikson described the development of identity of the self through successive stages that unfold throughout the life span. Reference: pp. 347-348

Which of the following elements of nutrition education are included when teaching the lactating mother about her nutritional needs? (select all that apply) A. Lactating women should consume the same amount of calories as those consumed with pregnancy. B. Lactating women need 7 to 11 servings of carbohydrates per day. C. Calcium requirements can be met using supplements. D. Seventy grams of protein per day should come from eating lean meat, fish, eggs, poultry, milk, and dairy products. E. Lactating women should consume 500 micrograms of folic acid.

B. Lactating women need 7 to 11 servings of carbohydrates per day. D. Seventy grams of protein per day should come from eating lean meat, fish, eggs, poultry, milk, and dairy products. E. Lactating women should consume 500 micrograms of folic acid. Nutritional needs for the lactating woman include: The consumption of 500 additional calories from a variety of sources 70 grams of protein per day from lean meat, fish, eggs, poultry, milk and dairy products 1000 mg per day of calcium from milk, cheese, dark green leafy vegetables, nuts, and dried fruit. Women with low calcium intake may use calcium supplements with vitamin D. 9 mg of iron per day and 500 micrograms of folic acid 7 to 11 servings of carbohydrates and 30% of calories from fat

Which of the following are goals of Gilligan's stages of moral development for women in the postconventional stage? (select all that apply) A. Agree upon rights B. Principle of nonviolence C. Justice D. Personal moral standards E. Do not hurt self or others

B. Principle of nonviolence E. Do not hurt self or others Gilligan identifies the goals for women in the postconventional stage as the principle of nonviolence and do not hurt self or others. Kohlberg's postconventional stage identifies the goals as: agree upon rights, personal moral standards, and justice. Reference: p. 348

Which maternal action demonstrates a mother's ability to ensure safe passage for her fetus? A. Fantasizes about the gender of her baby B. Seeks prenatal care from a health care provider C. Integrates the fetus as an integral part of her D. Examines what she will gain and lose by becoming a mother

B. Seeks prenatal care from a health care provider The woman attempts to ensure safe passage for herself and her infant by seeking health care from a doctor, midwife, or cultural health practitioner; by gaining support and information from family and friends; and by reading and watching videos. Fantasizing about the gender of her baby is a behavior seen in the mother as she attempts to ensure acceptance of her child. Integrating the fetus as an integral part of her is seen in the pregnant woman as she binds into her unknown child. The woman is learning to give of herself by examining what she will gain and lose by becoming a mother. Reference: p. 368

When an individual elicits the relaxation response through meditation, which stress-management skill is being practiced? A. Healthy pleasures B. Spiritual practice C. Affirmation D. Empathy

B. Spiritual practice Meeting spiritual needs may be facilitated by spiritual practice or activities that help people find meaning, purpose, and connection. Engaging in healthy pleasures occurs when a person participates in activities that are important to them and being them feelings of peace, joy, and happiness. An affirmation is a positive thought, in the form of a short saying or phrase, that has meaning for the individual. Empathy is an effective stress management intervention because it assists with communication. Empathy is the ability to consider another person's perspective and to communicate this understanding back to that person. Reference: p. 312

The nurse, teaching a class to primiparas about risk factors associated with sudden infant death syndrome (SIDS), explains that prevention strategies include: (select all that apply) A. Prone sleeping position B. Supine sleeping position C. Postnatal smoking D. Sleeping on soft surfaces E. Sleeping on firmer surface F. Overwrapping the baby G. Allowing the baby to sleep with the parents H. Breast-feeding the baby

B. Supine sleeping position E. Sleeping on firmer surface H. Breast-feeding the baby Observational studies have found an association between SIDS and several risk factors, including prone sleeping positions, prenatal or postnatal exposure to tobacco smoke, soft sleeping surfaces, hyperthermia or overwrapping, bed sharing, and lack of breast-feeding. The American Academy of Pediatrics Task force on SIDS recommends that those risk situations be eliminated as preventive strategies. Reference: p. 402

The nurse is performing an initial antepartal assessment on a woman who has missed two periods. Assessment of this woman for alcohol consumption is best determined by the: A. CAGE test. B. T-ACE test. C. non-stress test. D. protein dipstick test.

B. The T-ACE test provides a much more sensitive measure of alcohol intake patterns than that derived from the CAGE test. The T-ACE test considers the following assessment criteria: - How many drinks does it Take to make you feel high? - Have you ever been Annoyed by people criticizing your drinking? - Have you ever felt you ought to Cut down your drinking? - Have you ever had a drink first thing in the morning (Eye Opener) to steady your nerves or get rid of a hangover? The CAGE test considers data collected from the client on Cutting down on drinking, being Annoyed by criticism of drinking, feeling Guilty about drinking, and using alcohol as an Eye opener. The non-stress test evaluates the fetal heart rate response to fetal movement, which is assessed after the fetus is 20 weeks or more. The protein dipstick is performed at each prenatal visit and measures the amount of protein in the client's urine. Proteinuria is a symptom seen with pre-eclampsia. Reference: p. 128

Which of the following physical changes are expected during the toddler years? (select all that apply) A. Growth in height of 4 to 6 inches per year B. Weight gain of 4 to 6 pounds per year C. Urine specific gravity lower than that of an adult D. Bowel control generally occurs before urinary control E. Increase in heart rate because of increase in size

B. Weight gain of 4 to 6 pounds per year D. Bowel control generally occurs before urinary control The overall growth rate of the toddler slows significantly, and the increasingly active toddler begins the process of shedding baby fat and straightening their posture. A slow, steady growth in height of 2 to 4 inches per year and in weight of 4 to 6 pounds per year occurs during toddlerhood and remains steady until puberty. The kidneys are well differentiated by the toddler years, and specific gravity and other urine findings are similar to those of adults. The toddler's gastrointestinal tract also reaches functional maturity, although it continues to grow into adulthood. Bowel control usually occurs before urinary control. Lung capacity continues to increase as the toddler grows and changes in the circulatory system include a decrease in heart rate, increase in blood pressure, and changing vascular resistance in response to growth in the size of various blood vessel lumens. Reference: p. 429

The nurse is discussing strong evidence on effectiveness of alternative and complimentary therapies in reducing harmful effects of stress. Emphasis is placed on the effectiveness of: A. aromatherapy. B. acupuncture. C. chiropractic. D. herbal therapy.

B. acupuncture. A variety of alternatives and complimentary therapies are available as techniques to prevent and reduce harmful effects of stress. Common therapies include acupuncture, hypnosis, aromatherapy, reflexology, chiropractic, and herbal therapies. People are increasingly using alternative therapies as self-help measures, and research to study their effects has exploded in recent years. Nurses can assist clients to base their use on evidence of safety and efficacy. Among the variety of alternative therapies available, acupuncture and hypnosis have strong evidence of effectiveness. Herbal remedies require cautions because they can have harmful as well as beneficial effects, and may interfere with other treatments. Reference: p. 306

Piaget's stage of cognitive development states that characteristics of the sensorimotor stage include: A. development of egocentric animistic and magical thinking. B. development of the concept of object permanence. C. consideration of others' points of view. D. thought dominated by senses.

B. development of the concept of object permanence. Development of the concept of object permanence occurs from birth to 2 years old and is in the sensorimotor stage. Development of egocentric animistic and magical thinking occurs in 2- to 7-year-old children in the preoperational stage. Consideration of others' points of view is in the concrete operations stage, which is from 7 to 11 years of age. Thought dominated by senses occurs in the 2- to 7-year age group and is in the preoperational stage. Reference: p. 347

The nurse prevents cold stress in the newborn in the delivery room by: A. maintaining the delivery at 73° F. B. drying the baby with warm blankets. C. bathing the baby immediately after delivery. D. placing the baby in an open warmer with manual control.

B. drying the baby with warm blankets. Cold stress should be avoided by keeping the newborn dry, warmly wrapped, and avoiding environments causing heat loss in the newborn. The labor and delivery room should have the temperature increased to at least 78° F at the time of delivery. The infant should not be bathed immediately after birth, because evaporative heat loss will occur as the water evaporates from the skin. The newborn should be placed into an open warmer with servo control, so the heat output is regulated to deliver heat according to the newborn's skin temperature. Reference: p. 360

A person reports his exercise pattern is one golf game per week. The nurse evaluates this pattern and teaches the individual that: A. exercise should include jogging. B. exercises should be repetitive. C. golfing one time per week is adequate. D. weekly workouts at the gym should be included.

B. exercises should be repetitive. Exercise is a type of physical activity that is planned, structured, and repetitive, and performed to improve or maintain physical fitness. Active social activities such as backyard softball or golf would be considered physical activity. Activities such as jogging, walking, or gym workouts would be considered exercise. Sedentary social activities such as bingo, reading, knitting, stamp collection, cards, or participation in discussion groups would not be considered physical activity. Reference: p. 135

The nurse in the well-baby clinic informs the mother of a 6-month-old infant about introducing solid foods by instructing her to: A. feed the baby solids before the milk. B. make the baby's solid foods smooth and runny. C. introduce solid foods by adding it to the baby's formula bottle. D. mix a little honey in the fruit to stimulate the infant's taste buds.

B. make the baby's solid foods smooth and runny. Tips for introducing solid foods to infants: The infant's first solid foods should be smooth and runny. Pureed foods are used until the infant has teeth; chopped foods are used when the infant can chew. Introduce only one food at a time and in small amounts. Do not mix solid foods together; the infant should learn to appreciate different tastes and textures. Do not add solid foods to the infant's bottle. Do not start to reduce the milk supply until the infant is taking food successfully from the spoon. Until 1 year of age, feed the baby milk before solid foods. Do not give honey to infants less than 12 months of age. Honey is a known source of bacterial spores that produce a toxin, which can cause infant botulism. Reference: p. 399

Nurses caring for the toddler population instruct parents that one of the leading causes of visits to health care providers is: A. amblyopia. B. otitis media. C. burns. D. neglect.

B. otitis media. Otitis media, or inner ear infection, is one of the leading causes of visits to health care providers during the toddler years and the number one reason for which antibiotics are prescribed for these children. Discussing the current literature and evidence-based reports and recommendations often helps parents understand the proper use of antibiotics, which is also imperative in preventing antibiotic resistance. Amblyopia is a major health care concern of the toddler age group and occurs in 2% to 5% of children. Toddlers are at high risk for accidental injuries related to burns and parents should be instructed on measures to avoid injuries. Toddlers suffering from neglect are less likely to be seen by health care practitioners. Reference: p. 438

When the nurse is assessing a toddler for signs of child abuse, observations of parental behavior may include: A. difficulty leaving the child. B. parental delays in seeking help. C. spontaneous reporting of the details of the injury. D. parental questions about progress and discharge.

B. parental delays in seeking help. Parental behaviors observed by the nurse during an admission assessment of a toddler supporting child abuse may include: Parental delays in seeking help Inconsistencies in the history of how the injury occurred Injury inconsistent with the history or child's developmental capacity X-rays show old, unexplained fractures Bruises confined to back surface of the body—neck to knees Bare and broken hair Pattern to injury or bruising descriptive of object used to inflict injury Burns with sharply demarcated edges or circumferential patterns Perineal injuries of any kind

The nurse, teaching a class on primary prevention at a women's health club, emphasizes participation in: A. physician visits during illness. B. recommended immunization schedules. C. taking antibiotics at the first sign of symptoms. D. water aerobics to develop muscle building.

B. recommended immunization schedules. Primary prevention is a concept central to nursing and includes generalized health promotion and specific protection from disease. Health promotion connotes an active process involving specific protections, including immunizations, occupational safety, and environmental control, along with a set of behaviors that enhances health. Physician visits that promote health promotion focus on screening and wellness visits that include teaching on preventative health practices. Antibiotics should only be taken when there is evidence of an infection. Water aerobics focuses on flexibility, not muscle building. Reference: p. 129

The nurse is teaching prenatal couples about the critical principles of attachment. These principles include: A. parents of sick infants become attached as quickly as those of healthy infants. B. the mother and father should have close contact with their infant within minutes after birth. C. it is mandatory for the father to witness the birth process so that bonding and attachment will occur. D. parents take on the active role when interacting with their infant, realizing that their infant will be unresponsive.

B. the mother and father should have close contact with their infant within minutes after birth. In early studies on attachment, Klaus, Kennell, and Klaus have formulated seven critical principles in the process of attachment. These include: A sensitive period appears to exist in the first minutes and hours after birth during which it seems necessary for the mother and father to have close contact with their infant for later development to be optimal. Species-specific responses to the infant appear to exist in the human mother and father when the infant is first given to them. The attachment process seems to be structured such that the parents become attached to only one infant at a time. For attachment to occur appropriately, the infant must respond to the mother and father by some signal, such as body or eye movements. Individuals who witness the birth process become strongly attached to the infant. Some adults find it difficult to go through the processes of attachment and detachment simultaneously; becoming attached to an infant while mourning the loss or threatened loss of another person is difficult for parents. Some early events may have long-lasting effects. Reference: p. 405

Which statement, if made by a parent after attending a teaching session on initiating a toilet training program for toddlers, indicates a need for further teaching? A. "I take my child to the potty after a meal." B. "I offer praise when my child uses the potty." C. "I require my child to sit on the potty until she goes." D. "I have given my child underpants as a reward for using the potty."

C. "I require my child to sit on the potty until she goes." Before beginning toilet training, parents should begin to check their toddlers for the prerequisite skills for toileting, which include being able to walk well, stoop and recover, stay dry for at least 2 hours during the day, and communicate sensations before elimination as well as the discomfort of wet or messy pants, and the need for assistance. First, introduce the child to the potty seat or chair. The potty should provide secure seating with the child's feet touching the floor. Because of the gastrocolic reflex, bowel elimination is more likely after a meal; this is a good time to place the toddler on the potty. Encourage the toddler to stay on the chair for 2 to 3 minutes and always explain what to do ("Go potty") rather than what not to do ("Don't wet your pants"). Do not refer to elimination as dirty or yucky. Remember that this is your child's first creation. Praise the child for the desired behavior. Introduce underwear as a badge of success. Ignore undesired behavior and never punish the child by scolding, spanking, or other punitive measures. Reference: p. 434

During the 1-month well-baby visit, a pediatric nurse explains to the mother that she should expect to hear babbling in her infant by: A. 2 months. B. 4 months. C. 6 months. D. 9 months.

C. 6 months. During the first 2 months, most of the infant's sounds are vowels and are made primarily in the front part of the mouth. Cooing sounds are heard at approximately 2 to 3 months, usually in response to an adult's voice. By 6 months, babbling sounds are heard, and by 9 to 10 months, the infant forms two-syllable sounds. Reference: p. 404

According to Erikson, what is the developmental task of toddlers? A. Doubt B. Shame C. Autonomy D. Preoperational

C. Autonomy According to Erikson (1995, 1998), the developmental task of toddlers is to acquire a sense of autonomy while overcoming a sense of doubt and shame. To exert autonomy, toddlers must relinquish the dependence on others that was enjoyed during infancy. Continued dependency has the potential to create a sense of doubt in toddlers about their ability to take control of, and ultimately take responsibility for, their own actions. Toddlers begin to move into a preoperational stage, according to Piaget. Reference: pp. 438-439

Which of the following statements accurately describe biological growth? (select all that apply) A. Expected growth patterns exist in infants and children. B. Growth is steady throughout life. C. Extremely rapid growth occurs in the prenatal, infancy, and adolescent periods. D. Slower rates of growth occur during the toddler, preschool, and school-age periods. E. Infants typically double their birth weight by 6 months of age.

C. Extremely rapid growth occurs in the prenatal, infancy, and adolescent periods. D. Slower rates of growth occur during the toddler, preschool, and school-age periods. E. Infants typically double their birth weight by 6 months of age. Expected growth patterns exist for all people. Growth is not steady throughout life. The periods of extremely rapid growth—prenatal, infancy, and adolescence—are contrasted with slower rates of growth during the toddler, preschool, and school-age periods. Infants typically double their birth weight by 6 months of age and triple their birth weight by 1 year of age. The well known "growth spurt" in height typically occurs early in adolescence for girls and later in adolescence for boys. Reference: p. 343

The nurse performs assessments of the mother and her fetus throughout the labor process. Which finding indicates a complication? A. Clear amniotic fluid B. Active fetal movement C. Fetal heart rate below 100 beats/min D. Contractions every 3 minutes, lasting 60 seconds

C. Fetal heart rate below 100 beats/min Events that may signal difficulties with the progression of labor or development of a complication include unusual fetal or uterine activity, presence of fetal meconium in the amniotic fluid, fetal tachycardia (heart rate above 160 beats/min), or fetal bradycardia (heart rate below 120 beats/min) in a full-term infant, and the fetal heart rate decreases with uterine activity (late deceleration) during labor. Clear amniotic fluid is a normal finding during labor. The presence of fetal activity during labor is considered a good finding. Contraction with a frequency of 3 minutes and duration of 60 seconds indicates an acceptable contraction pattern. Reference: p. 359

The community health nurse performs an assessment on a local family to determine their stress-coping abilities. Which of the following is an example of the primary appraisal of the coping ability of a family experiencing financial hardship? A. The family becomes aware of information of which they were previously unaware. B. The family identifies information related to their perceived problems. C. The family describes perceived actual and potential positive and negative outcomes. D. Individuals within the family verbalize methods to cope with the actual or potential harm, threat, or challenge.

C. The family describes perceived actual and potential positive and negative outcomes. Assessment of the stress-coping abilities of an individual, family, or community is part of a comprehensive health assessment that includes past and present subjective and objective data. Primary appraisal of coping includes descriptions of perceived actual and potential positive and negative outcomes. Negative outcomes refer to harm, whereas positive outcomes refer to the challenges resulting from stressors that an individual perceives can be overcome. Secondary appraisal consists of the individual's identification of choices to cope with the actual or potential harm, threat or challenge. Reference: p. 303

The nurse assesses the woman for positive signs of pregnancy, which include: A. enlargement of the uterus. B. bluish color of the cervix and upper vagina. C. detection of fetal heart tones by Doppler auscultation. D. positive test results for human chorionic gonadotropin (hCG).

C. detection of fetal heart tones by Doppler auscultation. Positive signs of pregnancy are those that document the existence of the fetus. The presence of fetal heart tones is a positive sign of pregnancy. Other positive signs of pregnancy include the palpation of fetal parts through Leopold's maneuvers, the objective detection of fetal movements, and radiological or ultrasonic demonstration of fetal parts. Enlargement of the uterus, bluish color of cervix, and positive test results for hCG are all probable signs of pregnancy. They indicate that a pregnancy is likely but do not confirm the pregnancy. Reference: p. 354

The individual's perceived health and well-being and how health is managed describes the: A. cognitive-perceptual pattern. B. coping-stress tolerance pattern. C. health perception-health management pattern. D. self-perception-self-concept pattern.

C. health perception-health management pattern. The health perception-health management pattern provides an overview of the individual's health status and the health practices that are used to reach the current level of health or wellness. The focus is on perceived health status and the meaning of health, along with the individual's level of commitment to maintaining health. The cognitive-perceptual pattern focuses on sensory perceptual and cognitive patterns. The coping-stress tolerance pattern identifies the general coping pattern and effectiveness on stress tolerance. The self-perception-self-concept pattern describes the individual's perception of self to include body comfort, body image, and feeling state as well as self-conception and self-esteem. Reference: p. 131

The goal for the couple who attends childbirth education classes is to: A. promote a medication-free birth. B. prepare for an early discharge. C. increase knowledge of labor and delivery. D. provide information about hospital policies.

C. increase knowledge of labor and delivery. The nurse refers couples to early pregnancy and Lamaze childbirth preparation classes to increase their social support and help couples increase their knowledge about labor and delivery. Couples make decisions regarding pain relief during labor and birth based on information provided in the childbirth classes. Information provided during childbirth classes does facilitate a smooth transition to an early discharge, but that is not the goal of the education. Childbirth education may be provided to couples who are planning to deliver at different health care settings. The focus is not on sharing the policies of each of these facilities. Reference: p. 355

Physiological effects of stress include: A. decreasing the antiinflammatory response. B. decreasing musculoskeletal tension and tone. C. increasing the heart rate, blood pressure, and respiratory rate. D. shifting of blood for the large muscle groups to the visceral organs.

C. increasing the heart rate, blood pressure, and respiratory rate. Stress causes physiological arousal along three pathways: the musculoskeletal system, the autonomic nervous system, and the psychoneuroendocrine system. The musculoskeletal system responds to stress by increasing tension and tone. The autonomic nervous system causes an increase in heart rate, blood pressure, and respiratory rate. The heightened awareness of the environment is triggered, and the blood shifts from the visceral organs to the large muscles. The psychoneuroendocrine system stimulates the secretion of glucocorticoids and other neuroendocrine substances into the systemic circulation, which increases glucose levels and the antiinflammatory response. Reference: pp. 300-301

In assessing the nutritional-metabolic pattern, the nurse performs an examination of: A. attention span. B. blood pressure. C. mucous membranes. D. urine color.

C. mucous membranes. Assessment of the mucous membranes determines hydration status, which is part of the nutrition-metabolic pattern. Other specific assessment findings for the nutritional-metabolic pattern may point to an individual who is overweight, underweight, overly hydrated, dehydrated, or experiencing difficulties in skin integrity, such as skin breakdown or delayed healing. The attention span is part of the self-perception-self-concept pattern. Measurement of blood pressure is part of the activity-exercise pattern. Urine color is part of the elimination pattern. Reference: p. 134

The nurse is implementing cognitive restructuring as a stress-management intervention with a group of pregnant teens. The nurse explains that cognitive restructuring reduces stress by: A. glossing over misfortune, suffering, or negative feelings. B. helping people identify who is responsible for their stress. C. recognizing that negative thinking often causes emotional distress. D. assisting people to focus on a narrow range of feelings causing their stress.

C. recognizing that negative thinking often causes emotional distress. Cognitive therapy is a conceptual model for short-term intervention to modify thinking and reduce stress. In the context of cognitive therapy, cognitive restructuring is a technique or series of strategies that help people evaluate their thoughts, challenge them, and replace them with responses that are more rational. Cognitive restructuring teaches people to recognize that negative thinking often causes emotional distress. Cognitive restructuring does not gloss over or deny misfortune, suffering, or negative feelings. Cognitive restructuring assists people to become unstuck from negative moods, so they can experience a broader range of feelings. Reference: p. 311

The nurse is preparing a class on wellness and health promotion for a group of middle school students. Developmental tasks of early adolescence include a learning focus emphasis on: A. coping with life events and problems. B. economic responsibility. C. risk taking and its consequences. D. social responsibility for self and others.

C. risk taking and its consequences. Early adolescence developmental focus is on industry verses inferiority as identified by Erikson. The wellness tasks identified include: learning that health is an important value. learning self-regulation of physiological needs—sleep, rest, food, drink, and exercise. learning risk taking and its consequences (injury prevention). The other three options define adolescent (identity verses role confusion) wellness developmental tasks, which include learning to cope with life events and problems, learning economic responsibility, and learning social responsibility for self and others. Reference: p. 139

The time during which infants develop the coordination to master activities which allow them to interact with the environment is known as the: A. reflexive period. B. psychosocial period. C. sensorimotor period. D. immunological period.

C. sensorimotor period. Piaget's sensorimotor period (up to age 18 months) describes the time during which infants develop the coordination to master activities that allow them to interact with the environment. During this period the infant solves problems using sensory systems and motor activity rather than symbolic processes, which develop later. Piaget's cognitive developmental theory focuses on intellectual changes that occur in a sequential manner as a result of continual interaction between the infant and the environment. Reflexes are responses that are normally exhibited by new stimulation. Psychosocial development of the infant is established through a sense of trust and immunization efforts are not related to the infant's ability to master activities. Reference: p. 392

The nurse assessing a 24-month-old toddler expects expressive language to include: A. repeats 2 digits from memory. B. jargon and echolalia are predominately used. C. talks in word phrases, and 2 to 3 word sentences. D. average sentence length is approximately 2½ words.

C. talks in word phrases, and 2 to 3 word sentences. The 18-month-old toddler uses jargon and echolalia. The 24-month-old toddler talks in word phrases and 2 to 3 words sentence. The 30-month-old toddler repeats 2 digits from memory, and the average sentence length is approximately 2½ words for these children. Reference: p. 437

During a health screening of Hispanic children for lead poisoning, the initial question the nurse should ask is: A. "How old is the house you are living in?" B. "Do you eat canned foods from the United States only?" C. "Are there any areas in your home where paint is chipping off?" D. "Do you use ceramic containers made outside the United States for cooking?"

D. "Do you use ceramic containers made outside the United States for cooking?" Questions addressing the age of a house where lead paint was used targets only children whose exposure to lead is through lead-based paint. During the last 2 decades, assessment of children from homes with lead-based paint has resulted in a 90% decline in the overall number of children affected; however, the risk for Hispanic children has remained steady. Lead-based paint is not the primary source of lead poisoning for these children. Food and culturally defined health practices bring additional unscreened risk to this population. Foods packaged or canned outside the United States, foods prepared in ceramic containers or pottery made outside the United States, and wrapped Mexican candies all increase lead exposure to these children. Another common risk for these children is in home remedies containing lead. Reference: p. 343

The nurse teaches new mothers about research on pacifiers and breast-feeding. Which statement by a mother indicates an understanding of the instruction? A. "I have no problem giving a pacifier to a breast-feeding baby." B. "I offer a pacifier after each feeding to satisfy my baby's sucking needs." C. "There is significant research that indicates harm is associated with occasional pacifier use." D. "I do not give my baby a pacifier because I know it is associated with shorter breast-feeding duration."

D. "I do not give my baby a pacifier because I know it is associated with shorter breast-feeding duration." Research on breast-feeding and pacifiers includes findings that suggest a shorter duration of breast-feeding associated with pacifier use but little harm associated with occasional pacifier use. Researchers suggest that offering a pacifier after feeding is not recommended and that mother's should encourage the baby to satisfy sucking needs on the mother's breasts. Reference: p. 398

A new mother asks the nurse when the baby's anterior fontanel will close. The nurse explains that it will close at: A. 2 months. B. 6 months. C. 12 months. D. 18 months.

D. 18 months. The new mother is educated about the expected growth and development of the infant. She should be informed that the posterior fontanel closes at 2 months. The infant should grow about 1 inch per month for the first 6 months and by 12 months, the infant's birth weight has tripled. By 18 months of age, the anterior fontanel has closed. Reference: p. 391

Which mother is a candidate for the administration of Rho(D) immune globulin (RhoGAM)? A. An Rh-negative mother with an Rh-negative newborn B. An Rh-positive mother with an Rh-negative newborn C. A mother demonstrating the presence of Rh+ antibodies D. A pregnant Rh-negative mother who experiences a spontaneous abortion

D. A pregnant Rh-negative mother who experiences a spontaneous abortion All women should be assessed for blood type, Rh factor, and antibody development to Rh-positive cells at their first prenatal care visit and again at 24 to 28 weeks of pregnancy unless the father of the baby is Rh negative (USPSTF, 2011e). Rh incompatibility between a mother and future fetus may be prevented by administering Rho (D) immune globulin (RhoGAM) to an Rh-negative mother at 28 weeks of gestation and within 72 hours after birth. The immunization prevents the mother's sensitization to fetal Rh-negative cells by inactivating fetal red blood cells in the mother before she can develop an antibody response. The ideal injection time is after the mother's first delivery of an Rh-positive infant, miscarriage, or therapeutic abortion. The incompatibility generally does not occur during the first pregnancy, and the immunization prevents problems with later pregnancies. Reference: p. 376

The nurse is teaching a class to students of pediatric nursing on comparing the concepts of growth and development. Which statement most accurately represents these concepts? A. Growth patterns are qualitative changes. B. Growth is from the head to toe or cephalocaudal. C. Development reflects an increase in the number and size of cells. D. Development is a gradual change that includes advances in skills.

D. Development is a gradual change that includes advances in skills. Growth refers to changes in the structure, reflects an increase in the number and size of cells, and results in an increase in the size and weight of the whole or any of its parts. During childhood, physical changes in head circumferences, weight, height, and overall body proportion are part of growth. Growth also refers to increases or decreases, as in old age, in the size of organs and systems. Development refers to gradual change and expansion of ability and advance in skill from lower to more advanced complexity. In contrast to growth, which is a quantitative or precisely measurable change, development is a qualitative change. Development has best been conceptualized as a process that is assessed as following certain sequencing of patterns; however, the timing of the advancements are individual. Reference: p. 336

When teaching about proper nutrition to a person with congestive heart failure, which affective component should be included in the educational plan? A. Eating with someone B. Food preparation techniques C. Knowledge of dietary restrictions D. Values of adhering to the diet

D. Values of adhering to the diet The affective component of education addresses the attitudes and values the person believes regarding the education and how it will apply to his or her life beliefs. If the person values the education, it will be more likely to be followed as opposed to if the person finds that the education is not congruent with his or her values. Even when the person possesses the knowledge base, assessment of whether the individual also values the importance of adhering to the modifications in lifestyle is vital. Reference: p. 132

Erikson's theory of psychosocial development identifies the toddler stage as: A. trust versus mistrust. B. initiative versus guilt. C. industry versus inferiority. D. autonomy versus shame and doubt.

D. autonomy versus shame and doubt. Erikson identifies eight stages of psychosocial development across the life span. These include: Infancy—trust versus mistrust Toddler—autonomy versus shame and doubt Preschool—initiative versus guilt School-age—industry versus inferiority Adolescence—identity versus role confusion Young adulthood—intimacy versus isolation Middle adulthood—generativity versus stagnation Older adulthood—ego integrity versus despair

The process of gaining specific knowledge or skills that result from exposure, experience, education, and evaluation is known as: A. maturation. B. growth. C. development. D. learning.

D. learning. Learning is the process of gaining specific knowledge or skills that result from exposure, experience, education, and evaluation. Maturation is an increase in competence and adaptability that reflects changes in the complexity of a structure that make it possible for that structure to begin to function or to function at a higher level. Maturation of a structure, system, or individual refers to the emergence of the genetic potential of that structure, system, or individual. Development is closely interrelated with the concepts of learning and maturation. Reference: p. 345

The nurse, presenting a class on strategies to prevent drowning in toddlers, instructs parents to: A. teach their toddler how to swim. B. place the toddler in the tub with 1 or 2 inches of water. C. make sure pails of water are less than ½ full. D. use personal flotation devices on the toddler when boating.

D. use personal flotation devices on the toddler when boating. Children between the ages of 1 and 3 years old are the highest risk for drowning because most do not know how to swim, and most do not have the skills to keep their heads above water or to get out of the water. Toddlers can drown in water just deep enough to cover their noses and mouths. Although swimming pools and other natural bodies of water are a big part of the problem, even pails of water, toilets, bathtubs, and wading pools are dangerous to a toddler. When toddlers fall into a pail of water or a toilet, it is hard for them to straighten up because their entire weight is forward. Toddlers should never be left unattended—even for a few seconds—near the bathtub, hot tub, wading or swimming pool, toilet, or pail of water. All swimming pools should be fenced and have self-closing gates and latches. Toddlers must be supervised constantly and competently whenever they are near water and fitted properly with personal flotation devices whenever they are on a boat. Reference: p. 443

Which of the following foods is/are a choking hazard to a young child? Grapes Hot dog Applesauce Peanut butter and jelly sandwich

Grapes and Hot dog Hot dogs and grapes are both choking hazards for young children. Applesauce is easily swallowed, and although peanut butter on its own is a hazard, as part of a sandwich it is not. Size, shape, and texture should all be taken into account when determining whether a food is a choking hazard

The hormones progesterone, estrogen, and human chorionic gonadotropin all signal what to occur during pregnancy? Increased glucose circulation and increased immune response Increased glucose circulation and decreased immune response Decreased glucose circulation and increased immune response Decreased glucose circulation and decreased immune response

Increased glucose circulation and decreased immune response These three hormones signal for increased glucose circulation, or availability in the blood, and decreased immune response, among other functions. Both of these effects aid in fetal development and growth.

An 18-year old African-American patient enters the clinic. She is 21 weeks pregnant. She has been experiencing dizziness, headaches, severe nausea, and small amounts of blood in her urine. Her hands, face, and feet look puffy. What is a possible diagnosis for these symptoms? Diabetes mellitus Foodborne illness Maternal phenylketonuria Preeclampsia

Preeclampsia These symptoms indicate preeclampsia. Preeclampsia is pregnancy-induced hypertension and can be fatal to both the mother and the infant. This patient should immediately see her obstetrician to received appropriate medical care.

A pregnant patient is experiencing constipation and asks if this is normal. Constipation is normal and leads to increased absorption of nutrients, particularly iron and calcium, and is caused by an increased production of what hormone? Thyroxine Human placental lactogen Progesterone Estrogen

Progesterone Progesterone is a hormone that signals smooth muscle relaxation, including the muscle cells of the uterus and the gastrointestinal tract. Smooth muscle relaxation leads to increased transit time and increased nutrient absorption; however, it also leads to constipation for a majority of pregnant women. The patient is advised to drink plenty of fluids and follow a diet that will produce soft stools.

Vitamin A RDA and UL during pregnancy

RDA 750 - 770 mcg per day; UL 2800 - 3000 per day an excessive amount of vitamin A can cause birth defect

WIC

U.S. Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children. began in 1974 eligible participants must live in an area served by WIC, meet the federal income tax guidelines (income not greater than 185% of U.S. poverty level), and have a nutritional risk factor such as anemia, poor weight gain during pregnancy, previous low-weight-birth infant, or inadequate diet. pregnant and post partum (up to 12 months if breast feeding, 6 if not) are eligible to participate, as well as infants up to 5 years of age.

Breast feeding and formula - infant food

breast should be offered at least 10 to 12 times/day in the 1st several weeks 10 to 15 mins per breast ----------------------- only cold water should be used for formula preparation formula mixing should never be heat up in a microwave oven ------------------------ cow's milk may be introduced after 1 year of age introsuction to solid food between 4 to 6 months - b4 this time may be prone to excessive kcalintake, food allergies, and GI upset solid foods should b introduced gradually and one at the time with 4 to 5 day interval between new foods fruit juice - 6 to 12 months, no more than 4 to 6 ounces/day

Nurse assessment

confirm chief complaint, review allergies, brief past medical history determines the health status of individuals collection of data that culminates in problem identification or a diagnostic statement

hyperemesis

excessive vomiting, usually requires intravenous replacement of nutrients and fluids.

Colostrum

fluid secreted from the breast during late pregnancy and the first few days post partum

infant nutrition

in the 1st year, infant should triple birth weight and increase length by 50 % - do not put infant in low fat diets - human milk is high in cholesterol and fat content (omega 3 fatty acids - essential for proper brain and nervous system development) protein - higher during the first 4 months 9 grams from birth to 6 months 11 grams/day 2nd half of the 1st year iron - assessed periodically to prevent iron deficiency anemia fluoride supplementation is not recommended for infants younger than 6 months vitamin K - hospitals give infants 0.5 to 1 mg by injection, or 1 to 2 mg orally, once shortly after birth

Diabetes in pregnancy and birth defects

increased the risk of heart and CNS defects. macrosomia - large-bodied baby commonly seen in diabetic pregnancies hypoglycemia erythremia - increased RBC hyperbilirubinemia - leads to jaundice

Dietary Reference Intakes (DRIs) needs during pregnanacy

increases during pregnancy of all nutrients - exception: Vitamin D, E, K phosphorus fluoride Calcium biotin

endometrium

inner, mucous membrane lining of the uterus

alcohol and breast feeding

it passes into the milk inhibits oxytocin reduce milk let down

low birth weight

less than 5.5 pounds = 2500 grams may be full term or premature immature lung development poor immune functioning immature GI insufficient production of digestive enzymes inadequate bone mineralization minimal energy and minimal reserves

Prolactin (PRL)

milk synthesis

food borne illness during pregnancy

pathogens such as listeria monocytogenes salmonella specie toxoplasma gondii

fetal alcohol syndrome (FAS) fetal spectrum disorder (FASD)

physical and cognitive abnormalities (CNS defects) in children caused by a pregnant woman's heavy drinking. In severe cases, symptoms include noticeable facial misproportions (low nasal bridge, short nose, flat midface, short palpebral fissure - the separation between the upper and lower eyelids)

Oxytocin

posterior pituitary hormone - initiates uterine contraction - milk ejection - let down reflex - milk ejection reflex

BMP during pregnancy

rises by as much as 15 to 20%

energy recomendation

second trimester - 340 kcal per day third trimester - 452 kcal per day

vitamin concern for pregnant woman

vitamins A and D