PEDS: CH 32

5) A vegetarian adolescent is placed on iron supplementation secondary to a diagnosis of iron-deficiency anemia. Which will the nurse encourage the adolescent to drink when taking the daily iron supplement? 1. Orange juice 2. Black or green tea 3. Milk 4. Tomato juice

1 Explanation: 1. Acidity increases absorption of iron. 2. Foods containing phosphorus, such as in milk; oxalates, such as in tomatoes; and tannins, such as in teas, all decrease absorption of iron. 3. Foods containing phosphorus, such as in milk; oxalates, such as in tomatoes; and tannins, such as in teas, all decrease absorption of iron. 4. Foods containing phosphorus, such as in milk; oxalates, such as in tomatoes; and tannins, such as in teas, all decrease absorption of iron.

2) A nurse is teaching an African American mother of a 3-month-old infant, born in the late fall, who is being exclusively breastfed. Which is the priority nutrient for the nurse to include in the teaching session? 1. Iron 2. Vitamin D 3. Calcium 4. Fluoride

2 Explanation: 1. An infant's iron stores are usually adequate until about 4 to 6 months of age. 2. This infant will have limited exposure to sunlight due to decreased sun exposure in the fall and winter months. The limited sun exposure combined with the infant's dark skin means the infant may need additional vitamin D. 3. The infant should be receiving sufficient amounts of calcium from breast milk. 4. Fluoride supplementation, if needed, does not begin until the child is approximately 6 months old.

1) Which instruction from the nurse is appropriate when conducting teaching to new parents regarding infant care and feeding? 1. Delay supplemental foods until the infant is 4 to 6 months old. 2. Begin diluted fruit juice at 2 months of age, but wait 3 to 5 days before trying a new food. 3. Add rice cereal to the nighttime feeding if the infant is having difficulty sleeping after 2 months of age. 4. Delay supplemental foods until the infant reaches 15 pounds or greater.

1 Explanation: 1. Age 4 to 6 months is the optimal age to begin supplemental feedings. The infant does not need supplemental foods earlier, and introducing supplemental foods earlier does not promote sleep. 2. Fruit juice and rice cereal are not well tolerated by infants at 2 months of age as they lack the digestive enzymes to take in and metabolize many food products. 3. Fruit juice and rice cereal are not well tolerated by infants at 2 months of age as they lack the digestive enzymes to take in and metabolize many food products. Introducing cereal at this stage will not help promote sleep. 4. Earlier feeding of nonformula foods, regardless of the infant's weight, is more likely to cause the development of food allergies.

18) Which assessment findings would cause the nurse to believe that a school-age child is not receiving enough vitamin C in the diet? Select all that apply. 1. Dermatitis 2. Bleeding gums 3. Scaling of the skin 4. Muscle weakness 5. Headaches

1, 2 Explanation: 1. Dermatitis is a clinical manifestation associated with a vitamin C deficiency. 2. Bleeding gums is a clinical manifestation associated with a vitamin C deficiency. 3. Scaling of the skin is a clinical manifestation associated with a vitamin A, not C, deficiency. 4. Muscle weakness is a clinical manifestation associated with a vitamin D, not C, deficiency. 5. Headache is a clinical manifestation associated with an excess of vitamin A, not a deficiency of vitamin C.

20) The nurse is providing care for an infant who is diagnosed with colic. Which interventions will the nurse include in the infant's plan of care? Select all that apply. 1. Using a front-carrying sling 2. Recommending swaddling 3. Suggesting frequent burping 4. Recording all feedings in an intake journal 5. Removing gluten from the diet

1, 2, 3 Explanation: 1. A front-carrying sling is often useful for an infant diagnosed with colic. 2. Infant swaddling is often useful for an infant diagnosed with colic. 3. Frequent burping is often useful for an infant diagnosed with colic. 4. Recording all feedings in an intake journal is an appropriate intervention for an infant diagnosed with failure to thrive (FTT), not colic. 5. Removing gluten from the diet is an appropriate intervention for an infant diagnosed with celiac disease, not colic.

16) The nurse is teaching the parents of a 6-month-old infant about the introduction of solid foods. Which foods will the nurse include in the teaching session? Select all that apply. 1. Rice cereal 2. Fruits 3. Vegetables 4. Meats 5. Nut products

1, 2, 3 Explanation: 1. Rice cereal is typically the first solid food that is introduced at 6 months of age. It is appropriate to include this food in the teaching session. 2. Fruits are introduced at 6 to 8 months of age. It is appropriate to include this food in the teaching session. 3. Vegetables are introduced at 6 to 8 months of age. It is appropriate to include this food in the teaching session. 4. Meats are not introduced until 8 to 10 months of age. 5. Nut products are not introduced until 2 to 3 years of age.

11) A 2-month-old infant is admitted to the hospital with a diagnosis of "failure to thrive" (FTT). Which possible causes for FTT will the nurse include in the infant's plan of care? Select all that apply. 1. Overdilution of formula concentrate 2. Parental neglect 3. Rumination 4. Malabsorption syndromes 5. Pica

1, 2, 3, 4 Explanation: 1. Adding too much water to formula concentrate will lead to inadequate caloric intake and could lead to a diagnosis of FTT. 2. Parental neglect should be evaluated in a baby who is not gaining weight adequately. 3. Rumination involves regurgitation of recently ingested food followed by rechewing and reswallowing. It is often associated with sensory deprivation and may result in growth failure. 4. Malabsorption syndromes, such as cystic fibrosis, can cause nutrients to be excreted instead of absorbed. 5. Pica is an eating disorder characterized by ingestion of nonfood items. It would not be an issue in a 2-month-old infant.

15) Which concepts will the nurse use when conducting client teaching to a family regarding Dietary Reference Intake (DRI) in the United States (U.S.)? Select all that apply. 1. Estimated Average Requirement (EAR) 2. Recommended Daily Allowance (RDA) 3. Adequate Intake (AI) 4. Upper Intake (UI) 5. Reference Nutrient Intake (RNI)

1, 2, 3, 4 Explanation: 1. The nurse includes information on EAR when discussing DRI with a U.S. family. 2. The nurse includes RDA when discussing EAR with a U.S. family. 3. The nurse includes AI when discussing EAR with a U.S. family. 4. The nurse includes UI when discussing EAR with a U.S. family. 5. The nurse would not include RNI when discussing EAR with a U.S. family. This is a concept used in other countries, not in the U.S.

17) Which parental statements during the nutrition assessment for a toddler would cause the nurse concern? Select all that apply. 1. "My child drinks 20 ounces of fat-free milk each day." 2. "My child drinks 6 ounces of 100% fruit juice each day." 3. "We eat at fast-food restaurants several times each week." 4. "We only give our child pasteurized fruit juices." 5. "My child likes to drink water with snacks."

1, 3 Explanation: 1. Toddlers should consume whole milk until the age of 2 years at which time 2% milk should be used. Fat-free milk is not appropriate for the toddler. 2. It is appropriate for the toddler-age child to consume 6 ounces of 100% fruit juice each day. 3. Consumption of fast food should be restricted to only one time per week. 4. It is appropriate for a toddler-age child to drink only pasteurized fruit juices. 5. It is appropriate for the toddler-age child to drink water with snacks.

12) A vegetarian adolescent is prescribed iron supplementation secondary to a diagnosis of iron-deficiency anemia. Which food will the nurse encourage the adolescent to increase intake of based on the current diagnosis? 1. Black tea 2. Eggs 3. Fresh fruit 4. Milk

2 Explanation: 1. Black tea contains tannins, which decrease the absorption of iron. 2. Eggs are one type of food rich in iron. 3. Dried fruit, not fresh fruit, is rich in iron. 4. Foods containing phosphorus, such as milk, decrease absorption of iron.

3) Which statement should the nurse include when teaching parents of an infant about normal growth and development regarding weight gain? 1. "Your baby's weight should triple by 9 months of age." 2. "Your baby's weight should double by 5 months of age." 3. "Your baby's weight should triple by 6 months of age." 4. "Your baby's weight should double by 1 year of age."

2 Explanation: 1. The normal infant's birth weight triples by 1 year of age. 2. It is expected that the infant would double in weight by 5 months of age. 3. The infant's birth weight should double by 5 months of age. A child whose weight triples by 6 months of age has gained weight too rapidly. 4. The child's birth weight should triple by 1 year of age. This child may not be growing adequately.

4) The nurse is teaching the parents of a 4-month-old infant about good feeding habits. Which is the rationale for not letting the baby go to sleep with the bottle? 1. To decrease the risk for aspiration 2. To decrease the risk for dental caries 3. To decrease the risk for malocclusion problems 4. To decrease the risk for sleeping disorders

2 Explanation: 1. There have been limited data to date showing a positive correlation to putting a baby to sleep with a bottle and increased risk of aspiration. 2. Infants should not be put to bed with a bottle as this increases the risk for developing dental caries. 3. The primary concerns related to putting an infant to bed with a bottle are dental caries and otitis media. Poor dental alignment is not a significant problem. 4. Sleeping disorders have not been found to be related to letting an infant go to sleep with a bottle.

9) The mother of a 6-week-old male infant tells the nurse that her baby has had colic for several days, crying for up to 3 hours and drawing his legs up on his abdomen. The mother says she is at "wits end" and wonders what she can do. The nurse learns that the infant is being formula-fed and gaining weight satisfactorily. Which recommendations will the nurse make based on the current data? Select all that apply. 1. Breastfeeding the infant 2. Switching to a bottle that has a collapsible bag inside 3. Putting the infant in a baby swing after feeding 4. Burping the baby more frequently 5. Giving the baby a suppository once each morning

2, 3, 4 Explanation: 1. The infant is 6 weeks old. Initiating breastfeeding is not a good option at this time. 2. This would reduce the amount of air that the baby swallows. 3. The motion may reduce the abdominal discomfort. 4. This helps the infant expel gas, which is a factor contributing to colic. 5. Suppositories would not be recommended.

8) The parents of a 2.5-year-old boy are concerned about their child's finicky eating habits. While counseling the parents, which statements by the nurse would be accurate? Select all that apply. 1. "Nutritious foods should be made available at all times of the day so that the child is able to 'graze' whenever he is hungry." 2. "The child is experiencing physiologic anorexia, which is normal for this age group." 3. "A general guideline for food quantity at a meal is one quarter cup of each food per year of age." 4. "It is more appropriate to assess a toddler's nutritional demands over a 1-week period rather than a 24-hour one." 5. "The toddler should drink 16 to 24 ounces of milk daily."

2, 4, 5 Explanation: 1. Food should be offered only at meal and snack times. 2. Physiologic anorexia is caused when the extremely high metabolic demands of infancy slow to keep pace with the slower growth of toddlerhood, and it is a very normal finding at this age. 3. The correct general guideline for food quantity is 1 tablespoon of each food per year of age. 4. It is not unusual for toddlers to have food jags where they only want one or two food items for that day. So it is more helpful to look at what their intake has been over a week instead of a day. 5. Two to three cups of milk per day are sufficient for a toddler; more than that can decrease his desire for other foods and lead to dietary deficiencies. Children should sit at the table while eating to encourage socialization skills.

14) The nurse collects the weight and height measurements of a child, and calculates the child's body mass index (BMI) to be in the 10th percentile. Previous assessments indicate that the child's BMI was also in the 10th percentile. Which should the nurse include in the discussion of this child's BMI with the parents? 1. Undernutrition 2. Inconsistent growth 3. Consistent growth 4. Overnutrition

3 Explanation: 1. Body mass index (BMI) is a calculation that falls between the 10th and 90th percentiles. That a child consistently has a BMI in the 10th percentile reveals consistent growth, and does not necessarily indicate undernutrition. 2. Body mass index (BMI) is a calculation that falls between the 10th and 90th percentiles. That a child consistently has a BMI in the 10th percentile reveals consistent growth. 3. Body mass index (BMI) is a calculation that falls between the 10th and 90th percentiles. That a child consistently has a BMI in the 10th percentile reveals consistent growth, and doesn't necessarily indicate undernutrition. 4. Body mass index (BMI) is a calculation that falls between the 10th and 90th percentiles. That a child consistently has a BMI in the 10th percentile reveals consistent growth, and doesn't indicate overnutrition.

13) The nurse is providing nutritional guidance to the parents of a school-age child. Which comment by a parent would prompt the nurse to provide further education? 1. "We use separate utensils for food preparation and for eating." 2. "We allow our child to drink only pasteurized apple cider." 3. "We let our child sample cookie dough while making cookies." 4. "We always wash our hands well before any food preparation."

3 Explanation: 1. Using separate utensils for preparing raw meat and preparing fruits, vegetables, and other foods helps prevent infection with foodborne pathogens. 2. Not serving unpasteurized apple cider helps prevent infection with foodborne pathogens. 3. Raw cookie dough contains raw eggs which increases the risk for foodborne illness. 4. Washing hands helps prevent infection with foodborne pathogens.

6) The nurse is presenting a program on healthy eating habits to the parents of children attending the clinic. Which parental comment indicates the need for more information about safe food preparation? 1. "We always wash our hands well before any food preparation." 2. "We use separate utensils for preparing raw meat and for preparing fruits, vegetables, and other foods." 3. "We take the meat out of the freezer and then allow it to thaw on the counter for 2 to 3 hours before cooking it thoroughly." 4. "If our baby doesn't drink all the formula in his bottle, we throw the rest out."

3 Explanation: 1. Washing hands removes pathogens from the hands and prevents food contamination. 2. Raw meats are a good source of pathogens. Utensils used on raw meat can transfer the pathogens to other foods if they are not prepared in a manner to destroy these pathogens. 3. Allowing meat to sit out on a counter can cause the bacteria counts to increase quickly, and cooking the meat might not effectively destroy all of the bacteria. Frozen meat should be thawed in the refrigerator prior to cooking. 4. While drinking from a bottle, organisms can be transferred from the baby's mouth to the formula. If this formula is saved, the organisms can multiply in the formula.

19) The nurse is providing care to a toddler-age client who is diagnosed with celiac disease. Which interventions will the nurse include in the toddler's plan of care? Select all that apply. 1. Temporary removal of wheat products from the diet 2. Permanent removal of oat products from the diet 3. Fat-soluble vitamin supplements 4. Avoidance of processed foods 5. Obtaining a dietary prescription

3, 4, 5 Explanation: 1. Wheat products contain gluten; therefore, these products must be removed permanently from the diet. 2. Oat products are often tolerated by clients diagnosed with celiac disease. 3. Fat-soluble vitamin supplements are often needed by clients diagnosed with celiac disease. 4. Processed foods should be avoided because they are often hidden sources of gluten. 5. A dietary prescription is often necessary for clients diagnosed with celiac disease because this allows insurance company coverage for the purchase of specialized foods.

7) During a 4-month-old infant's well-child checkup, the nurse discusses introduction of solid foods into the infant's diet. Although the nurse recommends delaying the introduction of many foods into the diet, which food(s) will the nurse discuss delaying because they increase the risk for food allergy? 1. Honey 2. Carrots, beets, and spinach 3. Pork 4. Cow's milk, eggs, and peanuts

4 Explanation: 1. Although honey can contain botulism spores that cannot be detoxified by the infant younger than 1 year old, it does not cause an allergic reaction. 2. Carrots, beets, and spinach contain nitrates and should not be given before 4 months of age. 3. The addition of pork is delayed until the infant is 8 to 10 months old because meats are hard to digest. 4. Cow's milk, eggs, and peanuts are foods that have been associated with food allergies.

10) An adolescent is admitted to the eating disorders unit with a 2-year history of anorexia nervosa. Assessment data indicate that the adolescent has recently sustained additional weight loss and electrolyte imbalances. Which is the priority when planning care for this client? 1. Individual counseling 2. Family therapy 3. Regulation of antidepressant drugs 4. Nutritional support

4 Explanation: 1. This will be an important component of inpatient treatment but is not the priority intervention. 2. Family therapy is usually a component of the treatment of anorexia nervosa but is not the priority intervention. 3. Antidepressant drugs may be used as a component of the treatment, but this is not the priority intervention. 4. Hospitalization usually is in response to the weight loss and electrolyte imbalances, so nutritional support becomes the priority intervention. All other activities can be managed as outpatient therapies.