PEDs Chapt 3

A 3-month-old still has a Moro reflex. Which statement is most true of this reflex? a) A Moro reflex present at 3 months of age requires referral for a neurologic exam. b) A Moro reflex normally lasts until 9 months. c) Most 3-month-olds still have a Moro reflex. d) It is not important how long the reflex persists, only that it is present at birth.

Most 3-month-olds still have a Moro reflex. Correct Explanation: Typically, Moro (startle) reflexes last until 5 to 6 months and then fade.

A mother is discussing her 10-month old boy with the nurse. Which comment indicates a need for teaching? a) "He gets a few sips of apple juice each day from a cup." (not sippy) b) "We have safety gates at the top and bottom of our stairs." c) "He loves being in his walker and 'zips' around the house." d) "I wipe my son's teeth every day with a fresh washcloth."

"He loves being in his walker and 'zips' around the house." Walkers are safety hazards and not recommended by the American Academy of Pediatrics. They cause falls plus promote the ability to reach items on surfaces otherwise inaccessible. The other comments are age appropriate and acceptable practice.

A frustrated mother comes to a 9-month well-baby checkup complaining to you that her son is refusing all of the solid food she gives him. When talking with this mother, the nurse discovers that she has struggled all her life with a weight problem. She attributes this problem to being forced to eat all of the food she was served as a child, even when she was full. Because she doesn't want to cause the same problem in her child, she tells the nurse that each time her son pushes food away with his tongue she believes that he doesn't want it. Which of the following statements would be most appropriate for the nurse to say to this mother? a) "Because your baby is a fussy eater, have more than one food available at each feeding so he can choose a food he likes." b) "The baby needs to learn how to move the food to the back of the mouth for swallowing, so catch the food and offer it again until the baby learns this." c) "The baby might not be ready for solid food, so wait a month or so and try again." d) "The baby might be allergic to the particular foods you offered, so try different kinds of food."

"The baby needs to learn how to move the food to the back of the mouth for swallowing, so catch the food and offer it again until the baby learns this." Correct Explanation: The infant knows only one way to take food: namely to thrust the tongue forward as if to suck. This is called the extrusion (protrusion) reflex and has the effect of pushing solid food out of the infant's mouth. The process of transferring food from the front of the mouth to the throat for swallowing is a complicated skill that must be learned. If the food is pushed out, the caregiver must catch it and offer it again. The baby soon learns to manipulate the tongue and comes to enjoy this novel way of eating.

A mother is concerned that her infant is not gaining adequate weight. The baby is 6 weeks old. Birth weight was 7 pounds 8 ounces (3,400 g). The child should weigh about __________________.

9 pounds (4.32 kg) The child should gain about 20 to 30 g daily while making up the common 10% weight loss following birth.

A newborn infant requires skin care that includes bathing. Besides hygiene, what are other reasons for bathing an infant? a) Bathing is a time for bonding with the parents. b) Bathing can prevent infection. c) Bathing is a great time to apply lotion. d) Bathing helps moisten the skin.

Bathing is a time for bonding with the parents. Explanation: The parents can use bath time for bonding with their infant. This can be done with talking, cooing, and singing. Bath time should be paced and non-stressful.

What is the best awake state for infant interaction? a) Active or quiet sleep b) Crying c) Eyes wide and bright d) Drowsy state

Eyes wide and bright Correct Explanation: The best time for a family to interact with an infant is when the infant is in the quiet or active alert stage. Examples of this are: minimal body activity, regular respirations, face with shiny look, eyes wide and bright, and most attention to stimuli.

The nurse pulls the 5-month-old to sitting position from supine and notes head lag. The nurse's response is to: a) Consider this a normal response for the age. b) Conclude the earlier assessments carried out fatigued the infant. c) Suggest more awake tummy time for the child. d) Refer the infant for developmental and/or neurologic evaluation.

Refer the infant for developmental and/or neurologic evaluation. Correct Explanation: There should be no head lag by 4 months. Head lag in the 5-month-old may indicate motor or neurologic problems and needs immediate follow-up. All other nursing actions indicate failure to recognize the problem.

The nurse conducting a 6-month well-baby check-up assesses for the presence/absence of the asymmetric tonic neck reflex. At this age the reflex: a) Is a protective reflex and retained for life b) Should have disappeared c) Should be pronounced and easy to elicit d) Is expected to appear within 1 month

Should have disappeared Correct Explanation: This primitive (not protective) reflex should be present at birth and disappear around age 4 months.

The nurse enters her patient's room to find the new mom crying softly. The nurse asks what is wrong. The mom says, "I had my heart set on breast-feeding and now my baby has a cleft lip. My dreams of breast-feeding him are destroyed." What should the nurse tell her patient about breast-feeding an infant with this diagnosis? a) "Sometimes dreams do not come true." b) "I am so sorry, looks like bottle-feeding for you." c) " You can still attempt breast-feeding; let me call a lactation consultant for you." d) "I am so sorry your infant has that problem, maybe next time."

" You can still attempt breast-feeding; let me call a lactation consultant for you." Correct Explanation: The nurse should be therapeutic in her response and reassure the mother that breast-feeding may still be an option. Infants with cleft lips may still successfully breast-feed. The infant's feeding must be assessed, their weight monitored, and the feeding may be slower. The other responses are not therapeutic and supportive to the new mother.

A teen mom asks the discharge nurse if it is okay to sleep in bed with the baby. She says her mom always did it with her siblings and it seemed okay. The nurse should respond how? a) "Sure, you can, make sure you use a soft mattress for support." b) "Bed sharing has positive effects on babies, let me get you information." c) "Sure, you can do whatever you want, it is your baby." d) "Bed sharing is okay, just make sure the infant is between two people."

"Bed sharing has positive effects on babies, let me get you information." Correct Explanation: The nurse should enforce that bed sharing is sometimes a positive experience if the parents are safe and responsible. When done properly, the effect can be positive on infant nutrition and physiology. The other responses do not promote safety or educate the teen.

The caregiver of an infant tells the nurse that her dentist told her not to let the child go to bed with a bottle of milk. The caregiver states she doesn't understand the reason for this since her baby seems to enjoy the bottle. The most appropriate response to this caregiver would be: a) "Bottles given at bedtime can cause erosion of the enamel on the teeth." b) "You could give your baby a bottle of water at bedtime occasionally." c) "Giving your baby a pacifier at bedtime will satisfy the need to suck." d) "Giving a bottle of milk when the infant goes to bed can lead to obesity."

"Bottles given at bedtime can cause erosion of the enamel on the teeth." Correct Explanation: The sugar from formula or sweetened juice coats the infant's teeth for long periods and causes erosion of the enamel on the deciduous teeth. While giving water in a bottle at bedtime is acceptable (D) and a pacifier will satisfy the sucking need (C), the most appropriate response is B. Giving a bottle at bedtime is not a factor that leads to obesity.

Stacy and Matt are searching for a daycare provider for their infant son Max. At discharge the couple asks their maternity nurse what to look for when finding daycare providers. What response should the nurse make? a) "Interview daycares if they look clean, then register." b) "Look at the staff and see if they look nice." c) "Go look at daycares and ask questions about licensure, nutrition, staff, and safety." d) "Just look in the newspaper and see which ads need kids."

"Go look at daycares and ask questions about licensure, nutrition, staff, and safety." Correct Explanation: The nurse discusses with the parents the importance of a safe, competent daycare provider. The parents should ask questions about the administration and operations, staffing, cleanliness, safety, and food. This will ensure that they are comfortable in their choice. The other answers do not provide the parent with enough knowledge about the care provider.

Martha asks the nurse if her 2-month-old could have baby bananas yet. The nurse would respond and educate Martha on the nutrition stages of infants by which of these responses? a) "Sure, if you feel she is ready to have bananas." b) "In two months you can try bananas if you think she is ready." c) "In one month you can try bananas if you think she is ready." d) "When did you feed your other child bananas?

"In two months you can try bananas if you think she is ready." Correct Explanation: The nurse should choose this response because no solid foods are recommended for infants until 3 months of age. The age of 4 to 6 months is the age recommended to introduce solid foods. The other responses are the incorrect age or are letting the parent decide the appropriate answer.

Debbie asks her nurse what she thinks about giving her baby a pacifier. Debbie is struggling with this issue and is very teary-eyed about making a decision. How should the nurse respond to Debbie? a) "You should do whatever you want." b) "I always gave my kids a pacifier." c) "You should never give babies pacifiers." d) "It is a personal decision, let me give you a pamphlet from the AAP."

"It is a personal decision, let me give you a pamphlet from the AAP." Correct Explanation: The nurse would not give a biased opinion and would offer Debbie literature on which to base her own decision making. The other choices offer personal views or are not supportive in educating Debbie.

Patty calls the hospital nursing hotline and asks, "My 8-week-old daughter cries 8 hours a day, and she is hard to console, is that normal?" What should the nurse's response be to this mother? a) "No, call your doctor." b) "Let me ask you some more questions to see if there are symptoms of colic." c) "Yes, maybe she is just tired." d) "Yes, infants cry all the time at that age."

"Let me ask you some more questions to see if there are symptoms of colic." Correct Explanation: The nurse should seek more information to assess the infant's symptoms. The symptoms suggest colic, which is characteristic of an infant who cries more than 3 hours a day and is fussy and hard to console. The other responses are non-therapeutic and do not seek further information to gather a history.

Julie is an 18-year-old new mother. When the nurse discharges the mom and infant, she notices that the car seat is in the front seat of the car. What is the appropriate response for the nurse to make regarding the car seat? a) "With the car seat in front, you can keep an eye on your baby." b) "I see you have a car seat, that is great." c) "You should never put the car seat in the front." d) "Let me go over car seat safety with you, so you can install your car seat properly."

"Let me go over car seat safety with you, so you can install your car seat properly." Correct Explanation: The nurse should notice this is not the proper place for a car seat. The car seat should be rear facing and in the center of the back seat of the car. The nurse would review car seat safety with Julie and have Julie install the seat properly. The nurse should provide written materials if available. The other responses are not appropriate and do not ensure that proper installation will occur and that infant safety will be maintained.

The nurse goes in to check on Lilly and how breast-feeding is going with her new son. The nurse observes the infant is on her lap with the blanket unwrapped, and Lilly is washing his face, and gently stroking the baby. Lily has had trouble breast-feeding the last few times. What is the appropriate response from her nurse? a) "Lilly, maybe you should watch the breast-feeding video again." b) "Lilly, that is not how you get him to eat." c) "Lilly, you are doing a wonderful job attempting to waken the baby." d) "Lilly, you will never get him to eat all unwrapped like that."

"Lilly, you are doing a wonderful job attempting to waken the baby." Correct Explanation: The nurse should be emotionally supportive to the new mom. The mom's techniques are commonly used in breast-fed infants who are sleeping. The encouragement from the nurse will support the mom through this learning period. The other responses do not emotionally support the mom or contribute to a positive learning environment

The nurse comes into infant Lucy's room on the pediatric floor. She is going to try and feed her for the first time since her surgery. How does the nurse know what infant state Lucy is in by what Mom says and that it is okay to try and feed Lucy? a) "Lucy is still sleeping, I guess she is worn out." b) "Lucy has been a chatterbox and smiles just like her brother." c) "Lucy has been crying every time someone picks her up." d) "Lucy is so quiet today, that is not like her."

"Lucy has been a chatterbox and smiles just like her brother." Correct Explanation: The best time to feed Lucy is when she is in the awake state. Lucy is talking and smiling, which shows she is calm and actively awake. In the awake state the infant has normal respirations, limited movement, and eyes that are bright and shiny and attentive. The other choices put Lucy in a crying state, quiet or active sleep, or drowsing. These stages are not optimal for interacting with Lucy.

Nurse Betty is documenting her postpartum mother and baby. She must document the relationship between the mother and infant. Which observation would demonstrate attachment? a) "The infant is in the crib every time Betty goes into the room." b) "The mom is talking to the infant while breast-feeding the infant." c) "The father is always holding the infant." d) "The infant remains in the nursery most of the day."

"The mom is talking to the infant while breast-feeding the infant." Correct Explanation: The nurse would document attachment when she observes eye-to-eye contact between infant and mother, and the mother holding the infant close and talking softly with the infant. The attachment relationship occurs with eye-to eye contact, communication, and physical contact. The other choices display none of these characteristics between infant and mother.

A young breastfeeding mother calls the telephone nurse because she is concerned about her 3-month-old's stools. Which statement is of concern? a) "Her stools are loose and seedy." b) "The stools are foamy and smell terrible." c) "She hasn't had a stool for 3 days." d) "She grunts and squirms when filling her diaper."

"The stools are foamy and smell terrible." Correct Explanation: This may indicate a digestive problem or illness. The physician or nurse practitioner should be contacted. All the other statements describe normal stooling.

Bob and Nancy have financial issues and ask the nurse if a borrowed crib would be okay to use for their new twin boys. Which response should the nurse use in educating the parents? a) "You should just buy a new crib to be on the safe side." b) "You can use the crib, but there are guidelines to follow." c) "No, you cannot use a borrowed crib." d) "You can use any crib that you want."

"You can use the crib, but there are guidelines to follow." Correct Explanation: The nurse would educate the parents on the latest guidelines for using baby cribs and provide them with available safety and information pamphlets. All cribs made after 1973 have specific safety guidelines and standards. The other responses do not provide the correct available information or educate the parents on safety standards.

Stacy is going to visit her son in the intensive care unit. She has been pumping breast milk and storing it in the fridge. Stacy is making her son's bottle for his feeding and goes to warm the breast milk. What choices should the nurse give the mom to prepare the bottle? a) "It is okay if the frozen milk is in the bottle." b) "You can use the hot water tap to get warm water to warm the bottle." c) "Just take the bottle from the fridge and use it." d) "Just use the microwave in our kitchen."

"You can use the hot water tap to get warm water to warm the bottle." Correct Explanation: The nurse should recommend using warm water or a warm-water tap to place the bottle in before feeding. A microwave should never be used; it could create hot spots and burn the infant. The other choices are not recommended and can cause stomach discomfort

The nurse enters her patient's room and finds the infant on a pillow with a bottle propped up while mom is dressing. What reaction should the nurse make? a) "Is she almost done feeding?" b) "You should always hold your baby for feedings instead of propping the bottles." c) "Are you almost ready to be discharged?" d) "Look how cute she is."

"You should always hold your baby for feedings instead of propping the bottles." Correct Explanation: The nurse should educate the mother on the risks of propping bottles with infants. Infants are at risk for aspiration of milk and for otitis media. The other choices do not point out the safety risks or educate the mother.

Donna takes her 4-month-old to the doctor for a visit. She asks the nurse what type of baby cereal she should buy now that Jimmy is starting solid foods. The nurse should respond how? a) "You should buy barley cereal." b) "You should buy wheat cereal." c) "You should buy oat cereal." d) "You should buy rice cereal."

"You should buy rice cereal." Correct Explanation: The rice cereal should be first. The infant should be monitored for food allergies by following the rice cereal with oats, barley, and wheat. Wheat has the highest allergy reaction in infants.

The infant weighs 6 lbs. 8 oz. at birth. If the infant is following a normal pattern of growth, which of the following would be an expected weight for this child at the age of six months? a) 16 lbs. b) 15 lbs. 4 oz. c) 10 lbs. 8 oz. d) 13 lbs.

13 lbs. Explanation: During the first six months, the infant's birth weight doubles.

A 6-month-old arrives for a well-baby visit with a case of diaper rash. The baby's mother tells the nurse she is not concerned and believes this to be normal. She reports that she changes the baby's diaper when he wakes up and before she puts him in his crib for naps or bedtime. It would be important to teach this mother that she should start checking his diaper to see if it needs changing every a) 1-1 1/2 hours b) 2-4 hours c) 1/2 hour d) 5 hours

2-4 hours Correct Explanation: To prevent diaper rash, soiled diapers should be changed frequently. Check every 2-4 hours while the infant is awake to see if the diaper is soiled. Waking the baby to change the diaper is not necessary.

The infant weighs 7 lbs. 4 oz. at birth. If the infant is following a normal pattern of growth, which of the following would be an expected weight for this child at the age of 12 months? a) 25 lbs. b) 14 lbs. 8 oz. c) 28 lbs. 4 oz. d) 21 lbs. 12 oz.

21 lbs. 12 oz. Explanation: By one year of age, the infant has tripled his or her birth weight and has grown 10 to 12 inches

The infant measures 21 ½ inches at birth. If the infant is following a normal pattern of growth, which of the following would be an expected height for this child at the age of six months? a) 29 inches b) 30 ½ inches c) 27 ½ inches d) 32 inches

27 ½ inches Correct Explanation: Most infants double their birthweight by 4 months of age and triple their birthweight by the time they are 1 year old. By 12 months of age, the infant's length has increased by 50 percent

The infant measures 21 ½ inches at birth. If the infant is following a normal pattern of growth, which of the following would be an expected height for this child at the age of six months? a) 29 inches b) 27 ½ inches c) 30 ½ inches d) 32 inches

27 ½ inches Correct Explanation: Most infants double their birthweight by 4 months of age and triple their birthweight by the time they are 1 year old. By 12 months of age, the infant's length has increased by 50 percent.

The infant measured 20 inches at birth. If the infant is following a normal pattern of growth, which of the following ranges would be an expected height for this child at the age of 12 months? a) 40-42 inches b) 30-32 inches c) 36-38 inches d) 26-28 inches

30-32 inches Correct Explanation: By one year of age, the infant has tripled his or her birth weight and has grown 10 to 12 inches.

When weighing and measuring a child at her 1-year well-baby checkup, the nurse would expect to see that over the previous 6 months a baby who weighed 8 pounds and was 20 inches long at birth would have gained about a) 8 pounds and grown 2-3 inches b) 16 pounds and grown 2-3 inches c) 16 pounds and grown 4-6 inches d) 8 pounds and grown 4-6 inches

8 pounds and grown 4-6 inches Correct Explanation: During the first 6 months, an infant's birth weight doubles and his or her height increases by about 6 inches. Growth slows slightly during the second 6 months but is still rapid. By 1 year of age, the infant has tripled his or her birth weight and has grown 10 inches to 12 inches.

The nurse is helping the mother of a 5-month-old boy understand the importance of developmentally appropriate play. Which one of the toys best meets the needs of this child? a) Brightly colored stacking toy b) A push-pull toy c) Pots and pans from the kitchen cupboard d) A yellow rubber duck for the bath

A yellow rubber duck for the bath Correct Explanation: The rubber duck is most appropriate. It is safe, is visually stimulating while bobbing on the water, and adds pleasure to bath time. A push-pull toy promotes skill for a walking infant. Pots and pans from the kitchen cupboard are played with successfully after sitting is mastered. A 5-month-old does not have the fine motor coordination to use stacking toys.

What is the correct amount of urine diapers a mature infant should have each day? a) An infant should have 3 to 5 wet diapers/day. b) An infant should have 4 to 6 wet diapers/day. c) An infant should have 6 to 8 wet diapers/day. d) An infant should have 4 wet diapers/day.

An infant should have 6 to 8 wet diapers/day. Correct Explanation: Urination occurs in the first 24 hours of life. A normal amount of urine is 200 to 300ml/day as the infant matures. This amount is equal to 6 to 8 wet diapers/day.

A new mother asks for advice from the nurse about bathing her infant. Which of the following should the nurse tell her? a) Be sure to oil the scalp with mineral oil and leave it on overnight before bathing the infant the next day b) Be sure to give the baby a complete bath every day c) Be sure to wash the infant's face, hands, and diaper area daily d) Be sure to brush the scalp with a soft toothbrush during the bath to prevent seborrhea

Be sure to wash the infant's face, hands, and diaper area daily Correct Explanation: Except in very hot weather, an infant does not need a bath every day. If a parent is tired and would not enjoy bath time or if some days are just too rushed, a complete bath can be omitted, with only the infant's face, hands, and diaper area washed. Some infants do need their head and scalp washed frequently (every day or every other day) to prevent seborrhea, a scaly scalp condition often called cradle cap. If seborrhea lesions do develop, they adhere to the scalp in yellow, crusty patches. The skin beneath them may be slightly erythematous. The patches can be softened by oiling the scalp with mineral oil or petroleum jelly and leaving it on overnight. The crusts can then be removed by shampooing the hair the next morning. A soft toothbrush or fine-toothed comb can be used to help remove them.

An infant is breastfed. When assessing her stools, which of the following data would be typical? a) Breastfed infants usually have fewer stools than bottle-fed infants. b) Stools of breastfed infants are usually harder than those of bottle-fed infants. c) Stools of breastfed infants tend to have a strong odor. d) Breastfed infants are less likely to be constipated than bottle-fed infants.

Breastfed infants are less likely to be constipated than bottle-fed infants. Explanation: The stools of breastfed infants tend to be yellow and looser than those of bottle-fed babies.

Which of the following would you include when teaching the parents of an infant about colic? a) Symptoms will decrease if she is laid on her back after feedings. b) Colic symptoms will probably fade at 3 months of age. c) Their child will need future follow-up for a "nervous" bowel. d) Formula intake should be doubled to keep her from losing weight.

Colic symptoms will probably fade at 3 months of age. Correct Explanation: Colic symptoms typically fade at 3 months of age, probably because children begin to maintain a more upright position at that time.

The nurse is preparing a list of abilities of 10-month-olds to use in teaching a parenting group. Which of the following should appear at this age? a) Sits from standing position b) Feeds self with spoon (but spills) c) Cruises around furniture d) Uses two or three words with meaning

Cruises around furniture At 10 months, this ability appears and is practiced often in preparation for later independent walking. All the rest of the skills take an additional 2 months to develop and appear around age 1 year.

Infant development is best described by which of the following statements? a) Development proceeds from fine to gross. b) Development varies greatly from infant to infant. c) Development is not sequential but predictable. d) Development proceeds cephalocaudally.

Development proceeds cephalocaudally. Correct Explanation: Growth and development both proceed from head to toe, or in a cephalocaudal sequence.

The nurse is providing anticipatory guidance regarding the respiratory development of a 4-week-old girl for her mother. Which of the following is accurate? a) Advising the mother that the infant's usual respiratory rate should slow to about 20 breaths per minute by age 6 months b) Explaining to the mother the risk for infection is high due to the lack of antibodies c) Informing the mother that the respiratory system reaches maturity similar to the adult's by 12 months of age. d) Telling the mother that abdominal breathing disappears by 9 month of age

Explaining to the mother the risk for infection is high due to the lack of antibodies Correct Explanation: Attributing frequent infections to a lack of antibodies is accurate. The infant lacks IgA in the mucosal lining of the upper respiratory tract. The infant's respiratory rate drops to 20 to 30 breaths per minute by the end of the first year. Abdominal breathing persists until 6 to 12 years of age. The respiratory system matures by age 7 years.

Which measure would you suggest an infant's parents use to relieve teething discomfort? a) Give her a cold teething ring to chew. b) Ask her pediatrician for a sedative for her. c) Provide her with a fluid diet for 2 days. d) Offer her Aspergum to chew.

Give her a cold teething ring to chew. Correct Explanation: Cold can be very soothing for the tender gum lines during teething. A sedative is not necessary for normal teething discomfort.

Mark is a 2-month-old that has inconsolable crying, is gassy, and constantly draws his legs up. It has been determined that Mark has colic. What is the best intervention to treat colic? a) He needs to try a different formula to assess for sensitivity. b) His parents should sing and play music to comfort him. c) He is hungry so his mom should feed him more. d) His mom should have a regular diet.

He needs to try a different formula to assess for sensitivity. Correct Explanation: Colic peaks between 3 weeks and 6 months of age. Treatment is a restful, soothing environment. Changing an infant's formula or having a breast-feeding mom decrease her intake of gassy foods may alleviate the symptoms.

A parent who is feeding his child formula prepared at home using evaporated milk is concerned about whether the child is receiving all necessary nutrients. Which of the following would be important for this parent to add to his child's diet to supplement the formula? a) Vitamins D b) Iron c) Calcium d) Vitamin E

Iron Correct Explanation: Infants who are fed home-prepared formulas (based on evaporated milk) need supplemental vitamin C and iron. Evaporated milk has adequate amounts of vitamin D, which is unaffected by heat used in the preparation of formula. Calcium and vitamin E would not be concerns in this infant's formula.

Which of the following does Erikson describe as the psychosocial development task upon which other psychosocial development is built? a) Learning to feel anger b) Learning to fear c) Learning to trust d) Learning to love

Learning to trust Correct Explanation: Erikson's primary psychosocial developmental task for the infant is learning to trust. This task creates the foundation for the developmental tasks of the next stages of the child's life. If the infant does not receive food, love, attention, and comfort, the infant learns to mistrust the environment and those who are responsible for caring for the child.

A staff nurse is talking about Piaget's theory with a nursing student. Infants are in the sensorimotor stage of cognitive development during which object permanence is mastered. An example of an infant displaying this ability is: a) Smiling at herself in the mirror b) Shaking a rattle to enjoy the sound c) Pushing a spoon from her high chair tray to the floor d) Looking for a toy in her crib at the last place she saw it

Looking for a toy in her crib at the last place she saw it Correct Explanation: Looking for the toy where it was last seen indicates object permanence. The infant knows the object still exists even though she cannot see it. All the rest of the infant behaviors show use of her senses and motor activity but do not illustrate object permanence.

The nurse is teaching the mother of a 2-month-old girl about the social and emotional developments that will occur in the next 8 weeks. Which of the following behaviors is most likely to occur? a) Crying when the mother is out of sight b) Mimicking mother's facial expressions c) Participating in a game of peek-a-boo d) Becoming clingy around strangers

Mimicking mother's facial expressions Correct Explanation: Infants will mimic the facial expressions of their parents when they are 3 to 4 months old. Becoming clingy around strangers probably won't occur until the child reaches 6 months. Engaging in peek-a-boo becomes fun between 6 and 8 months. Crying when the mother is out of sight indicates separation anxiety and is common after 6 to 8 months of age.

The mother of a 3-month-old is concerned because her daughter does not yet sit by herself. Which of the following statements best reflects average sitting ability? a) Most babies sit steadily at 4 months; she is normal. b) Sitting ability and the age of first tooth eruption are correlated. c) Most babies do not sit steadily until 8 months; she is normal. d) Most babies sit steadily at 3 months; she is slightly delayed.

Most babies do not sit steadily until 8 months; she is normal. Explanation: Many infants sit steadily by 8 months of age.

While evaluating the development of 10-month-old boy, a nurse hides the boy's stuffed animal behind her back. The boy crawls around the examination table to look behind the nurse's back for the stuffed animal. Which of the following developmental phenomena has this infant demonstrated? a) Binocular vision b) Hand regard c) Depth perception d) Object permanence

Object permanence Correct Explanation: By 10 months, an infant looks under a towel or around a corner for a concealed object (beginning of object permanence, or become aware an object out of sight still exists). Hand regard, which is typically demonstrated by 3-month-olds, is phenomenon that involves the infant holding his hands in front of his face and studying them. Binocular vision, which is the ability to fuse two images into one, is demonstrated by 2-month-olds when they follow moving objects with their eyes. Depth perception allows 7-month-olds to transfer toys from hand to hand.

The nurse is caring for a 5-week-old infant who is spitting up "all the time." This is the mother's first child. Which of the following should be the priority nursing intervention?

Observe the mother while she feeds and burps her infant. Assessing the mother's feeding and burping technique is the first nursing action needed. The mother may be overfeeding or inadequately burping the child. Recommending smaller and more frequent feedings would be determined by the assessment. Assuring the mother that some spitting up is normal and describing the capacity of the infant's stomach is information helpful to parenting but not the priority.

A nurse notices that a 4-month-old infant has an asymmetric head, with the back of the skull flattened. Which of the following should she recommend to the parents to correct this condition? a) Consult a pediatric surgeon about surgically reshaping the skull b) Place the infant on her stomach to sleep each night c) Increase the infant's sleep time each day d) Place the infant on her stomach during play time each day

Place the infant on her stomach during play time each day Correct Explanation: Some infants' heads appear asymmetric until the second half of the first year, especially if they are always placed on their back to sleep (which they should be) causing the skull bones to flatten in the back. Suggest to parents they continue to place the infant on the back to sleep but spend "tummy time" time daily with the infant placed in a prone position to prevent this flattening. This early head distortion will gradually correct itself as the child sleeps less and spends more time with the head in an erect position. Persistence of asymmetry suggests an infant is not receiving enough stimulation or is spending the majority of time lying in bed. Surgery is not required to correct this condition.

What feeding practice used by the parents of an 8-month-old should the nurse discourage? a) Including the infant at family meals in her high chair b) Continuing to offer foods the child rejects c) Giving the child soft table food and finger foods d) Placing all liquids given the child in a "no spill" sippy cup

Placing all liquids given the child in a "no spill" sippy cup Correct Explanation: No spill sippy cups promote sucking rather than teach cup drinking. Reserve these for times avoiding spills is essential. The other feeding practices are age appropriate and safe. Soft table and finger foods promote accepting new textures and self-feeding. Reoffering rejected food allows the child to accept it when ready. Including the infant at the family table provides for modeling of eating behaviors and socialization.

The nurse is working with the caregivers of an infant. The caregivers tell the nurse their child cries when her mother leaves for even a short amount of time. Which of the following might the nurse suggest as a way to console the infant and help the child develop a sense of security when the child's primary caregiver is out of sight? a) Give her dolls and stuffed animals so she learns to distract herself b) Pick the child up as soon as she begins to cry c) Play "peek-a-boo" with the child when she is happy d) Slowly increase the amount of time she is allowed to cry before being picked up

Play "peek-a-boo" with the child when she is happy Explanation: For the infant, self-assurance is necessary to confirm that objects and people do not cease to exist when out of sight. This is a learning experience on which the infant's entire attitude toward life depends. The ancient game of "peek-a-boo" is a universal example of this learning technique. It is also one of the joys of infancy as the child affirms the ability to control the disappearance and reappearance of self. In the same manner by which the infant affirms self-existence, it learns to confirm the existence of others, even when they are temporarily out of sight.

The nurse is promoting a healthy diet to the mother of a 6-month-old girl. Which of the following would have the most effect on the infant's neurologic development? a) Requiring more solid foods in the diet b) Establishing an adequate level of dietary iron intake c) Promoting continuation of breastfeeding d) Adding fruit juice daily

Promoting continuation of breastfeeding Correct Explanation: Continuing to breastfeed ensures the proper level of nutritional fat for myelination of the nervous system. Having adequate dietary iron would help prevent anemia as the stores from fetal development are depleted. Promoting increased intake of solid foods is not necessary at 6 months and may diminish the amount of breast milk consumed. Fruit juice in the diet is not recommended. Fruits provide more nutrition and will soon be gradually added to the infant's diet.

A 5-month-old infant being assessed was born at 32 weeks. The nurse doing the well-child check-up should compare the baby to what norms? a) The growth of a 2-month-old b) The development of a 10-week-old c) The development of a 3-month-old d) The growth of a 5-month-old

The development of a 3-month-old Correct Explanation: The infant was born 8 weeks early. Two months are subtracted from the present age of 5 months. Both growth and development should be assessed using 3-month norms.

Which of the following shows an example of Erik Erikson's developmental task for the infant? a) The infant cries and the caregiver picks the child up. b) The infant smiles as people walk past the crib. c) The infant cries when they have a wet diaper. d) The infant plays the game peek-a-boo.

The infant cries and the caregiver picks the child up. Correct Explanation: Erikson's psychosocial developmental task for the infant is to develop a sense of trust. The development of trust occurs when the infant has a need and that need is meet consistently.

A nurse places a toy car in front of a 6-month-old girl. She swats at it, and the car flies across the examination table and lands on the floor. She squeals with surprise and delight. When the nurse puts the toy car in front of her again, she immediately swats it again and laughs as it rolls across the table and falls to the floor again. Which of the following has the girl just demonstrated? a) Binocular vision b) Primary circular reaction c) Object permanence d) Secondary circular reaction

Secondary circular reaction Correct Explanation: By the third month of life, a child enters a cognitive stage identified by Piaget as primary circular reaction. During this time, the infant explores objects by grasping them with the hands or by mouthing them. Infants appear to be unaware of what actions they can cause or what actions occur independently, however. At about 6 months of age infants pass into a stage Piaget called secondary circular reaction. Now when infants reach for an object, hit it, and watch it move, they realize it was their hand that initiated the motion, and so they hit it again. By 10 months, infants discover object permanence. Infants are ready for peek-a-boo once they have gained this concept. They know their parent still exists even when hiding behind a hand or blanket and wait excitedly for the parent to reappear. Binocular vision, which is the ability to fuse two images into one, is demonstrated by 2-month-olds when the follow moving objects with their eyes, although not past the midline.

Which developmental milestone would the nurse expect an 11-month-old infant to have achieved? a) Walking independently b) Turning a doorknob c) Building a tower of four cubes d) Sitting independently

Sitting independently Correct Explanation: Infants typically sit independently, without support, by age 8 months. Walking independently may be accomplished as late as age 15 months and still be within the normal range. Few infants walk independently by age 11 months. Building a tower of three or four blocks is a milestone of an 18-month-old. Turning a doorknob is a milestone of a 24-month-old.

Which of the following milestones would you expect an infant to accomplish by 8 months of age? a) Being able to sit from a standing position b) Sitting without support c) Creeping on all fours d) Pulling self to a standing position

Sitting without support Correct Explanation: Most babies sit steadily at 8 months, creep at 9 months, and pull to standing at 10 months.

Lea is 3 months old. At what age would it be okay for Lea's mother to introduce carrots to her for dinner? a) Solid food can be introduced at 4 to 6 months of age. b) Solid food can be introduced at 7 to 9 months of age. c) Solid food can be introduced whenever the child seems ready. d) Solid food can be introduced at 9 months of age.

Solid food can be introduced at 4 to 6 months of age. Explanation: Solid food may be introduced at 4 to 6 months of age. The infant must be ready to handle spoon-feeding. The first food should be rice cereal. Rice cereal is bland and usually does not cause an allergic reaction.

Place these primitive protective reflexes of infancy in the order in which they will disappear as the child matures. Root Plantar Babinski Step Moro

Step Root Moro Plantar Babinski

Put the following developmental milestones related to an infant's hearing in correct chronological order: Turn head to locate sound Stop activity in response to spoken word Recognize name when spoken Locate & turn toward sound in any direction Locate sounds made above Locate sounds downward and to side

Stop activity in response to spoken word Turn head to locate sound Locate sounds downward and to side Locate sounds made above Recognize name when spoken Locate & turn toward sound in any direction Explanation: That an infant can hear can be demonstrated at birth by the way a newborn quiets momentarily at a distinctive sound such as a bell or a squeaky rubber toy. By 1 month, this reaction is even more marked. Hearing awareness becomes so acute by 2 months of age infants will stop an activity at the sound of spoken words. Many 3-month-old infants turn their heads to attempt to locate a sound. At 4 months of age, when infants hear a distinctive sound they turn and look in that direction. By 5 months of age, infants demonstrate they can localize sounds downward and to the side, by turning their head and looking down. Six-month-olds have progressed to being able to locate sounds made above them. By 10 months, infants can recognize their name and listen acutely when spoken to. By 12 months, infants can easily locate sound in any direction and turn toward it.

A father mentioned to the nurse that his usually smiling, happy 8-month-old boy was clingy and intensely serious when his grandmother visited from a distant city. The nurse explained the child was experiencing:

Stranger anxiety Stranger anxiety occurs around 8 months and manifests as the father described. This behavior indicates the infant sees himself as a separate person. The other options are incorrect and not related to social/emotional development.

In working with the infant age child, the nurse recognizes which of the following as a characteristic of the infant. a) The child has an increased attention span and can be interested in an activity for a long length of time b) The child grows and develops skills more rapidly than at any other time in their life c) The child takes in new information at a rapid rate and asks "why" and "how" d) The child insists they can "do it," the next moment they revert to being dependent

The child grows and develops skills more rapidly than at any other time in their life Explanation: The infant grows and develops skills more rapidly than he or she ever will again. The toddler insists they can do things one minute and then becomes dependent the next minute. The preschool age child soaks in information and asks "why" and "how" over and over. The school-age child has a longer attention span and can become absorbed in a craft or activity for several hours

A 12-month-old seen at a walk-in clinic weighed 8 pounds 4 ounces (3.75 kg) at birth. Weight now is 20 pounds 8 ounces (9.3 kg). The nurse determines:

The child weighs less than expected for age. Birth weight should triple by 12 months. The child should weigh near 24 pounds 12 ounces (11.25 kg). The child is underweight for age.

A father asks you what symptoms he can expect with normal teething in his infant. Which of the following would you tell him? a) He can expect his child to be constipated for 2 days. b) The child's gum line will be tender. c) The child will not play or eat for 2 days. d) The child's temperature may go as high as 102°F.

The child's gum line will be tender. Correct Explanation: Normal teething creates tender gum lines but does not include an elevated temperature or constipation.

The nurse is conducting a physical examination of a 5-month-old boy. Which of the following observations may be cause for concern about the infant's neurologic development? a) The infant displays an asymmetric tonic neck reflex (fencing reflex). b) The anterior fontanel is open and easily palpated. c) His toes hyperextend when the bottom of the foot is stroked. d) The infant grasps a finger when it is placed in his palm.

The infant displays an asymmetric tonic neck reflex (fencing reflex). Correct Explanation: The tonic neck reflex normally disappears by age 4 months, the palmar grasp reflex by age 6 months, and the Babinski reflex (fanning of toes when sole of foot stroked) by 12 months. Retaining these primitive reflexes may indicate a neurologic abnormality. The anterior fontanel, which remains open for brain growth, closes between 12 and 18 months of age.

The nurse is assessing development of a 4-month-old boy during a well-child visit. Which of the following observations needs further investigation? a) The infant turns his head in the direction of a squeak toy. b) The infant responds to his mother when he sees her but not at other times when she is near. c) The infant shows interest in looking at near or high-contrast objects. d) The infant makes babbling sounds, coos, and smiles.

The infant responds to his mother when he sees her but not at other times when she is near.

A nurse is talking to and making facial expressions at a 9-month-old baby girl during a routine office visit. Which of the following represents the most advanced milestone of language development that the nurse should expect to see in this child? a) The infant says "da-da" when looking at her father b) The infant imitates her father's cough c) The infant squeals with pleasure d) The infant coos, babbles, and gurgles

The infant says "da-da" when looking at her father Correct Explanation: By 9 months, an infant usually speaks a first word: "da-da" or "ba-ba." The other answers refer to earlier milestones in language development. In response to a nodding, smiling face, or a friendly tone of voice, a 3-month-old infant will squeal with pleasure or laugh out loud. By 4 months, infants are very "talkative," cooing, babbling, and gurgling when spoken to. At 6 months, infants learn the art of imitating. They may imitate a parent's cough, for example, or say "Oh!" as a way of attracting attention.

The nurse is reviewing topics to be discussed with caregivers related to caring for infants. Which of the following statements would be the most appropriate statement for the nurse to make to this group of caregivers? a) The infant should wear hard-soled shoes in order to protect their feet from injury b) The infant sleeps 10-12 hours at night and take 2-3 naps during the day c) The infant should be sound asleep before being put into the crib for sleeping d) The infant should be dressed more warmly than older children and caregivers

The infant sleeps 10-12 hours at night and take 2-3 naps during the day Explanation: Most infants sleep 10-12 hours at night and take 2-3 naps. By being put to bed while awake and allowed to fall asleep, the infant learns good sleeping habits. The infant should be dressed in the same amount of clothing the adult finds comfortable. Hard-soled shoes are not needed by infants and may hamper the development of the foot.

Using knowledge of normal growth and development, which of the following would be expected when observing a 12-week-old infant? a) The infant bears weight on legs when held in standing position b) The infant grasps objects and brings them to the mouth c) The infant is able to sit up and can roll over d) The infant smiles at significant others

The infant smiles at significant others Explanation: By 12 weeks of age the infant smiles at mom and significant others. The other choices are seen in the infant who is about 20 weeks of age.

Sonograms demonstrate thumb sucking as early as in utero. a) False b) True

True

The nurse at a family health clinic is teaching a group of parents about normal infant development. What patterns of communication should the nurse tell parents to expect from an infant at age 1? a) Understands "no" and other simple commands b) Squeals and makes pleasure sound c) Uses speech-like rhythm when talking with an adult d) Uses multisyllabic babbling

Understands "no" and other simple commands Explanation: At age 1, most babies understand the word "no" and other simple commands. Children at this age also learn one or two other words. Babies squeal, make pleasure sounds, and use multisyllabic babbling at age 3 to 6 months. Using speech-like rhythm when talking with an adult usually occurs between ages 6 to 9 months

A new mother complains that she is exhausted and that the little sleep she gets is determined by her baby's daytime naps and the few hours the baby sleeps during the night. The nurse discusses with this mother the importance of helping the infant establish healthy sleeping patterns. Which of the following would be most helpful for this mother to do to encourage healthy sleeping patterns? The mother should a) Use the crib for sleeping only, not for play activities b) Let the baby cry during the night and she will eventually fall back to sleep c) Wake the baby from afternoon naps after 1 hour to ensure she is sleepy by nighttime d) Put the baby to bed a various times of the evening

Use the crib for sleeping only, not for play activities Correct Explanation: A consistent bedtime routine is usually helpful in establishing healthy sleeping patterns and in preventing sleep problems. Using the crib for sleeping only helps the child associate the bed with sleep. Depriving the baby of sleep during the afternoon or evening will make the baby over-tired and less able to establish a healthy sleeping pattern. While letting a baby cry for a while is acceptable, this does not promote consistency in the baby's sleeping pattern.

The nurse is examining an 8-month-old girl for appropriate development during a regular check-up. Which of the following observations points to a developmental risk? a) Picks up small objects using entire hand b) Cannot pull self to standing c) Uses only the left hand to grasp d) Crawls with stomach down

Uses only the left hand to grasp Favoring one hand over the other may be a warning sign that proper motor development is not occurring in the other arm or hand. Grasping small objects with the entire hand is common at 8 months and precedes the pincer grasp, which is used about 2 months later. Crawling with stomach down and being unable to pull to standing are abilities that may not occur for 4 to 8 weeks.

The mother of an infant asks you when to begin tooth brushing with her son. Your best response would be a) as soon as the first tooth erupts. b) as soon as he begins to eat fruit. c) when weaning is complete. d) by 12 months of age.

as soon as the first tooth erupts. Correct Explanation: Tooth brushing should begin with the eruption of the first tooth.

When teaching an infant's mother about bathing her, it would be important to instruct her that a) infants need a daily bath. b) soap lubricates and oils an infant's skin. c) bath time provides an opportunity for play. d) she should never use soap on a baby's hair.

bath time provides an opportunity for play. Correct Explanation: Infants do not need a daily bath as long as the diaper area is washed with diaper changes. Soap is actually drying to an infant's skin. Washing the hair with soap can help remove excess oil.

Anticipatory guidance for an infant for the 4th month should include the fact that she probably will a) insist on things being done her way. b) be able to turn over onto the back. c) develop a fear of strangers. d) have many "blue" or moody periods.

be able to turn over onto the back. Correct Explanation: Infants typically turn over front to back at 4 months, enlarging the area of the house that needs to be childproofed.

The best way for an infant's father to help his child complete the developmental task of the first year is to a) keep her stimulated with many toys. b) expose her to many caregivers to help her learn variability. c) respond to her consistently. d) talk to her at a special time each day.

respond to her consistently. Correct Explanation: A sense of trust is difficult to learn if things are constantly changing. Consistently responding to an infant's needs helps to build a sense of trust.

The nurse is teaching the mother of a 5-month-old boy who is concerned about thumb sucking. Which of the following should be included in the teaching plan? Select all that apply. a) Assuring the mother this behavior won't cause malocclusion b) Informing the mother that thumb sucking occurs more often during periods of stress c) Telling the mother this behavior usually decreases by 6 to 9 months of age d) Advising the mother this behavior is a form of self-comfort

• Advising the mother this behavior is a form of self-comfort • Assuring the mother this behavior won't cause malocclusion • Informing the mother that thumb sucking occurs more often during periods of stress • Telling the mother this behavior usually decreases by 6 to 9 months of age Explanation: All are accurate and should help the mother better understand and accept the behavior.

Which of the following statements regarding infant safety are accurate? (select all that apply) a) Car seats should be placed in back seats b) A safe temperatures for hot water heaters in households with infants is 120 degrees c) Only small pillows should be used in cribs d) Bottle should only be propped for infants 8 months or older e) Crib and playpen bars should be no more than 2 3/8 inches apart

• Crib and playpen bars should be no more than 2 3/8 inches apart • Car seats should be placed in back seats • A safe temperatures for hot water heaters in households with infants is 120 degrees Explanation: Crib and playpen bars should be no more than 2 3/8 inches apart so the infant can be safe from getting body parts caught between the bars. Car seats are placed in the back seat and manufacturers' instructions are followed regarding forward or backward facing depending on the age and size of the child. Water heaters should be set no higher then 120 degrees to prevent potential dangers. Bottles should never be propped and pillows are not placed in cribs of infants

Parents complain of being "worn out" at their child's 6-month check-up because their boy awakens each night and cries. The nurse suggests which measures? (Select all that apply.) a) During night awakening, keep interactions minimal. b) Establish a quieting ritual before bed. c) Add rice cereal to the evening bottle to prevent hunger and awakening. d) At bedtime, rock the child to sleep and then place in crib.

• During night awakening, keep interactions minimal. • Establish a quieting ritual before bed. Correct Explanation: Bedtime rituals and minimal interactions during night awakening both promote sleep. Adding rice cereal to bottles does not promote sleeping through the night and isn't recommended. Putting the infant asleep into the crib does not teach the child to self-soothe and fall asleep independently.

The infant in the exam room has the following signs and symptoms. Which ones will the nurse attribute to teething? (Select all that apply.) a) Irritability and awakening from sleep b) Refusing to eat c) Fever and diarrhea d) Increased sucking on hands e) Drooling and biting

• Irritability and awakening from sleep • Refusing to eat • Increased sucking on hands • Drooling and biting Correct Explanation: Fever and diarrhea are considered signs of illness, not teething. The others are typical of teething.