Chapter 10 Health Problems of Infants

What clinical manifestations are most likely to be seen in a child with kwashiorkor? 1 Sunken abdomen with dermatoses 2 Sunken abdomen and severe muscle wasting 3 Prominent abdomen with generalized edema 4 Prominent abdomen with severe muscle atrophy

4 The child with kwashiorkor presents with a prominent abdomen and severe muscle atrophy. A sunken abdomen is not correlated with kwashiorkor. Dermatoses may be present in a child with kwashiorkor, but they will be accompanied by a prominent, rather than sunken, abdomen. Generalized edema is not correlated with kwashiorkor.

What does the nurse ask the parent before giving influenza vaccination to a child? (p. 334) 1 "Is your child allergic to eggs of any kind?" 2 "Does your child have celiac disease?" 3 "Is your child allergic to cow's milk?" 4 "Is your child allergic to any antibiotics?"

1 In the preparation of the influenza vaccine, eggs are used. Therefore, if the child is allergic to eggs, the child may develop an allergic reaction after receiving influenza vaccine. Therefore, the nurse should ask the parent whether the child is allergic to eggs. The influenza vaccine is not contraindicated for children who have celiac disease. Celiac disease is a condition in which the patient is either allergic or intolerant to gluten, which is not related to egg allergy. It is safe to administer the influenza vaccine to children allergic to cow's milk and antibiotics, because neither is a component of the vaccine.

A 1-month-old infant is admitted to the hospital for failure to thrive (FTT) secondary to a cardiac condition. How is this type of FTT categorized? (p. 337) 1 Organic 2 Idiopathic 3 Nonorganic 4 Generalized

1 Organic failure to thrive (FTT) is the result of a physical cause, such as a cardiac condition, neurologic condition, renal failure, endocrine system disorder, or other possible chronic or acute disease process. Nonorganic FTT is most often the result of psychosocial factors, such as inadequate nutritional information by the parent. Idiopathic FTT is unexplained by the usual organic and environmental etiologies. Generalized FTT is not a recognized term.

The parents of a 10-year-old child who underwent emergency treatment recently were informed that the child should wear a medical identification bracelet and have an injectable epinephrine cartridge (EpiPen). What is the purpose of the EpiPen? (p. 335) 1 It can save the life of a person with extremely sensitive food allergies. 2 When given into a vein, EpiPen stops anaphylactic shock. 3 It is the first choice drug to treat status epilepticus. 4 It is used to treat asthma attacks due to dust and mold.

1 The EpiPen cartridge contains epinephrine (adrenaline). An anaphylactic reaction happens when someone is exposed to highly sensitive antigens found in substances to which they are allergic. Giving epinephrine (adrenaline) during an anaphylactic reaction stops the cascade of events. It also prevents the loss of intravascular fluids into tissues. This in turn prevents hypotension and also relieves bronchospasms. The route of administration of an EpiPen is through intramuscular injection. EpiPen should not be injected into the veins, because it can cause severe vasoconstriction and hypotension. Epinephrine (adrenaline) is not an anti-epileptic drug, nor is it used to treat asthma attacks.

Which infants are at greatest risk for sudden infant death syndrome (SIDS)? Select all that apply. (p. 345) 1 Those who sleep in a prone position 2 Those who sleep in a supine position 3 Those who were preterm 4 Those with prenatal drug exposure 5 Those with a cousin who died of SIDS

1, 3, 4 (I put 1, 3, 4, 5) Infants at increased risk for sudden infant death syndrome (SIDS) are those of low birth weight, those with low Apgar scores, those who sleep in a prone position or co-sleep, those who were preterm, and those who have a mother who smokes. It is recommended that infants sleep in a supine position to reduce the risk of SIDS. A cousin dying of SIDS does not present an increased risk for the infant.

The nurse is performing a well-child assessment of an infant. The infant's mother tells the nurse that the family follows a strict vegan diet. For what nutritional deficiencies is this child at risk? 1 Vitamin D, vitamin B12, vitamin C, iron, calcium, zinc 2 Vitamin D, vitamin B12, vitamin B6, iron, calcium, zinc 3 Vitamin D, vitamin B12, vitamin C, iron, calcium, magnesium 4 Vitamin D, vitamin B12, vitamin B6, iron, calcium, magnesium

2 Children who consume a strict vegan diet are at risk for vitamin D, vitamin B12, vitamin B6, iron, calcium, and zinc deficiencies. They are also at risk for inadequate intake of protein and calories and poor digestion. Deficiencies in vitamin C and magnesium are not as likely as deficiencies in vitamin B6 and zinc.

Which neonatal complication can be prevented when the nurse instructs a pregnant patient to increase folic acid in her diet? (p. 331) 1 Rickets 2 Spina bifida 3 Kwashiorkor 4 Cystic fibrosis

2 Folic acid is necessary for women who are of childbearing age and in their early pregnancy stages because it helps prevent neurologic defects such as spina bifida in neonates. Folic acid deficiency will not result in rickets in the neonate; rather, vitamin D deficiency causes rickets in neonates. Protein deficiency can result in kwashiorkor, not folic acid deficiency. Vitamin A and D deficiencies can cause cystic fibrosis, but cystic fibrosis is not caused by folic acid deficiency.

A child is admitted to the hospital for the management of failure to thrive. What should the mother of the child be instructed regarding feeding? Select all that apply. (p. 337) 1 "Do not maintain eye contact." 2 "Introduce new foods slowly." 3 "Maintain a face-to-face posture." 4 "Forced feeding works sometimes." 5 "Change the place of feeding daily."

2, 3 Children do not like sudden changes; therefore, new food should be introduced slowly. It is important to maintain face-to-face posture with the child and eye contact with the child feeding. This is important because it provides structure and nurturing, which in turn facilitates feeding. Forced feeding should be discouraged because the child may associate a negative experience with mealtime. Children like to eat in a structured routine, so they do not like changing the place of feeding daily.

What are the clinical situations in which a nurse expects occurrence of sudden infant death syndrome (SIDS)? Select all that apply. (p. 345) 1 Firstborn child 2 Preterm infant 3 Postterm infant 4 Bronchopulmonary dysplasia 5 Neonates with low Apgar score

2, 4, 5 Preterm infants, infants with bronchopulmonary dysplasia, and neonates with low Apgar scores have immature or underdeveloped lungs. Therefore they are at increased risk of developing SIDS. Subsequent siblings have a higher risk than firstborns. Postterm infants are not at higher risk of developing SIDS.

The addition of vitamins to commercially prepared infant foods increases the risk of which disorder? (p. 331) 1 Kwashiorkor 2 Malabsorption 3 Hypervitaminosis 4 Vitamin D deficiency

3 Hypervitaminosis—excessive dosage of a vitamin, usually defined as 10 or more times the Recommended Dietary Allowance (RDA)—is more common today with the addition of vitamins to commercially prepared infant foods. Kwashiorkor is a deficiency of protein with an adequate supply of calories that has nothing to do with the addition of vitamins to commercially prepared foods. The potential for malabsorption has not increased as a result of vitamins being added to commercially prepared foods.

What are the most common allergenic foods? (p. 334) 1 Nuts, legumes, wheat, berries 2 Nuts, eggs, wheat, shellfish, soy 3 Nuts, eggs, wheat, soy, potatoes 4 Nuts, spices, chocolate, shellfish

2 The most common allergens are nuts, eggs, wheat, shellfish, soy, and legumes (peanuts). Other foods that are allergenic include chocolate, spices, milk, corn, and citrus fruits.

Which statement is the most descriptive of kwashiorkor? (p. 332) 1 Kwashiorkor is of multifactorial origin. 2 Kwashiorkor occurs primarily in breastfed infants. 3 Kwashiorkor results from excessive amounts of vitamin K. 4 Kwashiorkor is related to inadequate calories, not adequate protein.

1 Cultural, environmental, and infectious components contribute to kwashiorkor, a deficiency of protein with an adequate supply of calories. Kwashiorkor occurs in infants and children who are beyond the age of breastfeeding. There is no correlation between excessive vitamin K and kwashiorkor. Kwashiorkor is a disorder in which there are adequate calories but a deficiency of protein.

Apnea of infancy has been diagnosed in an infant who is now scheduled for discharge with home monitoring. The discharge teaching plan should include which information? 1 Cardiopulmonary resuscitation 2 Administration of intravenous fluids 3 Foreign airway obstruction removal with the Heimlich maneuver 4 Advice that the infant not be left with caregivers other than the parents

1 Knowledge of how to perform cardiopulmonary resuscitation (CPR) is essential for all parents and caregivers, especially when an infant has a history of apnea of infancy that is being monitored at home. Most likely the child will not be undergoing home intravenous therapy as part of the discharge care. The Heimlich maneuver is used to intervene when a child or an adult is experiencing a choking episode. It would not be necessary for the parents to learn the maneuver at this time. (Back slaps and chest thrusts are used on the responsive infant who is choking.) The parents should arrange for other caregivers to help when possible. There is no reason that the infant cannot be left with capable and trained individuals. Anyone caring for the infant will need to be taught to use the necessary equipment and how to perform CPR.

The nurse works in a neonatal care unit. Which infant is at high risk of developing sudden infant death syndrome (SIDS) and needs to be closely monitored? (p. 345) 1 An infant whose mother smokes 2 An infant who sleeps in a crib 3 An infant who sleeps in a supine position 4 An infant who sleeps on firm bedding

1 SIDS is characterized by unexplained sudden death of the infant. Maternal smoking is a major risk factor of SIDS. Studies suggest that a high nicotine level in the infant's lung tissue may lead to SIDS. Cosleeping is another risk factor. Infants who share a bed with an elder sibling or any other adult may have high risk of developing SIDS. Infants who sleep in their cribs tend to have decreased risk of SIDS. Infants who sleep in a prone position may obstruct their airways. They also tend to inhale carbon dioxide, increasing the risk of SIDS. Soft bedding may accidentally obstruct the airway and increase risk of SIDS.

A nurse is caring for a 2-month-old exclusively breastfed infant with an admission diagnosis of colic. What type of stool does the nurse, drawing on knowledge of breastfed infants, expect? (p. 343) 1 Semiformed, seedy, yellow 2 Formed and containing white mucus 3 Loose and streaked with green mucus 4 Dark brown, consisting of small, hard pebbles

1 (I put 3) Colic does not change the appearance, texture, or color of stools. The color, consistency, and texture of the stools would be normal for the particular type of feeding; in a breastfeeding infant, that would be semiformed, seedy, and yellow. Small, hard dark-brown pebbles; loose stool streaked with green mucus; and formed stool with white mucus are not typical bowel movements in an exclusively breastfed infant.

A mother is bringing her 4-month-old infant into the clinic for a routine well-baby check. The mother is exclusively breastfeeding. No other liquids are given to the infant. What vitamin does the nurse anticipate the provider will prescribe for this infant? (p. 330) 1 Vitamin B 2 Vitamin D 3 Vitamin C 4 Vitamin K

2 The American Academy of Pediatrics recommends that infants who are exclusively breastfed receive 200 IU of vitamin D daily by the age of 2 months to decrease vitamin D deficiency. Vitamins B, C, and K are not needed.

A 6-month-old infant died suddenly in the crib during the winter. There was no identifiable reason for the death, even after conducting a postmortem examination. What should the nurse instruct the mother to do to prevent death in another infant? Select all that apply. (p. 345) 1 "The baby should always sleep in the supine position." 2 "You should have the baby sleep with you in your bed." 3 "You should not smoke while you are pregnant." 4 "Do not allow the infant to sleep with a pacifier." 5 "Your husband should not ever smoke in the home."

1, 3, 5 Sudden infant death syndrome (SIDS) may be one of the possible reasons for the unexplained death of a baby. The parents should be advised to place the baby on the back when sleeping. The prone position increases the risk for SIDS because pharyngeal obstruction can occur or the baby may rebreathe exhaled carbon dioxide. Smoking by the pregnant mother or others in the home during the pregnancy or after the delivery should be strictly discouraged. Co-sleeping with the infant increases the risk for SIDS because it can lead to suffocation. Studies have shown that when the baby sleeps with a pacifier there is a decreased incidence of SIDS.

The nurse is caring for an infant who has protein-energy malnutrition. Which nutritional supplement is administered only when the infant is able to tolerate a steady food source? (p. 332) 1 Zinc 2 Iron 3 Copper 4 Vitamin A

2 Iron supplementation in a protein-energy malnourished child should not be recommended until the child is able to tolerate a steady food source. Zinc, copper, and vitamin A are recommended nutritional supplements for a child with protein-energy malnutrition even when the child is unable to tolerate a steady food source.

The parents of a 5-month-old child complain to the nurse that they are exhausted because the infant still wakes up as often as every 1 to 2 hours during the night. When the child awakens, the parents change the diaper and the mother nurses the child back to sleep. Which should the nurse suggest to help the parents deal with this problem? (p. 343) 1 Put the child in the parents' bed to cuddle. 2 Start putting the infant to bed while still awake. 3 Give the infant a bottle of formula instead of breastfeeding so often at night. 4 Allow the infant to cry for 30 minutes, then rock the infant back to sleep before putting the infant back in the crib.

2 Parents need to develop bedtime rituals that involve putting the child in bed while awake. This will allow the infant to become accustomed to falling asleep somewhere besides the parent's arms or in the parent's presence. The issue of a child sleeping with the parents should be discussed fully. Having the infant in bed with them may still interfere with their sleep and increases the risk of injury to an infant of this age. The elimination of crying episodes should be done progressively, beginning with checking on the infant every 5 minutes during the first night and extending this interval by 5 minutes on subsequent nights. This will allow the infant to learn to self-soothe. Providing formula in a bottle at night will contribute to bottle-mouth caries. Additionally, 5-month-old infants generally wake up during the night not to feed but rather to be soothed. Using feeding as a mechanism to soothe begins a pattern that may lead to eating problems later in childhood.

The nurse is explaining the health problems of infants and children to a student nurse. The student nurse is working with a parent who is upset because their child is diagnosed with a dyssomnia. What should the student nurse look for in this child to understand about dyssomnias? (p. 343) 1 Parents noticed child sleepwalks 2 Trouble in falling asleep at night 3 Signs of protein-energy malnutrition 4 Allergic to milk and milk products

2 The nurse should be aware that, in dyssomnias, children have trouble with either falling asleep or staying asleep at night. They may have problems with staying awake during the daytime as well. Therefore, to understand dyssomnias, the student nurse has to observe the child's sleeping patterns. Sleepwalking is a parasomnia, not a dyssomnia. There may be other signs and symptoms of the deficiency of vitamins, protein-energy malnutrition, or allergy to milk and its products.

The community nurse is teaching a group of parents about ways to prevent rickets in children. What information should the nurse include in the teaching? (p. 330) 1 "You can feed your baby fresh cow's milk, but make sure it is not low-fat milk." 2 "You have to take your baby outside so the baby can get sunlight regularly." 3 "Your baby needs to only be breastfed for the first year of life and no other foods are necessary." 4 "Don't give strained mango after feeding the baby with iron-fortified cereals."

2 The risk factors for rickets in children are deficiencies in vitamin D, phosphorus, and calcium. These are required for the growth of the skeletal system in children. Regular exposure to sunlight (ultraviolet B rays) is essential for the synthesis of vitamin D from cholesterol in the body. Calcium deficiency can occur in children who are fed unfortified cow's milk. Calcium deficiency can also appear in infants who are breastfed for more than 6 months by mothers who have an inadequate vitamin D intake. Mangos are rich in vitamin C, which increases the absorption of iron.

A 3-year-old child has thin limbs and a protruding abdomen. The nurse notices that the abdomen is edematous when palpating the abdomen. As the nurse questions the parents, the nurse learns that the baby is fed a diet rich in carbohydrates but poor in proteins. What is this condition called? (p. 332) 1 Marasmus 2 Kwashiorkor 3 Kawasaki disease 4 Nephrotic syndrome

2 The symptoms and signs of the child and the diet pattern show that the child has kwashiorkor. It is a protein-energy malnutrition disorder. In marasmus, the patient has malnutrition from a poor intake of carbohydrates and proteins. Kawasaki disease is an autoimmune vascular disorder and not a protein-energy malnutrition disorder. Nephrotic syndrome is a disorder of the kidneys and hence it is not associated with these symptoms.

A pregnant woman informs the nurse that allergy to cow's milk runs in her family and asks her what she can do to prevent it from occurring in her children. What should the nurse tell her? (p. 336) 1 "Do not eat any eggs or milk during pregnancy." 2 "You should breastfeed your baby for at least 6 months." 3 "Do not drink cow's milk while you are breastfeeding." 4 "You can take over the counter Benadryl for the duration of the pregnancy."

2 (I put 3) When an allergy has a hereditary tendency in a family, it is called atopy. Atopy is mediated by immunoglobulin E antibodies. It is now highly recommended that women should exclusively breastfeed their baby to prevent atopy. There is no evidence that consuming eggs or cow's milk during pregnancy or lactation prevents atopy to the baby. Atopic allergies are genetically inherited. These cannot be prevented by asking the mother to take medications while she is pregnant. Moreover the drugs may have the potential of causing fetal malformations and thus should be avoided.

While caring for a child with an allergic reaction in the emergency department, the nurse finds that a child who weighs 16 kg has a barky cough, severe bradycardia, and dyspnea. What is the appropriate nursing action in this situation? (p. 335) 1 Administer 0.3 mg of epinephrine as prescribed. 2 Administer 0.15 mg epinephrine as prescribed. 3 Administer oral iron supplements to the child immediately. 4 Administer intravenous fluids and electrolytes to the child.

2 A child with an allergic reaction to peanuts presents with a barky cough, severe bradycardia, dyspnea, cyanosis, wheezing, and respiratory arrest. EpiPen Jr, which contains 0.15 mg epinephrine, can reverse the effects of peanut allergy in children who have a body weight of 8 to 25 kg. Therefore, the nurse administers 0.15 mg epinephrine, as ordered. EpiPen, which contains 0.3 mg of epinephrine, should be administered to children who weigh more than 25 kg. Iron supplements do not reverse allergic reactions to peanuts. Fluids and electrolytes maintain hydration in the body, but do not reverse allergic reactions caused by peanuts.

A parent is worried about the flattened shape of their baby's skull. The primary health care provider assessed the baby and diagnosed the baby with plagiocephaly. The health care provider informed the parent that this is not a serious problem. What information should be given to the parent by the nurse? Select all that apply. (p. 348) 1 Ensure that the child sleeps only on one side. 2 Do not leave a child in car restraints for a long time. 3 Make sure the child is in a prone position during tummy time. 4 Place the child in an infant seat for long periods of time. 5 Avoid changing the head position of the child while sleeping.

2, 3 Flattening of the skull is called plagiocephaly. A baby should not be left in car restraints for extended amounts of time because car restraints do not allow the baby to move the head around, which can lead to flattening. Plagiocephaly is becoming more prevalent, because babies are being placed in the supine position to prevent sudden infant death syndrome. This can lead to flattening of the back of the head over time. An infant seat is just as restrictive as car restraints and can cause cranial flattening if the baby is left in it for long periods of time. It is important that the parents be taught to alternate the baby's head position each time they sleep to prevent flattening. In addition, infants should be placed prone on a firm surface during awake time (tummy time), which prevents plagiocephaly and facilitates development of upper shoulder girdle strength.

What are clinical manifestations of failure to thrive? Select all that apply. (p. 338) 1 Smiling 2 Growth failure 3 Fear of strangers 4 Developmental delays 5 Avoidance of eye contact

2, 4, 5 Clinical manifestations of failure to thrive include growth failure, developmental delays, malnutrition, apathy, withdrawn behavior, feeding or eating disorders, and avoidance of eye contact. Smiling and fear of strangers are not clinical manifestations of failure to thrive.

What are the primary goals in the nutritional management of children with failure to thrive? Select all that apply. (p. 337) 1 Don't allow catch-up growth. 2 Correct nutritional deficiencies. 3 Achieve excess weight for height. 4 Restore optimal body composition. 5 Educate the parents or primary caregivers on the child's nutritional requirements. 6 Explain to the parents or primary caregiver that the child will need tube feedings first.

2, 4, 5 Correction of nutritional deficiencies is a goal that may require multivitamin supplements and dietary supplements with high-calorie foods and drinks in addition to treatment of any coexisting medical problems. Optimization of body composition is a goal of treatment. Another goal is to provide education to the parents or primary caregiver of the child's nutritional requirements, along with appropriate feeding methods. The goal is to provide sufficient calories to support "catch-up" growth, a rate of growth greater than the expected rate for age. Accurate assessment of the child's initial weight and height are important, as is the daily recording of weight, food intake, and feeding behavior. One more primary goal is to avoid the need for tube feedings.

The school nurse is explaining to a child's kindergarten teacher that the child is allergic to peanuts. What should the nurse explain? (p. 335) 1 The child will most likely outgrow the allergy soon. 2 The child usually only shows skin signs such as hives when allergic. 3 The child should have an injectable epinephrine cartridge available at all times. 4 The child allergic to peanuts can usually have peanut butter but not whole peanuts.

3 Exposure to peanuts can result in a potentially life-threatening allergic reaction that may include anaphylaxis and shock. Immediate treatment to prevent such reactions includes the injection of epinephrine; therefore this medication should be available at all times wherever the child is within the school premises. Peanut allergies may be lifelong. Children who are allergic to peanuts are allergic to all peanut products, whole and processed. They should have no peanut-containing products at all. The signs and symptoms of an allergic reaction to peanuts vary from individual to individual.

An 18-month-old child has fever, rash, runny nose, and Koplick's spots on the inside of the mouth. The child is diagnosed with measles. Which vitamin administration is recommended to decrease the risk of mortality in this child? (p. 331) 1 Two doses of vitamin C on consecutive days 2 Two doses of vitamin D on consecutive days 3 Two doses of vitamin A on consecutive days 4 Two doses of vitamin K on consecutive days

3 Measles with vitamin deficiency can be fatal to children. Two doses of vitamin A (200,000 IU) should be given on two successive days after the diagnosis of measles is made. This can reduce the mortality rate, pneumonia-specific mortality, and morbidity associated with measles. Vitamin A prevents any complications associated with measles, such as diarrhea and infections. A single dose of vitamin A may not be effective. Vitamins C, D, and K do not play any role in treating or preventing measles. Vitamin C deficiency causes scurvy, vitamin D deficiency causes rickets, and vitamin K deficiency can lead to blood clotting abnormalities.

While reviewing the laboratory results of a 4-month-old infant, the nurse concludes that the infant has neonatal tetany. Which statement made by the parent supports the nurse's conclusion? 1 "I do not give honey to my child." 2 "I feed my child with infant formula." 3 "I give whole cow's milk to my child." 4 "I do not give bottles to my child during the night."

3 Whole cow's milk may cause an imbalance in the intake of calcium and phosphorous in the body. Therefore, feeding whole cow's milk to an infant can result in neonatal tetany. Infant formula does not cause imbalances of calcium and phosphorous and therefore does not result in neonatal tetany. Refraining from the use of honey does not cause neonatal tetany. Honey can cause botulism. Bottle-feeding during the night can cause dental caries, but not neonatal tetany.

The school nurse is called to the cafeteria because a child "has eaten something he's allergic to." The child is in severe respiratory distress. What is the priority action by the nurse? (p. 335) 1 Determining what the child has eaten 2 Moving the child to the nurse's office or hallway 3 Administering oral diphenhydramine stat 4 Having someone call for emergency assistance

4 Because the child is in severe respiratory distress, the nurse should have someone call for a rescue squad or 911. Because severe respiratory distress is occurring, treatment of the response is indicated. What the child has eaten can be determined later. Oral diphenhydramine will not be effective in this type of emergency allergic reaction. The child should not be moved unless he or she is currently in a place that puts the child at greater hazard.

What best describes the origin of a cow's milk allergy? (p. 336) 1 A result of colic in babies 2 A gastrointestinal underresponse to dairy 3 A response caused by gastroesophageal reflux 4 A multifaceted disorder representing adverse systemic and local gastrointestinal reactions to cow's milk protein

4 Cow's milk allergy (CMA) is believed to be a multifaceted disorder representing adverse systemic and local gastrointestinal reactions to cow's milk protein. CMA is not a gastrointestinal underresponse to dairy but rather an over- or hypersensitive response. CMA is not caused by gastroesophageal reflux or best described as the reason for colic in babies.

A nurse is providing education to a community group in preparation for a mission trip to a Third World country with limited access to protein-based food sources. For what are the children in this country at increased risk? (p. 332) 1 Rickets 2 Pellagra 3 Marasmus 4 Kwashiorkor

4 Kwashiorkor is defined primarily as a deficiency of protein with an adequate supply of calories. Rickets results from a lack of vitamin D, calcium, or phosphate. It leads to softening and weakening of the bones. Marasmus results from general malnutrition of both calories and protein. Pellagra is a vitamin-deficiency disease most commonly caused by a chronic lack of niacin (vitamin B3) in the diet.

A mother of an 11-month-old infant tells the nurse, "We are vegetarians and I feed soy to my child every other day." Which complication should the nurse assess for in the infant? (p. 331) 1 Cystic fibrosis 2 Phenylketouria 3 Thrombocytopenia 4 Iron-deficiency anemia

4 Substances found in plant proteins, such as phytates or oxalates, form insoluble complexes with iron, zinc, and calcium, and can impair the absorption of these elements in the body. Soy proteins consist of high amounts of phytates. Therefore, consuming excessive amounts of phytates can impair iron and zinc absorption and result in iron-deficiency anemia. Phytates do not cause cystic fibrosis, nor do they elevate the phenylalanine levels in the body. Therefore, the infant will not have phenylketonuria. Phytates do not reduce blood platelet levels in the body. Therefore, the infant will not have thrombocytopenia.

A 3-month-old bottle-fed infant is allergic to cow's milk. What is the best substitute for the nurse to teach the parents to use? (p. 336) 1 Goat's milk 2 Soy-based formula 3 Skim milk diluted with water 4 Casein hydrolysate milk formula

4 The milk protein is broken down in casein hydrolysate milk formulas, making them a safe alternative for the infant who is allergic to cow's milk. The milk protein in goat's milk cross-reacts with cow's milk protein, and goat's milk is therefore not a safe alternative. Soy-based formulas are avoided because of the cross-reaction with cow's milk protein; they are not a safe alternative. Cow's milk protein is contained in skim milk, making it an unsafe alternative.

A 2-year-old child developed mild allergic symptoms after eating mashed potatoes. What should the nurse advise the parent regarding the safety of consumption of allergenic food? (p. 335) 1 Feed the child mashed potatoes in very small quantities once a week. 2 Advise the child not to eat potatoes in any form for the rest of his or her life. 3 Mix the potatoes into vegetable soup, because this is good for the child's health. 4 Reintroduce potatoes into the diet after 2 years of total abstinence.

4 The parent should be advised to reintroduce potatoes after a considerable period of abstinence to test the safety, because they caused only a mild allergic response in the child. The parent should be informed that most allergic foods tend to lose their hypersensitivity over time. If it is safe in a couple of years, the child can continue to eat potatoes. Usually, more than 1 year of abstinence is required before reintroducing the food into the diet. Giving the food that triggered the allergy in very small quantities or mixing it with other vegetables will not make it safe. If it triggers a severe anaphylactic reaction, the food that caused the allergic reaction must not be consumed for the rest of the child's life.