Chapter 25: Growth and Development of the Newborn and Infant

What will the nurse include in the care plan for a hospitalized 8-month-old infant based on developmental needs? A. Assign a primary nurse to provide care when possible. B. Demonstrate procedures on a doll prior completing on the child. C. Provide the child with advance warning for any painful procedures. D. Have the parent leave the room during painful procedures to avoid association with pain.

A. Assign a primary nurse to provide care when possible. Fear of strangers peaks at 8 months old, so providing the same nurse can help to establish familiarity and decrease fear in a child this age. The parent is a comfort for the child, and their absence may increase anxiety during procedures. Demonstration on a doll and advance warning are strategies for older hospitalized children.1

The nurse is assessing a 6-month-old infant in the clinic. Which characteristic represents normal language development for this age? A. Babbling B. Laughing out loud C. Producing noises when spoken to D. Cooing

A. Babbling Cooing begins in the first 4 weeks of life, productions of noises when spoken to and laughing out loud are seen later than 6 months of age. Infants begin to babble around 6 months of age.

When performing neurological reflexes on the infant, which primitive reflex will be present longest? A. step B. Babinski C. Moro D. rooting

B. Babinski Primitive reflexes are subcortical and involve a whole-body response. Selected primitive reflexes present at birth include Moro, root, suck, asymmetric tonic neck, plantar and palmar grasp, step, and Babinski. Except for the Babinski, which disappears around 1 year of age, these primitive reflexes diminish over the first few months of life, giving way to protective reflexes.

The mother of an infant questions the nurse about her baby's teething. The nurse provides client education. Which statement by the mother indicates understanding of the information provided? A. "My baby's first tooth will likely appear between 5 and 6 months." B. "By 1 year my baby should have about three teeth." C. "The first teeth that will likely appear are the lower incisors." D. "My baby will most likely have his upper middle teeth come in first."

C. "The first teeth that will likely appear are the lower incisors." Teeth will begin erupting between 6 and 8 months. Traditionally, the first teeth to erupt will be the lower incisors, followed by the upper incisors. By the age of 12 months, the infant will have between 4 and 8 teeth, if progressing normally.

The nurse is observing a 6-month-old boy for developmental progress. For which typical milestone should the nurse look? A. Picks up an object using his thumb and fingertips. B. Enjoys hitting a plastic bowl with a large spoon. C. Puts down a little ball to pick up a stuffed toy. D. Shifts a toy to his left hand and reaches for another.

C. Puts down a little ball to pick up a stuffed toy. At 6 months of age, the child is able to put down one toy to pick up another. He will be able to shift a toy to his left hand to reach for another with his right hand by 7 months. He will pick up an object with his thumb and fingertips at 8 months, and he will enjoy hitting a plastic bowl with a large spoon at 9 months

The parents of a 10-month-old infant ask the nurse for recommendations for television programs for their infant. What will the nurse recommend? A. Programs with simple language can help to promote language development. B. Cartoons should be avoided due to violence. C. Screen time is not recommended for infants of this age. D. Bright colors and music will be most engaging for an infant this age.

C. Screen time is not recommended for infants of this age. Television and screen time are not recommended for children under the age of 2, and should be limited in toddler and preschool-aged children. The other options all recommend different types of programs, which is not consistent with screen time recommendations.

The nurse is providing anticipatory guidance to the parent of a 2-month-old infant in relation to growth and development. Which statement from the parent demonstrates proper understanding? A. "I can expect my infant to be able to hold a rattle within the next month." B. "I can expect my infant to become clingy around strangers within the next month." C. "I can expect my infant to laugh out loud within the next month." D. "I can expect my infant to be able to raise the head up when on the stomach within the next month."

D. "I can expect my infant to be able to raise the head up when on the stomach within the next month." It is expected that a 3-month-old infant can raise the head to 45 degrees while laying on the stomach. Becoming clingy around strangers occurs in the infant around 6 to 8 months of age. The infant can begin to hold a rattle around 5 months of age. At 4 to 5 months, the infant will typically begin to laugh out loud.

A mother of a 10-month-old states to the nurse, "I brush my child's teeth every day with flavored kids' toothpaste." Which is the most appropriate response by the nurse? A. "Toothpaste plays an important role in overall oral health." B. "That is great, infants typically hate toothpaste." C. "Drinking water is really all you need to do to rinse your child's mouth." D. "Toothpaste is not necessary; it is the scrubbing that is required."

D. "Toothpaste is not necessary; it is the scrubbing that is required." Toothpaste for infants is not required. The important health technique is the removing of plaque, and that is accomplished through scrubbing of the teeth.

At the 6-month-old well-child visit, the parent is concerned that the child is unsteady and often falls over when sitting. What will the nurse advise the parent about this? A. The child should have a referral for a neuromuscular assessment. B. The child is progressing well on other milestones so there's no cause for worry. C. child should be provided with a baby seat to support the sitting position. D. The child's stability will progress to independent sitting over the upcoming months.

D. The child's stability will progress to independent sitting over the upcoming months. It is a normal finding for the 6-month-old child to be shaky and fall over when learning to sit and for the child to often only sit with a "tripod" sit supported by the hands. No further assessment or support is needed.

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 expected to appear within 1 month. B. is a protective reflex and retained for life. C. should be pronounced and easy to elicit. D. should have disappeared.

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

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 development of a 3-month-old B. the growth of a 2-month-old C. the growth of a 5-month-old D. the development of a 10-week-old

A. the development of a 3-month-old 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.

A nurse is reviewing the health records of several 4-month-old infants who were seen in the pediatric office today. Which infant behavior will require referral for further evaluation of growth and development? A. unable to support head B. cannot sit without assistance C. rolls from prone to supine position D. reaches for nearby objects

A. unable to support head An infant at 4 months of age who cannot support his or her head should be referred for evaluation. A 4-month-old infant should be able to reach for objects of interest and should be able to roll from a prone to a supine position. A 4-month-old infant is not able to sit alone without support.

A 12-month-old seen at a walk-in clinic weighed 8 pounds 4 ounces (3750 g) at birth. Weight now is 20 pounds 8 ounces (9300 g). The nurse determines: A. the child weighs more than expected for age. B. the child weighs less than expected for age. C. the child weighs the expected amount for age. D. the weight assessment is blatantly inaccurate.

B. the child weighs less than expected for age. Birth weight should triple by 12 months. The child should weigh near 24 pounds 12 ounces (11250 g). The child is underweight for age.

Which client will the nurse assess first after receiving 0700 shift report? A. A 6-month-old infant with a respiratory rate of 44 breaths/minute B. A 1-month-old infant with positive Moro and root reflexes C. A 12-month-old infant with a blood pressure of 60/40 mm Hg D. A 1-day-old newborn who just passed a black, sticky stool

C. A 12-month-old infant with a blood pressure of 60/40 mm Hg The nurse will first assess the 12-month-old infant with a blood pressure of 60/40 mm Hg. This is the expected blood pressure in an infant; however, by 12 months of age the blood pressure should rise to around 100/60 mm Hg. The normal respiratory rate of an infant is 30 to 60 breaths/minute. It is expected for a 1-month-old infant to still have Moro and rooting reflexes. These should diminish over the first few months of life. Stools are dark green to black and sticky for the first few days of life.

Which activity is most beneficial in the development of the newborn? A. listening to classical music B. laying on his back with a mobile overhead C. being sung to by his mother D. placement in an infant swing in a position to allow observation of the family's activities

C. being sung to by his mother Interaction between the newborn and his parents is the most beneficial activity. Later, toys and music may have a good influence but initially the parental interaction is best.

What action 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 cries when they have a wet diaper. C. The infant smiles as people walk past the crib. D. The infant plays the game peek-a-boo.

A. The infant cries and the caregiver picks the child up. 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 met consistently. Crying with a wet diaper without a change of the diaper leads to an unmet need. Playing peek-a boo and smiling are developmental tasks that indicate a normal healthy, happy baby. These would be attributed to Piaget theory.

The nurse is caring for the family with a 2-month-old boy with colic. The mother reports feeling very stressed by the baby's constant crying. Which intervention would provide the most help in the short term? A. Urging the baby's mother to take time for herself away from the child. B. Assessing the parents' care and feeding skills. C. Educating the parents about when colic stops. D. Watching how the parents respond to the child.

A. Urging the baby's mother to take time for herself away from the child. Urging the parents to get time away from the child would be most helpful in the short term, particularly if the parents are stressed. Educating the parents about when colic stops would help them see an end to the stress. Observing how the parents respond to the child helps to determine if the parent/ child relationship was altered. Assessing the parents' care and feeding skills may identify other causes for the crying.

The nurse is examining an 8-month-old girl for appropriate development during a regular check-up. Which observation points to a developmental risk? A. Uses only the left hand to grasp B. Crawls with stomach down C. Picks up small objects using entire hand D. Cannot pull self to standing

A. 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 another 4 to 8 weeks.

During a well-baby visit the mother of a 3-month-old infant tells the nurse that she does not understand why her baby continues to spit out food during feeding of solid foods. What is the best response by the nurse? A. "A lot of babies do this at first. Just give it some time and I'm sure your baby won't continue spitting out solid food." B. "Maybe if you make your own baby food your infant will like it better." C. "I will make sure to let the physician know." D. "Infants still have a tongue protrusion reflex until 4 to 6 months so they can't help but push out the solid food."

D. "Infants still have a tongue protrusion reflex until 4 to 6 months so they can't help but push out the solid food." Introducing solid food with a spoon prior to 4 to 6 months of age will result in extrusion of the tongue. The parent may think that the infant does not want the food and is spitting it out intentionally, but the extrusion reflex is still present.

The nurse is educating the mother of a newborn about feeding practices. The nurse correctly advises the mother that: A. the newborn's stomach can hold between 0.5 oz and 1 oz. B. most newborns need to eat about 4 times per day. C. demand scheduled feeding is associated with increased difficulty getting the baby to sleep through the night. D. the best feeding schedule offers food every 4 to 6 hours.

A. the newborn's stomach can hold between 0.5 oz and 1 oz.The capacity of the normal newborn's stomach is between 0.5 oz and 1 oz. The recommended feeding plan is to use a demand schedule. Newborns may eat as often as 1.5 to 3 hours. Demand scheduled feedings are not associated with problems sleeping at night.

The nurse is teaching healthy eating habits to the parents of a 7-month-old girl. Which recommendation is the most valuable advice? A. Provide small portions that must be eaten. B. Serve new foods several times. C. Actively urge the child to eat new foods. D. Let the child eat only the foods she prefers.

B. Serve new foods several times. When introducing a new food to an infant, it may take multiple attempts before the child will accept it. Parents must demonstrate patience. Letting the child eat only the foods she prefers, forcing her to eat foods she does not want, or actively urging the child to eat new foods can negatively affect eating patterns.

A group of nursing students are preparing a presentation illustrating basic safety measures which can be utilized for infants. Which measures should the students prioritize in their presentation? Select all that apply. A. Crib and playpen bars should be no more than 2 3/8 inches apart. B. Bottle should only be propped for infants 8 months or older. C. Only small pillows should be used in cribs. D. Car seats should be placed in back seats. E. A safe temperature for hot water heaters in households with infants is 120°F (48.9°C).

A. Crib and playpen bars should be no more than 2 3/8 inches apart. D. Car seats should be placed in back seats. E. A safe temperature for hot water heaters in households with infants is 120°F (48.9°C). 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°F (48.8°C) to prevent potential burns. Bottles should never be propped and pillows are not placed in cribs of infants.

The nurse is completing a developmental assessment on a 6-month-old infant. Which findings indicate the need for additional follow-up? Select all that apply. A. The infant has frequent episodes of crossed eyes. B. The infant babbles. C. The infant does not pay attention to noises behind him. D. The infant seems disinterested in the surrounding environment. E. The infant is unable string together 2 word sentences.

A. The infant has frequent episodes of crossed eyes. C. The infant does not pay attention to noises behind him. D. The infant seems disinterested in the surrounding environment. Warning signs that may indicate problems with sensory development include the following: young infant does not respond to loud noises; child does not focus on a near object; infant does not start to make sounds or babble by 4 months of age; infant does not turn to locate sound at age 4 months; infant crosses eyes most of the time at age 6 months. Language development at this stage of development does not include stringing together 2-word sentences.

The nurse is providing education about nutrition and feeding to the parents of a healthy 10-month-old child. What foods, if reported by the parents, indicate the need for further education? Select all that apply. A. pureed beef B. whole grapes C. cooked peas D. honey E. rice cereal

B. whole grapes D. honey Grapes can be a choking hazard and should be cut up to reduce this risk. Honey has a risk of botulism and should not be provided to children under 1 year of age. The other foods are all appropriate choices for a child this age.

The nurse enters her client's room and finds the infant on a pillow with a bottle propped up while the mother is dressing. What statement should the nurse make? A. "Are you almost ready to be discharged?" B. "Look how cute she is." C. "You should always hold your baby for feedings instead of propping the bottles." D. "Is she almost done feeding?"

C. "You should always hold your baby for feedings instead of propping the bottles." 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.

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

D. 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.

A nurse in a pediatrician's office is educating a parent of a 2-month-old infant about developmental milestones. Drag words from the choices below to fill in each blank in the following sentence. The parent requires further education when the parent states A. "I will be able to play games like peek-a-boo with my infant when they are 4 months old.", B. "At 6 months, my baby should be able to feed themselves.", and C. "My infant should be able to sit on their own by 3 months." E. "My infant should be able to crawl by 9 months" D. My infant should be able to support themselves on elbows and wrists when lying on the stomach

"I will be able to play games like peek-a-boo with my infant when they are 4 months old.", "At 6 months, my baby should be able to feed themselves.", and "My infant should be able to sit on their own by 3 months." An infant is not able to sit on their own until 6 months of age.An infant is able to feed themselves with a cup and a spoon by 12 to 18 months of age.At 9 months of age, an infant can play games such as "peek-a-boo," not at 4 months of age. A 4-month-old infant should be able to support themselves on their elbows and wrists when lying on their stomach.An infant should be able to crawl by 9 months of age.

A parent has a 3-year-old child and a 4-month-old infant who both have gastroenteritis. The 3-year-old child is well enough to be cared for at home, but the 4-month-old infant requires hospitalization. How does the nurse explain the difference between these outcomes to the family? A. The 4-month old infant has a greater proportion of extracellular fluid, which increases risk of dehydration. B. The 4-month-old infant has not yet had all of their vaccinations and is more prone to severe illness. C. The 3-year-old child has a milder case of the illness, and the 4-month-old infant has a more severe case. D. The 3-year-old child is taking solid foods they can be fed at home, but the 4-month-old infant requires greater nutritional support.

A. The 4-month old infant has a greater proportion of extracellular fluid, which increases risk of dehydration. The extracellular fluid accounts for approximately 35% of an infant's body weight, with intracellular fluid accounting for approximately 40%, in contrast to adult proportions of 20% and 40%, respectively. This proportional difference increases an infant's susceptibility to dehydration from illnesses, such as diarrhea, because the loss of extracellular fluid could result in the loss of more than one-third of an infant's body fluid.

The parents of an 8-month-old boy voice concern to the nurse that their child is not developing motor skills as he should. What question would be appropriate for the nurse to ask in determining if their fears are warranted? A. "Is he able to hold a pencil and scribble on paper?" B. "Does he move a toy back and forth from one hand to the other when you give it to him?" C. "Is he able to drink with a cup by himself?" D. "Does he place toys into a box or container and take them out?"

B. "Does he move a toy back and forth from one hand to the other when you give it to him?" Transferring an object from one hand to the other is expected at 7 months of age, so this would be expected of an 8-month-old. The other options are not expected until later months, so questioning the parents about these skills would not help in determining if he was at the motor skill developmental level that should be expected.

The nurse is meeting with a group of older siblings of infants to discuss various aspects of infant care.The group will be helping the parents with infant care. Which instruction should the nurse prioritize with this group? A. The infant should be dressed more warmly than older children and caregivers. B. The infant should be sound asleep before being put into the crib for sleeping. C. The infant sleeps 10 to 12 hours at night and can take two to three naps during the day. D. The infant should wear hard-soled shoes in order to protect their feet from injury.

C. The infant sleeps 10 to 12 hours at night and can take two to three naps during the day. Most infants sleep 10 to 12 hours at night and take two to three naps during the day. 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.

Which developmental milestone would the nurse expect an 11-month-old infant to have achieved? A. Walking independently B. Building a tower of four cubes C. Sitting independently D. Turning a doorknob

Introducing solid food with a spoon prior to 4 to 6 months of age will result in extrusion of the tongue. The parent may think that the infant does not want the food and is spitting it out intentionally, but the extrusion reflex is still present.

The mother of an infant is confused after being told by her dentist not to let her baby go to bed with a bottle of milk. She does not agree with that suggestion. Which response should the nurse prioritize when addressing this situation with the mother? A. "Bottles given at bedtime can cause erosion of the enamel on the teeth." B. "Giving a bottle of milk when the infant goes to bed can lead to obesity." C. "Giving your baby a pacifier at bedtime will satisfy the need to suck." D. "You could occasionally give your baby a bottle of water at bedtime."

A. "Bottles given at bedtime can cause erosion of the enamel on the teeth." 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 and a pacifier will satisfy the sucking need, the most appropriate response is to warn of possible enamel erosion. Giving a bottle at bedtime is not a factor that leads to obesity.

The student nurse is reviewing the records of a pediatric client. Which statement about the client's progress indicates the need for further instruction? A. "Maturation refers to the child's increases in body size." B. "Increases in body size are referred to as growth." C. "Development refers to the increase in skills the child demonstrates as they grow and age." "Both growth and development are influenced by heredity."

A. "Maturation refers to the child's increases in body size." Growth refers to an increase in physical size. Development is the sequential process by which infants and children gain various skills and functions. Heredity influences growth and development by determining the child's potential, while environment contributes to the degree of achievement. Maturation refers to an increase in functionality of various body systems or developmental skills.

Which assessment findings if noted in a 4-month-old infant would the nurse recognize as normal growth and development? A. uses palmer grasp, starts to make vowel sounds, reaches out B. holds head up when prone, bears partial weight on legs, reflexes are fading C. follows object past midline with eyes, keeps hands fisted, rolls over D. rolls over, grasp reflex fading, cooing sound

B. holds head up when prone, bears partial weight on legs, reflexes are fading At 4 months of age, the infant should be able to hold the head up when prone and bear partial weight on the legs; newborn reflexes are beginning to fade. The nurse should recognize these changes as normal growth and development.

A 9-month-old has been brought to the clinic for a well-child visit. The mother reports her son was born 6 weeks prematurely. During the data collection, the child's mother reports her son seems to be a few months "behind" what she recalls from her older children. What is the best response by the nurse? A. "All children mature and develop at different rates so it is unwise to compare them in this way." B. "Delays are normal when a child is premature." C. "You should talk with the doctor about getting your son tested." D. "We will need to check this out since any delays related to prematurity should be resolved by the time a child is 6 months old."

B. "Delays are normal when a child is premature." When infants are born prematurely delays may be noted. When assessing the growth and development of a premature infant, use the infant's adjusted age to determine expected outcomes. To determine adjusted age, subtract the number of weeks that the infant was premature from the infant's chronological age. Plot growth parameters and assess developmental milestones based on adjusted age. Delays will not necessarily be resolved by the age of 6 months. While the mother should talk with the physician about concerns, this is not the best initial response by the nurse.

An infant has been brought to the clinic for a well-child check. The infant is 12 months of age. The child's birth weight was 6 pounds, 7 ounces. What is the anticipated weight for the child at this visit? A. 20 pounds B. 19 pounds, 5 ounces C. 21 pounds, 9 ounces D. 18 pounds

B. 19 pounds, 5 ounces Most infants double their birth weight by 4 months of age and triple their birth weight by the time they are 1 year old.

The nurse is assessing the sleeping practices of the parents of a 4-month-old girl who wakes repeatedly during the night. Which parent comment might reveal a cause for the night waking? A. If she is safe, they lie her down and leave. B. They put her to bed when she falls asleep. C. The child has a regular, scheduled bedtime. D. They sing to her before she goes to sleep.

B. They put her to bed when she falls asleep. If the parents are keeping the child up until she falls asleep, they are not creating a bedtime routine for her. Infants need a transition to sleep at this age. If the parents are singing to her before she goes to bed, if she has a regular, scheduled bedtime, and if they check on her safety when she wakes at night, then lie her down and leave, they are using good sleep practices.

A new mother reports that she is exhausted and that the little sleep she gets is determined by her baby. Which suggestion should the nurse prioritize to help the mother establish healthy sleeping patterns in her infant? A. Wake the baby from afternoon naps after 1 hour to ensure she is sleepy by nighttime. B. Use the crib for sleeping only, not for play activities. C. Put the baby to bed at various times of the evening. D. Let the baby cry during the night and she will eventually fall back to sleep.

B. Use the crib for sleeping only, not for play activities. 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 providing a nutrition workshop for the parents of infants. The nurse understands that further instruction is required when hearing which comments from the parents? Select all that apply. A. "I try to eat healthy in front of my daughter so she will hopefully pick up good eating habits." B."I plan on encouraging my son to cook with me when he is old enough so that he will enjoy a variety of foods and learn how to cook too." C. "I have tried at least 10 times with every green vegetable and I can't get my son to like them." D. "I let my child eat whatever he wants right now so that we don't argue about food. Hopefully he will like healthy foods when he grows up." E. "Food is so expensive. I can't afford for my child to leave any food on the plate."

C. "I have tried at least 10 times with every green vegetable and I can't get my son to like them." D. "I let my child eat whatever he wants right now so that we don't argue about food. Hopefully he will like healthy foods when he grows up." E. "Food is so expensive. I can't afford for my child to leave any food on the plate." Encouraging children to eat everything on their plate can lead to overeating and obesity. Children may need to be exposed to new food at least 20 times before determining if they like it or not. Letting a child eat whatever he wants does not lead to good choices as the child matures.

The nurse is performing an assessment on a 8-month-old infant. The infant's medical history notes that he was born at 32 weeks' gestation. The infant is progressing normally. At what adjusted age should the nurse expect the infant's developmental accomplishments? A. The infant will likely show the skills of an infant with the adjusted age of 7 months. B. By 8 months of age, the child's skill level will vary greatly and cannot be predicted. C. The infant will most likely present with developmental skills consistent with a 6-month-old infant. D. The infant can be expected to display developmental skills consistent with a 8-month-old infant.

C. The infant will most likely present with developmental skills consistent with a 6-month-old infant. When assessing the growth and development of a premature infant, the nurse will use the infant's adjusted age to determine expected outcomes. To determine adjusted age, the nurse subtracts the number of weeks that the infant was premature from the infant's chronological age. The infant who was born at 32 weeks' gestation was 8 weeks (or 2 months) premature. To determine the adjusted age, the nurse subtracts 2 months from the chronological age of 8 months: 6 months.

The parent of an infant asks the nurse when to begin brushing the infant's teeth. What would be the nurse's best response? A. by 12 months of age B. when weaning is complete C. as soon as the first tooth erupts D. as soon as the infant begins to eat fruit

C. as soon as the first tooth erupts Before tooth eruption occurs, parents should clean the infant's gums after feeding with a damp wash cloth. After the first tooth erupts, parents can use a soft bristle tooth brush. Dental hygiene should be part of the infant's everyday care. The American and Canadian Dental Associations recommend the first dental checkup to occur around 1 year of age. Infants should not go to bed with bottles or sippy cups to prevent dental caries.

The best way for an infant's parent to help the child complete the developmental task of the first year is to: A. keep the infant stimulated with many toys. B. expose the infant to many caregivers to help the infant learn variability. C. respond to the infant consistently. D. talk to the infant at a special time each day.

C. respond to the infant consistently. The developmental task of an infant is gaining a sense of trust. The infant develops this sense from the caretakers who respond to the child's needs, such as feeding, changing diapers, being held. It is a continuous process. 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. An infant is too young to have variability in caretakers. This causes mistrust. The parents or caretakers do not need a special time to talk to the infant each day. It should be done with each interaction. Providing too much stimulus before the infant develops gross motor skills causes frustration from the child and not enjoyment.

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 regular cup, not a sippy cup." B. "I wipe my son's teeth every day with a fresh washcloth." C. "We have safety gates at the top and bottom of our stairs." D. "He loves being in his walker and 'zips' around the house."

D. "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.

The nurse comes into an infant's room on the pediatric floor. The nurse wants to try to feed the infant for the first time since her surgery. How does the nurse know what state the infant is in by what the mother says, and that it's fine to try and feed the infant? A. "She has been crying every time someone picks her up." B. "She is still sleeping; I guess she is worn out." C. "She is so quiet today; that is not like her." D. "She has been a chatterbox and smiles just like her brother."

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

The infant measures 21.5 in (54.6 cm) at birth. If the infant is following a normal pattern of growth, what would be an expected height for the infant at the age of 6 months? A. 30.5 in (77.5 cm) B. in (74 cm) C. 32 in (81 cm) D. 27.5 in (70 cm)

D. 27.5 in (70 cm) Infants gain about 0.5 to 1 in (1.25 to 2.5 cm) in length for each of the first 6 months of life. Therefore, a 21.5-in (54.6-cm) infant adding 6 in (15 cm) of growth would be 27.5 in (70 cm). Infants grow the fastest during the first 6 months of life and slow down the second 6 months. By 12 months of age, the infant's length has increased by 50%, making this infant 32 in (81 cm) at 1 year old.

The nurse is completing an infant history on a 5-month-old and documents the following symptoms. Which will the nurse attribute to teething? Select all that apply. A. Increased sucking on hands B. Refusing to eat C. Drooling and biting D. Fever and diarrhea E. Irritability and awakening from sleep

A. Increased sucking on hands B. Refusing to eat C. Drooling and biting E. Irritability and awakening from sleep Infants at age 5 months are in the process of cutting their first teeth, typically the upper or lower central incisors. Symptoms associated with the mouth and feeding are common. Fever and diarrhea are considered signs of illness, not teething.

During a well-baby visit the mother tells the nurse that she thinks her baby has a decayed tooth and doesn't understand how this could have happened. What are appropriate questions for the nurse to ask this mother? Select all that apply. A. "Do you frequently put your baby to bed with a bottle of milk or juice?" B. "Is your child using a bottle for milk?" C. "Does your baby use no-spill sippy cups?" D. "Haven't you seen a dentist yet?" E. "Did you read any of the nutrition information we send home with each visit?"

A. "Do you frequently put your baby to bed with a bottle of milk or juice?" B. "Is your child using a bottle for milk?" C. "Does your baby use no-spill sippy cups?" Milk and juice pool around teeth leading to dental caries (tooth decay) when babies are given bottles in bed and with the use of no-spill sippy cups, so these are appropriate questions. Using a bottle after the age of 12 to 15 months can also lead to dental caries. Asking the mother, "Haven't you seen a dentist yet?" or "Did you read any of the nutrition information we send home with each visit?" are very accusatory questions and will likely make the mother very defensive.

The mother of a 6-week-old infant reports she doesn't know if her child recognizes her face yet. What response by the nurse is most appropriate? A. "Since about 4 weeks of age your child has been able to recognize those who are around him often." B. "Recognition of faces and voices will come with time." C. "Recognition of this type begins around 8 weeks of age." D. "Don't worry. He knows you are his mother."

A. "Since about 4 weeks of age your child has been able to recognize those who are around him often." At 1 month of age the infant can recognize by sight the people he or she knows best. Telling the child's mother that this will come with time is not correct as this developmental milestone has already occurred. Telling her not to worry minimizes her questions and concerns.

During the first visit to the pediatrician's practice the nurse is performing an admission interview and assessment of a 4-week-old infant. The mother states, "I am sure my baby girl knows my smell because she is much more settled in my arms rather than my mother's arms when she is upset." What is an appropriate response by the nurse? A. "You may be right, since infants can sense their mother's smell as early as 7 days old." B. "Babies really can't tell the difference between people at that age." C. "Maybe she just knows your voice better than your mother's." D. "I'm not sure a 4-week-old infant can tell their mother from another woman's smell."

A. "You may be right, since infants can sense their mother's smell as early as 7 days old." The sense of smell develops rapidly: the 7-day-old infant can differentiate the smell of his or her mother's breast milk from that of another woman and will preferentially turn toward the mother's smell.

The nurse is caring for a parent following the birth of the newborn. The new parent asks the nurse, "When is the best time for me to start bonding with my baby?" Which response by the nurse is appropriate? A. "You should interact with your newborn when the eyes are open wide and bright." B. "Newborns prefer to have verbal interaction as they enter a drowsy state." C. "When newborns begin to cry, they are in need of parental interaction." D. "Interaction has the best effect on bonding when the newborn is in a quiet sleep state."

A. "You should interact with your newborn when the eyes are open wide and bright." A newborn's neurological development includes 6 states of consciousness. The best time for a family to interact with a newborn is when the newborn is in the quiet or active alert stage. The quiet alert state is when the body is calm and the eyes are wide open. The active alert state is when the eyes are wide open and there are body movements. Examples of this are minimal body activity, regular respirations, face with shiny look, eyes wide and bright, and paying attention to stimuli. When the newborn is crying it is very difficult to get the newborn's attention. The newborn needs immediate needs met at this time such as feeding, repositioning, or a diaper change. When the newborn is in a drowsy state, trying to interact only causes frustration for the newborn as sleep is interrupted.

The parent of 1-week-old infant voices concerns about the infant's weight loss since birth. At birth the infant weighed 7 lb (3.2 kg); the infant currently weighs 6 lb 5 oz (2.9 kg). Which response by the nurse is most appropriate? A. "Your infant's weight loss is within the expected range." B. "Your infant has lost too much weight and may need to be hospitalized." C. "Your infant has lost a bit more than the normal amount." D. "All infants lose a substantial amount of weight after birth."

A. "Your infant's weight loss is within the expected range." The normal newborn may lose up to 10% of birth weight. This infant has lost 9.1%. This degree of weight loss will likely not require hospitalization. Expressing to the parent that the infant may be hospitalized is rash and will most likely not occur.

The nurse is assessing a 1-year-old at the well-child annual visit and notes the child is meeting the growth parameters. After noting the birth weight was 8 pounds (3.6 kg) and length was 20 inches (50.8 cm) long, which measurements reflecting height/weight would the nurse expect to document for this visit? A. 24 pounds (10.8 kg) and 30 inches (75 cm) B. 16 lb (7.2 kg) and 26 inches (65 cm) C. 20 lb (9.1 kg) and 28 inches (70 cm) D. 28 pounds (12.7 kg) and 32 inches (80 cm)

A. 24 pounds (10.8 kg) and 30 inches (75 cm) By 1 year of age, the infant should have tripled his or her birth weight and grown 10 to 12 inches (25 to 30 cm). If this infant was 8 pounds (3.6 kg) at birth, at 1 year, this child should weigh 24 pounds (8 x 3 = 24) and grown to 30 to 32 inches (20 + 10 to 12 = 30 to 32 inches). Most of the growing occurs during the first 6 months with the infant's birth weight doubling and height increasing about 6 inches (15 cm). Growth slows slightly during the second 6 months but is still rapid.

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. A yellow rubber duck for the bath B. Pots and pans from the kitchen cupboard C. A push-pull toy D. Brightly colored stacking toy

A. A yellow rubber duck for the bath The rubber duck is most appropriate. It is safe, 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.

The nurse establishes the following plan of care based on the nursing diagnosis: Caregiver role strain related to infant crying throughout night as manifested by parents stating, "We are exhausted." Which nursing interventions are included in the plan of care? Select all that apply. A. During night awakening, keep interactions minimal. B. Having one parent awake at a time with infant C. At bedtime, ensure the child is in a deep sleep then place in crib. D. Add rice cereal to the evening bottle to prevent hunger and awakening. E. Establish a quieting ritual for infant before bed.

A. During night awakening, keep interactions minimal. B. Having one parent awake at a time with infant E. Establish a quieting ritual for infant before bed. Both encouraging the infant to sleep or providing a time for the parent to sleep decreases caregiver role strain. Bedtime rituals and minimal interactions during night awakening both promote sleep. Also having only one parent awake allows for the other parent to rest, decreasing parent exhaustion. Adding rice cereal to bottles does not promote sleeping through the night and isn't recommended. Putting the sleeping infant into the crib does not teach the child to self-soothe and fall asleep independently.

The caregivers of an infant state that their child cries when her mother leaves for even a short amount of time. What might the nurse suggest as a way to console the infant and develop a sense of security when the child's primary caregiver is out of sight? A. Play peek-a-boo with the child when happy. B. Pick the child up as soon as she begins to cry. C. Give her dolls and stuffed animals so she learns to distract herself. D. Slowly increase the amount of time allowed to cry before being picked up.

A. Play peek-a-boo with the child when happy. 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, she learns to confirm the existence of others, even when they are temporarily out of sight.

Which activity will the nurse encourage new parents to complete in order to assist their infant in accomplishing Erikson's developmental task for the first year of life? A. Respond promptly when the infant cries. B. Praise the infant when a new milestone is reached. C. Appropriately enunciate words when speaking to the infant. D. Read age-appropriate books to the infant daily.

A. Respond promptly when the infant cries. The developmental task of the infant year, according to Erikson, is to gain a sense of trust. This can be accomplished by promptly meeting the infant's needs during the first year of life. If the infant does not learn to trust, mistrust will develop. Praising will help meet the future developmental tasks of the child. Reading books and appropriately enunciating words will aid in the infant's language development.

A nurse is educating a client being discharged with her newborn baby. What is the highest priority item that must be included in the teaching plan? A. Restrain the baby in a car seat. B. Give warm bottles of formula to the baby. C. Lock all cabinets that contain cleaning supplies. D. Keep all pots and pans in lower cabinets.

A. Restrain the baby in a car seat. The client should restrain the baby in a car seat when driving. Infants are especially vulnerable to injuries resulting from falls from changing tables or being unrestrained in automobiles. Locking the cabinets and giving warm bottles of formula to the baby are secondary teachings.

The mother of a 1-month-old infant voices concern about her baby's respirations. She states they are rapid and irregular. Which information should the nurse provide? A. The respirations of a 1-month-old infant are normally irregular and periodically pause. B. The irregularity of the infant's respirations are concerning; I will notify the physician. C. An infant at this age should have regular respirations. D. The normal respiratory rate for an infant at this age is between 20 and 30 breaths per minute.

A. The respirations of a 1-month-old infant are normally irregular and periodically pause. The normal respiratory rate for a 1-month-old infant is 30 to 60 breaths per minute. By 1 year of age the rate will be 20 to 30 breaths per minute. The respiratory patterns of the 1-month-old infant are irregular. There may normally be periodic pauses in the rhythm.

Anticipatory guidance for an infant for the 4th month should include the fact that the infant will be able to achieve which developmental milestone? A. be able to turn over onto the back B. have many "blue" or moody periods C. develop a fear of strangers D. insist on things being done the infant's way

A. be able to turn over onto the back At four months of age, the infant is able to lift the head and look around. The infant can roll from prone to supine. When being pulled up, the head leads. The 4-month-old infant can make simple vowel sounds, laugh aloud, and vocalize in response to voices. A fear of strangers does not occur until the child is older; a 4-month-old infant has not developed emotionally to have "moody" periods and is dependent on parental care.

The nurse pulls the 5-month-old to sitting position from supine and notes head lag. The nurse's response is to: A. refer the infant for developmental and/or neurologic evaluation. B. conclude the earlier assessments carried out fatigued the infant. C. suggest more awake tummy time for the child. D. consider this a normal response for the age.

A. refer the infant for developmental and/or neurologic evaluation. 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 is reviewing the medical record of an infant who is being seen for the 12-month well-child visit. Which finding(s) is normal for this infant? Select all that apply. A. respiratory rate 28 breaths/min B. infant walks independently C. heart rate 101 beats/min D. infant has moderate head lag temperature 100.6°F (38.1°C)

A. respiratory rate 28 breaths/min B. infant walks independently C. heart rate 101 beats/min The respiratory rate slows from an average of 30 to 60 breaths/min in the newborn to about 20 to 30 breaths/min in the 12-month-old infant. As the cardiovascular system matures, the average pulse rate decreases from 120 to 140 beats/min in the newborn to about 100 beats/min in the 12-month-old infant. Walking independently often occurs at 12 months of age. Head lag should not be present in a 12-month-old infant (usually not present by 4 months of age). A temperature of 100.6°F (38.1°C) is abnormal and could indicate an infection.

The nurse is reviewing the diet of an 8-month-old infant with the mother who reveals she has been using evaporated milk to make the formula. Which additional ingredient should the nurse ensure she is including in the formula? A. Vitamin E B. Calcium C. Iron D. Vitamin D

C. Iron 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 a concern in this infant's formula.

The nurse is educating the parents of a newborn prior to discharge home. The parents demonstrate teaching was successful when making which statement(s)? Select all that apply. A. "We should get some rest in about 1 month when the newborn starts sleeping through the night." B. "I understand it is normal for newborns to lose 5% to 10% of their bodyweight after birth." C. "I plan to add a little rice cereal to my breast milk so my newborn will sleep longer at night." D. "I will not be concerned if my newborn has stools that begin to have a yellowish color to them." E. "My newborn can see up-close things, like our faces, better than things at a distance."

B. "I understand it is normal for newborns to lose 5% to 10% of their bodyweight after birth." D. "I will not be concerned if my newborn has stools that begin to have a yellowish color to them." E. "My newborn can see up-close things, like our faces, better than things at a distance." Newborn stools will become yellowish in color after the first few days of life. Newborns typically lose 5% to 10% of their birthweight the first few days of life, and begin to gain weight after this period. Newborns have better up-close vision and begin to recognize human faces during their newborn stage. Most infants will not sleep through the night until about 3 months of age. There is no evidence that rice cereal keeps a newborn from waking and the practice of feeding rice cereal to newborns is discouraged by physicians as the newborn needs formula or breast milk specifically.

The father of a 6-week-old infant voices concerns about his son's stooling. He further shares that his son grunts and cries when having a bowel movement. What response by the nurse is most appropriate? A. "Grunting is normal with infant stool formation." B. "What does his stool look like?" C. "Is he in pain?" D. "We will need to collect a stool specimen for analysis."

B. "What does his stool look like?" Grunting, crying and straining during bowel movements by infants and newborns is normal. This is due to the immaturity of the gastrointestinal system. The most important thing to do initially is to determine the appearance of the stool. The grunts and cries are not of concern unless the stool is dry and hard, so asking about the characteristics is the initial response. Simply indicating this is normal without having additional information is not the appropriate response. There is no need for a stool specimen based upon the information provided.

The postpartum nurse observes new mothers as they put their newborns in the bassinet to sleep. Which actions by the new mothers require further instruction from the nurse? Select all that apply. A. A mother tells her husband to be sure to place the newborn on his back when putting the baby in the bassinet. B. A mother places her newborn on its side after falling asleep. C. A mother places the baby comforter her grandmother made over the newborn's body. D. A mother states her baby looks too warm, so she is moving the bassinet in front of the air conditioner to cool him off. E. A mother states all of her children like sleeping on their abdomen and this newborn likes it too.

B. A mother places her newborn on its side after falling asleep. C. A mother places the baby comforter her grandmother made over the newborn's body. D. A mother states her baby looks too warm, so she is moving the bassinet in front of the air conditioner to cool him off. E. A mother states all of her children like sleeping on their abdomen and this newborn likes it too. Newborns and infants should be on their backs when sleeping in order to help prevent sudden infant death syndrome (SIDS). A firm mattress without pillows or comforters should also be used. The baby's bed should be placed away from air conditioner vents, open windows, and open heaters.

The nurse is providing anticipatory guidance for a mother regarding the respiratory development of her 4-week-old daughter. Which action is accurate? A. Informing the mother that the respiratory system reaches maturity similar to the adult's by 12 months of age. B. Explaining to the mother the risk for infection is high due to the lack of antibodies C. Telling the mother that abdominal breathing disappears by 9 months of age D. 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 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.

An infant is breastfed. When assessing the stools, which findings would be typical? A. A strong odor B. Less constipation than bottle-fed infants C. Fewer stools than bottle-fed infants D. Harder stools than those of bottle-fed infants

B. Less constipation than bottle-fed infants The first stool of the infant is meconium. It is the result of digestion of amniotic fluid and it is black-green color and sticky. Following that, in 1 to 2 days the infant's stools change to a yellowish-tan color. The stools of breastfed infants tend to be yellow-tan. They are looser in texture and appear "seedy." The stool of a bottle-fed baby has the consistency of peanut butter. The stools of breastfed babies generally have no odor since all milk is digested. Some babies will have a bowel movement with every feeding but it is small. Bottle-fed babies have less stools each day but they are larger and more likely to have an associated odor.

The student nurse is reviewing the chart of a newborn. The document indicates the newborn is in the quiet alert state. Which is the best description of this sleep phase? A. The newborn's eyes are open and he is smacking his lips. B. The newborn's eyes are open and no body movements are noted. C. The infant's eyes are partially open and there are small movements in the extremities. D. The infant is awake but appears drowsy.

B. The newborn's eyes are open and no body movements are noted. The normal newborn moves through 6 stages of consciousness. The quite alert state is when the infant's eyes are open but the body is calm. Open eyes accompanied by body movements is characteristic of the active alert state.

The nurse assesses a 9-month-old client during a well-child visit (above). Which assessment finding should the nurse report to the health care provider? A. waking at night for breastfeeding B. gross motor development C. fear of strangers D. slowed weight gain

B. gross motor development This child is not meeting expected milestones for 9 months of age for gross motor development, including sitting independently (not tripod sit), rolling in both directions, and beginning to crawl. These could be symptoms of underlying musculoskeletal or neurologic challenges and require follow-up. Night waking is still common among many breastfed infants of this age; the waking and feeding pattern should be addressed but is not urgent. Slowed weight gain is expected from 6 to 9 months of age, and this weight gain is in the normal range. Fear of strangers is also common at 9 months of age.

A client's caregivers ask the nurse about good choices for solid foods for their 10-month-old child. The caregivers are lacto-ovo vegetarian and wish to raise their child with the same diet. What food(s) will the nurse recommend? Select all that apply. A. unsalted nuts B. iron-fortified infant cereals C. yogurt or cottage cheese D. pureed chicken E. cooked egg yolk

B. iron-fortified infant cereals C. yogurt or cottage cheese E. cooked egg yolk Iron-fortified cereals and egg yolk provide good sources of iron. Egg yolk and yogurt/cottage cheese provide protein. All of these are appropriate choices for a child this age. Pureed chicken is not appropriate for a vegetarian diet, and nuts are a choking hazard and not appropriate for a 10-month-old child.

The nurse assesses a 4-month-old child during a well-child visit (above). Which assessment finding should the nurse report to the primary health care provider? A. occasionally spitting up after breastfeeding B. not smiling or tracking faces C. not rolling over D. waking 3 times per night to feed

B. not smiling or tracking faces Preterm infants should be assessed developmentally based on their corrected age. For a 2-month-old infant, corrected waking at night, spitting up, and not rolling over are all normal findings. Not smiling or tracking faces are concerning findings that could indicate problems with vision. This requires follow-up by the health care provider.

The nurse is assessing an infant at the 6-month well-baby check-up. The nurse notes that at birth the baby weighed 8 lb (3600 g) and was 20 in (50.8 cm) in length. Which finding is consistent with the normal infant growth and development? A. weight of 18 lb (8200 g) and length of 28 in (71.1 cm) B. weight of 16 lb (7300 g) and length of 26 in (66.0 cm) C. weight of 20 lb (9100 g) and length of 30 in (76.2 cm) D. weight of 14 lb (6400 g) and length of 24 in (61.0 cm)

B. weight of 16 lb (7300 g) and length of 26 in (66.0 cm) The average newborn weighs 7.5 lb (3400 kg) at birth. Most infants double their birth weight at 4 to 5 months and will triple by the time they are 1 year old. If this infant was 8 lb (3600 kg) at birth, then it is most likely now 16 lb (7300 g). The average newborn is 20 in (50 cm) long at birth. They grow more quickly in length over the first 6 months, than during the second 6 months. By 12 months of age, the infant's length has increase by 50%. At 1 year, this infant will most likely be 30 in (76.2 cm) in length; however, since most of the growth occurs in the first 6 months, it is possible for the infant to grow an additional 6 in (15 cm) during that time.

The nurse is evaluating the effectiveness of nutrition counseling for new mothers. Which comments by the mothers indicate the need for more instruction? Select all that apply. A. "As long as I wait for at least 3 days to introduce new foods I should be able to determine if my child has any food allergies." B. "I can start giving my baby a small snack like cheerios around 8 months of age." C. "It is much healthier if I puree my own baby food and add a very small amount of salt to make it taste better." D. "My mother said that I shouldn't introduce rice cereal as the first solid food, but I'm confident that is best." E. "No-spill sippy cups are a good way to limit the amount of juice that comes into contact with the baby's teeth."

C. "It is much healthier if I puree my own baby food and add a very small amount of salt to make it taste better." E. "No-spill sippy cups are a good way to limit the amount of juice that comes into contact with the baby's teeth." Either home-made pureed or pre-packaged baby food is acceptable, but neither should have any spices (eg, salt, cinnamon) added to it. No-spill sippy cups actually allow juice to be in constant contact with the teeth because they are much like bottles in that the child must suck on them to get a drink.

A client who is breastfeeding asks the nurse if she can give the newborn a pacifier. Which nursing response is most appropriate? A. "I will request the lactation consultant come talk to you about pacifier usage while breastfeeding." B. "I know a lot of people who breastfed and also gave their newborns a pacifier." C. "It is recommended to wait until breastfeeding is well-established before introducing a pacifier." D. "This decision should be made by you and your partner based on your personal preferences."

C. "It is recommended to wait until breastfeeding is well-established before introducing a pacifier." It is recommended to wait to introduce a pacifier once breastfeeding is well-established, which can take about 1 month. This is to limit nipple confusion and promote an adequate milk supply. Stating other people have done this does not provide education to the client, nor does it address this specific client's situation. While the decision is up to the newborn's parents, this response does not address the client's concern. Requesting a lactation consultant come does not address the client at this moment. The nurse can provide education now, and also request the consultant for follow-up information.

The nurse is reinforcing teaching with a group of caregivers related to the nutritional needs of the infant. One caregiver asks why the 6-month-old infant needs to have solid foods when breast milk is such a good source of nutrition. What would be the best response by the nurse? A. "The extrusion reflex must be developed and feeding solid foods will help the child to develop this reflex." B. "Breastfeeding will become painful when the child gets more teeth, so the infant needs to eat solid foods." C. "Milk will not fully provide the child's needs for iron, which is found in solid foods." D. "By this age the child becomes interested in trying new skills."

C. "Milk will not fully provide the child's needs for iron, which is found in solid foods." At about 4 to 6 months of age, the infant's milk consumption alone is not likely to be sufficient to meet caloric, protein, mineral, and vitamin needs. In particular, the infant's iron supply becomes low, and supplements of iron-rich foods are needed. It is also around 4 to 6 months when the infant is able to swallow solids effectively and has the necessary enzymes necessary to digest them. It is true that the child becomes interested in new skills, but this is not the primary rationale for introducing solids. Few parents will understand the "extrusion reflex" so using that term is not effective in teaching. The nurse should, however, describe the reflex to the parents. Breastfeeding does not become painful when the child develops teeth. Many mothers nurse for long after their infants develop teeth.

A teen mom asks the discharge nurse if it is okay to sleep in bed with her baby. She says her mom always did it with her siblings and it seemed okay. How should the nurse respond? A. "Bed sharing is okay, just make sure the infant is between two people." B. "Sure you can, but make sure you use a soft mattress for support." C. "The baby can sleep in your room in an infant crib, but not in an adult bed." D. "Sure, you can do whatever you want, it is your baby."

C. "The baby can sleep in your room in an infant crib, but not in an adult bed." According to the 2016 recommendation by the American Academy of Pediatrics, infants should sleep in the same bedroom as the parents, but on a separate firm surface, such as a crib or bassinet, and never on a couch, armchair or adult bed, to decrease the risks of sleep-related deaths.

A first-time mother, who is breastfeeding, phones the clinic nurse because she is concerned about her 3-month-old infant's stools. Which statement by the mother would alert the nurse to contact the health care provider? A. "My infant has not had a bowel movement in almost 8 hours." B. "The stools are loose and seedy." C. "The stools are small and hard." D. "My infant grunts and squirms when having a bowel movement."

C. "The stools are small and hard." The breastfed infant has stools that appear yellow and seedy. Consistency of stool is more important than frequency. Small, hard stools are a concern, and the infant should be evaluated for gastrointestinal issues. The nurse will contact health care provider. It is normal for infants to appear to have difficulty with bowel movements because the gastrointestinal system is still immature. It is common for infants to go several days without having a bowel movement.

A parent takes the 4-month-old infant to the health care provider. The parent asks what type of baby cereal to provide now that the infant is starting solid foods. How should the nurse respond? A. "You should buy oat cereal." B. "You should buy wheat cereal." C. "You should buy rice cereal." D. "You should buy barley cereal."

C. "You should buy rice cereal." 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.

A mother asks the nurse where the microwave is so that she can warm up breast milk to feed her baby. What is the best response by the nurse? A. "Breast milk can be given cold, so there is no need to heat it." B. "You should only give fresh breast milk to an infant." C. "You should warm the milk under warm water instead." D. "Make sure that you test the milk on your wrist before feeding."

C. "You should warm the milk under warm water instead." A microwave can heat unevenly and cause burns and therefore should never be used to heat breast milk or formula for an infant. In addition, it can change the immune properties of the breast milk.

The infant measured 20 in (50 cm) at birth. If the infant is following a normal pattern of growth, which range would be an expected height for this child at the age of 12 months? A. 26 to 28 in (66 to 71 cm) B. 40 to 42 in (102 to 107 cm) C. 30 to 32 in (76 to 81 cm) D. 36 to 38 in (91 to 96 cm)

C. 30 to 32 in (76 to 81 cm) The average newborn is 20 in (50 cm) in length. The infant grows more quickly in length during the first 6 months of life than the last 6 months of their first year. By 12 months the infant's length has increased 50%. That would mean a 20-in (50-cm) infant would have grown approximately 10 in (25 cm) in 1 year, making the normal length be 30 to 32 in (76 to 81 cm).

The nurse is providing client education to the parent about bathing the infant. What would be important to instruct the parent? A. Infants need a daily bath B. Soap lubricates and oils an infant's skin C. Bath time provides an opportunity for play D. Never use soap on an infant's hair

C. Bath time provides an opportunity for play The work of children is play. Play provides a natural way for the infant to learn. In early infancy infants prefer their parents rather than toys. Parents can talk and sing to infants during feeding, bathing, and changing diapers. 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.

Infant development is best described by which statement? A. Development is not sequential but predictable. B. Development varies greatly from infant to infant. C. Development proceeds cephalocaudally. D. Development proceeds from fine to gross.

C. Development proceeds cephalocaudally. Growth and development both proceed from head to toe, or in a cephalocaudal sequence. The baby needs first to learn to lift the head. Once that developmental milestone has been achieved then progression can occur to rolling over and then learning to sit. Development proceeds in a proximodistal fashion. Skills are learned in a gross motor fashion before developing fine motor skills. Infants may develop skills at different ages but the process is always sequential. Unless there are other problems to interfere with development, all children will develop in the same manner.

The nurse is providing helpful feeding tips to the mother of a 2-week-old boy. Which recommendations will best help the child feed effectively? A. Encourage the infant to latch on properly. B. Apply warm compresses to the breast. C. Maintain a feed-on-demand approach. D. Maintain adequate diet and fluid intake.

C. Maintain a feed-on-demand approach. The best way to ensure effective feeding is by maintaining a feed-on-demand approach rather than a set schedule. Applying warm compresses to the breast helps engorgement. Encouraging the infant to latch on properly helps prevent sore nipples. Maintaining proper diet and fluid intake for the mother helps ensure an adequate milk supply.

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. What has the girl demonstrated? A. Object permanence B. Primary circular reaction C. Secondary circular reaction D. Binocular vision

C. Secondary circular reaction 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.

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

C. The infant says "da-da" when looking at her father 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 teaching the parents of a 6-month-old infant about proper dental care. Which action will the nurse indicate as most likely to cause dental caries in this infant? A. using a cloth instead of a brush for cleaning the infant's teeth B. brushing the infant's teeth with fluoride-free toothpaste C. putting the infant to bed with a bottle of milk or juice D. not cleaning the infant's gums after eating meals or snacks

C. putting the infant to bed with a bottle of milk or juice The nurse will warn against putting the infant to bed with a bottle of milk or juice because this allows the sugar content of these fluids to pool around the infant's teeth at night. Not cleaning the infant's gums when the infant is done eating will have minimal impact on the development of dental caries, as will using a cloth instead of a brush for cleaning teeth when they erupt. Failure to clean the teeth with fluoridated toothpaste is not a problem if the water supply is fluoridated. Fluoridated toothpaste is recommended for use once the infant is able to not swallow during brushing.

What is the correct amount of wet diapers a mature infant should produce each day? A. An infant should have 1 to 2 wet diapers/day. B. An infant should have 9 to 10 wet diapers/day. C. An infant should have 3 to 5 wet diapers/day. D. An infant should have 6 to 8 wet diapers/day.

D. An infant should have 6 to 8 wet diapers/day. Urination occurs in the first 24 hours of life. A normal amount of urine is 200 to 300 ml/day as the infant matures. This amount is equal to 6 to 8 wet diapers/day. The infant should have an intake of between 140 to 160 ml/kg/day to be well hydrated and nourished. This amount of intake will produce the 6 to 8 diapers/day.

The parents of a 4-day-old infant report concern about his weight loss. What is the best response by the nurse? A. "Babies may lose up to 10% of their body weight in the first month of life." B. "Babies will begin to rapidly regain weight and will double birth weight around 4 to 6 months of age." C. "Weight loss after birth is normal." D. "With appropriate nutrition weight gain will commence with a return to the birth weight within 2 weeks."

D. "With appropriate nutrition weight gain will commence with a return to the birth weight within 2 weeks." The question asks for the best response which typically informs or instructs the client on a situation in which they are concerned. The average newborn weighs 7 lb 8 oz (3,400 g) at birth. Newborns lose up to 10% of their body weight over the first week of life. The average newborn then gains about 30 g per day and regains his or her birth weight by 10 to 14 days of age. Most infants double their birth weight by 4 to 6 months of age and triple their birth weight by the time they are 1 year old.

A 2-month-old infant has inconsolable crying, is gassy, and constantly draws the legs up. It has been determined that the infant has colic. Which education will the nurse provide to the parents? A. "Your baby is very hungry, so you should try to feed more often." B. "This is a temporary condition that should have resolved by now." C. "Colic is usually the result of poor feeding techniques or improper burping." D. "You can try a pacifier, music, or carrying the baby to help stop crying."

D. "You can try a pacifier, music, or carrying the baby to help stop crying." Colic is defined as inconsolable crying that lasts at least 3 hours or longer per day. Colic can begin as early as 2 weeks and usually resolves itself by 3 months. Parents should take a stepwise approach to resolving colic. The first step is to make sure all the infant's needs are met. Then decrease any stimuli, use soothing techniques such as carrying the infant, swaddling, pacifiers, etc. Colic does not mean the infant is very hungry and needs to eat more frequently, and is not the result of improper feeding or burping.

The infant weighs 6 lb 8 oz (2,950 g) at birth. If the infant is following a normal pattern of growth, what would be an expected weight for this child at the age of 12 months? A. 13 lb (5900 g) B. 10 lb 8 oz (4760 g) C. 15 lb 4 oz (6920 g) D. 19 lb 8 oz (8825 g)

D. 19 lb 8 oz (8825 g)The average newborn weighs 7.5 lb (3400 g). The average newborn loses 10% of birth weight over the first week of life but regains it in about 10 to 14 days. Most infants double their birth weight by 4 to 6 months of age and triple their birth weight by the time they are 1 year old. If the newborn weighed 6 lb 8 oz (2,950 g) at birth and tripled that weight at 12 months, the infant should weigh 19 lb 8 oz (6.5 lb × 3 = 19.5 lb) or 8825 g.

The parent of a 3-month-old infant is concerned because the infant does not yet sit by oneself. Which statement best reflects average sitting ability? A. Most infants sit steadily at 4 months; this infant is normal. B. Sitting ability and the age of first tooth eruption are correlated. C. Most infants sit steadily at 3 months; this infant is slightly delayed. D. Most infants do not sit steadily until 8 months; this infant is normal.

D. Most infants do not sit steadily until 8 months; this infant is normal. At 3 months of age the infant should be able to raise the head about 45 degrees when in the prone position. The infant does yet have the developmental skills for sitting. Most infants are unable to sit steadily until 8 months of age. Gross motor skill development does not correlate with tooth eruption. The nurse should reassure the parent that this infant is on tract developmentally.

The nurse is caring for a 5-week-old infant who is spitting up "all the time." This is the mother's first child. What should be the priority nursing intervention? A. Offer assurance that spitting up is normal. B. Recommend the mother offer smaller and more frequent feedings. C. Describe the capacity of a 5-week-old infant's stomach. D. Observe the mother while she feeds and burps her infant.

D. 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 helpful information but not the priority.

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.

D. Placing all liquids given the child in a "no spill" sippy cup. No-spill sippy cups promote sucking rather than teach cup drinking. Reserve these for times when avoiding spills is a must. The other feeding practices are age appropriate and safe. Soft table food 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.

Which milestone would the nurse expect an infant to accomplish by 8 months of age? A. Pulling self to a standing position B. Creeping on all fours C. Being able to sit from a standing position D. Sitting without support

D. Sitting without support Physical development of infants occurs in a cephalocaudal fashion. That means they must learn to control and lift their heads first. This is followed by the ability to turn over. Once this occurs the remainder of development occurs quickly. Most infants are able to sit unsupported by 8 months. They are able to creep at 9 months and pull to a standing position by 10 months. At 12 months the infant is able to sit from a standing position and is learning to walk.

The nurse is assessing an infant at the 6-month well-baby check-up. The nurse notes that at birth the baby weighed 8 lb (3.6 kg) and was 20 in (50.8 cm) in length. Which finding is most consistent with the normal infant growth and development? A. The baby weighs 15 lb (6.8 kg) and is 24 in (61.0 cm) in length. B. The baby weighs 24 lb (10.9 kg) and is 26 in (66.0 cm) in length. C. The baby weighs 21 lb (9.5 kg) and is 30 in (76.2 cm) in length. D. The baby weighs 18 lb (8.2 kg) and is 26 in (66.0 cm) in length.

D. The baby weighs 18 lb (8.2 kg) and is 26 in (66.0 cm) in length. The average infant's weight doubles at 4 months and will triple at 1 year of life. The infant's length will increase by 50% by the first year.