Chapter 31

Sara, age 4 months, was born at 35 weeks' gestation. She seems to be developing normally, but her parents are concerned because she is a "more difficult" baby than their other child, who was term. The nurse should explain that:

infants' temperaments are part of their unique characteristics.

Which clinical manifestations should cause the nurse to suspect that a child, diagnosed with a digestive disorder, may be demonstrating signs of failure to thrive?

Avoidance of eye contact.

Which statement accurately describes an event associated with an infant's physical development?

Birth weight doubles by age 5 and triples by age 1 year.

The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as:

a normal finding.

A mother tells the nurse that she does not want her infant immunized because of the discomfort associated with injections. The nurse should explain that:

a topical anesthetic, eutectic mixture of local anesthetic (EMLA), will minimize the discomfort.

When is the best age for solid food to be introduced into the infant's diet?

4 to 6 months

A parent asks the nurse "At what age do most babies begin to fear strangers?" The nurse responds that most infants begin to fear strangers at what age?

6 months

By what age does the posterior fontanel usually close?

6 to 8 weeks

At which age can most infants sit steadily unsupported?

8 months

By what age should the nurse expect that an infant will be able to pull to a standing position?

9 months

The parent of a 2 week old asks the nurse if the infant needs fluoride supplements because they plan to exclusively breastfed. What is the nurse's best response?

"Your infant may need to begin taking them at age 6 months."

The nurse should teach parents that at what age it is safe to give infants whole milk instead of commercial infant formula?

12 months

The nurse assessing a 6-month-old healthy infant who weighed 7 lbs at birth, shares with the parents that the infant should weigh approximately how many pounds?

15lbs.

At what age should the nurse expect an infant smiling in response to pleasurable stimuli?

2 months

The parents of a 12-month-old child ask the nurse if the child can eat hot dogs. The nurse's reply should be based on what understanding?

Hot dogs must be sliced into sections to prevent aspiration.

The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurse's response should be based on what knowledge?

Acceptable to encourage head control and turning over.

Which behavior indicates that an infant has developed object permanence?

Actively searches for a hidden object

Which interventions should the nurse implement when caring for a family of a sudden infant death syndrome (SIDS) infant? (Select all that apply.)

Allow parents to say goodbye to their infant. Arrange for someone to take the parents home from the hospital. Conduct a debriefing session with the parents before they leave the hospital.

A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. What should the nurse recommend to be used as substitute for the breastmilk?

Commercial iron-fortified formula

How should the nurse describe the fact that a 6 month old has 6 teeth?

Earlier-than-normal tooth eruption.

In teaching parents about appropriate pacifier selection, the nurse should explain that a pacifier should have which characteristics? (Select all that apply.)

Easily grasped handle One-piece construction Sturdy-flexible material

A nurse is teaching parents about prevention and treatment of colic. Which should the nurse include in the teaching plan?

Eliminate all secondhand smoke contact.

Which consideration should be considered when planning care for an infant diagnosed with failure to thrive?

Establishing a structured routine and follow it consistently.

Which information could be given to the parents of a 12-month-old child regarding appropriate play activities for this age?

Give large push-pull toys for kinesthetic stimulation.

A nurse is conducting education classes for parents of infants. The nurse plans to discuss sudden infant death syndrome (SIDS). Which risk factors should the nurse include as increasing an infant's risk of a SIDS incident? (Select all that apply.)

Low Apgar scores Male sex Recent viral illness

What is an important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS)?

Make a follow-up home visit to parents as soon as possible after the infant's death.

A parent asks the nurse whether her infant is susceptible to pertussis. The nurse's response should be based on which statement concerning susceptibility to pertussis?

Most children are highly susceptible from birth.

The parents of a 4-month-old infant tell the nurse that they are getting a microwave oven and will be able to heat the baby's formula faster. What recommendations should the nurse provide the parents?

Never heat a bottle in a microwave oven.

A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands; however, she will not voluntarily grasp it. How should the nurse interpret this behavior?

Normal development

With the goal of preventing plagiocephaly, the nurse should teach new parents to consider which intervention?

Place the infant prone for 30 to 60 minutes per day.

Which is an appropriate play activity for a 7-month-old infant to encourage visual stimulation?

Playing peek-a-boo.

The clinic is lending a federally approved car seat to an infant's family. Where in the car should the nurse explain is the safest place to put the car seat?

Rear facing in back seat.

The mother of a breastfed infant being seen in the clinic for the sixth month checkup is concerned that the infant has begun thumb sucking. How should the nurse respond to the mother's concern?

Reassure the mother that this behavior is very normal at this age.

In terms of gross motor development, what hallmark action should the nurse identify for the parents of a 5-month-old infant to anticipate?

Roll from abdomen to back.

In terms of gross motor development, what would the nurse educate the parents to expect a 5-month-old infant to do? (Select all that apply.)

Roll from abdomen to back. Put feet in mouth when supine.

According to Piaget, the 6-month-old infant would be in what stage of the sensorimotor phase?

Secondary circular reactions

The parents of a 9-month-old infant tell the nurse that they have noticed foods such as peas and corn are not completely digested and can be seen in their infant's stool. The nurse bases her explanation on what fact?

This is normal because of the immaturity of digestive processes at this age.

The nurse determines an infant of 7 months is demonstrating appropriate fine motor development when performing which action?

Transferring a rattler from one hand to the other.

The nurse is interviewing the father of 10-month-old. When the child, playing on the floor and notices an electrical outlet and reaches up to touch it, the father says "No" firmly and removes the child away from the outlet. The nurse should use this opportunity to teach the father that the child is capable of understanding what association?

Understand the word "no".

Parent guidelines for relieving colic in an infant include:

changing the infant's position frequently.