FINAL EXAM Pedi 2023/ PrepU CH3

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. "You can try a pacifier, music, or carrying the baby to help stop crying." D. "Colic is usually the result of poor feeding techniques or improper burping."

"You can try a pacifier, music, or carrying the baby to help stop crying." Explanation: 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 nurse is assessing a 12-week-old infant in the clinic at a well-baby visit. Which assessment finding does the nurse predict to assess in this healthy infant? A. Able to sit up and roll over B. Smiles at significant others C. Grasps objects and brings them to the mouth D. Bears weight on legs when held in standing position

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

CHAPTER 3

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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 places her newborn on its side after falling asleep. B. A mother states all of her children like sleeping on their abdomen and this newborn likes it too. C. A mother places the baby comforter her grandmother made over the newborn's body. D. A mother tells her husband to be sure to place the newborn on his back when putting the baby in the bassinet. E. A mother states her baby looks too warm, so she is moving the bassinet in front of the air conditioner to cool him off.

A, B, C, E Explanation: 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 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. "It is much healthier if I puree my own baby food and add a very small amount of salt to make it taste better." B. "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." C. "No-spill sippy cups are a good way to limit the amount of juice that comes into contact with the baby's teeth." D. "My mother said that I shouldn't introduce rice cereal as the first solid food, but I'm confident that is best." E. "I can start giving my baby a small snack like cheerios around 8 months of age."

A, C Explanation: 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.

The nurse is providing education to the woman about foods commonly associated with allergies in infants and young children. What items should be included in this list? Select all that apply. A. cow's milk B. peanut butter C. egg substitutes D. soy products E. strawberries

A,B, E Explanation: In infants and children, certain foods are associated with allergies. These foods include cow's milk, egg whites, peanut butter and strawberries. Soy products and egg substitutes are not among those foods associated with allergies in children.

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. "Food is so expensive. I can't afford for my child to leave any food on the plate." B. "I have tried at least 10 times with every green vegetable and I can't get my son to like them." C. "I try to eat healthy in front of my daughter so she will hopefully pick up good eating habits." 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. "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."

A,B,D Explanation: 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 parents of an 8-month-old infant voice concern to the nurse that their infant is not developing motor skills as they should. What question should the nurse ask to help determine if their fears are warranted? A. "Does your infant move a toy back and forth from one hand to the other when you give it to them?" B. "Does your infant place toys into a box or container and take them out?" C. "Is your infant able to drink with a cup by themselves?" D. "Is your infant able to hold a pencil and scribble on paper?"

A. "Does your infant move a toy back and forth from one hand to the other when you give it to them?" Explanation: Transferring an object from one hand to the other is expected at 7 months of age, so this ability would be expected of an 8-month-old. The other questions relate to abilities that are not expected until later months. Questioning the parents about these skills would not help in determining if the infant has the motor skill developmental level that should be expected.

A parent calls the hospital nursing hotline and asks, "My 8-week-old infant cries 8 hours a day and is hard to console. Is this normal?" How should the nurse respond? A. "Let me ask you some more questions to see if there are symptoms of colic." B. "Yes, infants cry all the time at that age." C. "No, you should call your doctor for an appointment." D. "Yes, this is normal. Your infant may just be tired."

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

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 is the best response by the nurse? A. "Milk will not fully provide the infant's needs for iron, which is found in solid foods." B. "By this age, the infant becomes interested in trying new skills." C. "The extrusion reflex must be developed and feeding solid foods will help the infant to develop this reflex." D. "Breastfeeding will become painful for you when the infant gets more teeth, so the infant needs to eat solid foods."

A. "Milk will not fully provide the infant's needs for iron, which is found in solid foods." Explanation: 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 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 parents breastfeed for long after their infants develop teeth.

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

A. Placing all liquids given the child in a "no spill" sippy cup. Explanation: 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.

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. Educating the parents about when colic stops. C. Assessing the parents' care and feeding skills. D. Watching how the parents respond to the child.

A. Urging the baby's mother to take time for herself away from the child. Explanation: 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. Picks up small objects using entire hand C. Crawls with stomach down D. Cannot pull self to standing

A. Uses only the left hand to grasp Explanation: 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.

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

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

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

B. Babinski Explanation: 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.

A newborn requires skin care that includes bathing. Besides hygiene, what is another reason for bathing the newborn? A. Bathing can prevent infection. B. Bathing is a great time to apply lotion. C. Bathing is a time for bonding with the parents. D. Bathing helps moisten the skin.

B. Bathing is a time for bonding with the parents. Explanation: The parents can use bath time for bonding with their newborn. This can be done with talking, cooing, and singing. Bath time should be slow-paced and nonstressful. Newborns prefer interacting with parents over toys and they love to watch people's faces.

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. Explanation: 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 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. They sing to her before she goes to sleep. B. They put her to bed when she falls asleep. C. If she is safe, they lie her down and leave. D. The child has a regular, scheduled bedtime.

B. They put her to bed when she falls asleep. Explanation: 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.

After the nurse provides education to new parents about appropriate sleeping habits for infants, which statement by a parent would indicate to the nurse that teaching needs to reoccur? A. "I will place my infant on the back to sleep every night." B. "I have a crib in my room so that I can breastfeed my baby." C. "My husband gave the baby a special bear that I will place in the crib." D. "By keeping the room at a neutral temperature, I do not have to use blankets."

C. "My husband gave the baby a special bear that I will place in the crib." Explanation: The nurse should reinforce that stuffed animals, blankets, pillows, and soft mattresses are suffocation hazards for infants.

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. Put the baby to bed at various times of the evening. B. Let the baby cry during the night and she will eventually fall back to sleep. C. Use the crib for sleeping only, not for play activities. D. Wake the baby from afternoon naps after 1 hour to ensure she is sleepy by nighttime.

C. Use the crib for sleeping only, not for play activities. Explanation: A consistent bedtime routine is usually helpful in establishing healthy sleeping patterns and in preventing sleep problems.

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

D. Development proceeds cephalocaudally. Explanation: 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.