peds infant

The nurse provides nutritional counseling to the parents of a 6-month-old formula-fed infant who will begin eating solid foods. Which statement by a parent indicates understanding of the nurse's advice? 1. "I'll keep giving him formula instead of regular cow's milk." 2. "I'll buy plenty of pureed spinach so she gets enough iron." 3. "Using a natural sweetener like honey is better than using table sugar." 4. "Baby food is sterilized, so it's better to feed directly from the jar than from a bowl."

1. "I'll keep giving him formula instead of regular cow's milk." Infants should receive formula or breast milk for a full year; cow's milk should not be introduced until 1 year of age. Commercially prepared spinach, collard greens, and certain other foods contain nitrates and so should be used very sparingly; if the infant is iron deficient, other sources should be used. Honey should not be given to infants because there is risk of botulism poisoning. Infants should not be fed from the jar because enzymes from saliva on the spoon will affect the quality of the food remaining in the jar.

An infant with talipes equinovarus has a plaster cast applied to the involved foot. How should the nurse move the infant while the cast is wet? 1. By handling the cast with just the palms 2. By touching the cast with just the fingertips 3. By turning the infant without touching the cast 4. By moving the infant's body while sliding the cast

1. By handling the cast with just the palms The palm provides a wide base of support for the infant's body and the casted extremity. Touching the cast with the fingertips will cause indentations that may create pressure points; this may compromise the skin, neurovascular function, or both. The cast must be touched because the lower extremity and the cast must be supported.

A cast is applied to the involved extremity of an infant with talipes equinovarus (clubfoot). How often does the nurse tell the parents to bring their baby back to the clinic for a cast change? 1. Each week 2. Once a month 3. When the cast edges fray 4. If the cast becomes soiled

1. Each week Casts are changed weekly to accommodate the rapid growth of early infancy. Once a month is not frequent enough in early infancy; the cast may become too tight because of the infant's rapid growth. The cast is not on the foot long enough for fraying to occur. Soiling is usually not a problem, because casts for clubfoot do not extend to the perineal area.

An infant who underwent revision of a ventriculoperitoneal shunt is found to have meningitis, the result of an infected shunt. What clinical manifestations support this conclusion? Select all that apply. 1. Fever 2. Lethargy 3. Stiff neck 4. Poor feeding 5. Depressed fontanels

1. Fever 2. Lethargy 3. Stiff neck 4. Poor feeding 1. A low-grade fever progressing to a high fever occurs in meningitis. 3. (stiff neck) An infectious process that causes meningitis may result in rigidity and hyperextension of the neck (opisthotonos). . Central nervous system irritation results in irritability, 2. lethargy, and 4. (poor feeding) anorexia. The fontanels will be tense or bulging as intracranial pressure increases.

The parents of a sick infant talk with a nurse about their baby. One says, "I'm so upset; I didn't realize that our baby was ill." What major indication of illness in an infant should the nurse explain to the parent? 1. Grunting respirations 2. Excessive perspiration 3. Longer periods of sleep 4. Crying immediately after feedings

1. Grunting respirations Grunting and rapid respirations are signs of respiratory distress in an infant. Grunting is a compensatory mechanism by which the infant attempts to keep air in the alveoli to increase arterial oxygenation; increased respirations increase oxygen and carbon dioxide exchange. Sweating in infants usually is scant because of immature function of the exocrine glands; profuse sweating is rarely seen in a sick infant. Longer periods of sleep are not necessarily a sign of illness, nor is crying immediately after feedings.

The nurse is caring for a group of clients who require various interventions. What client care may be delegated to unlicensed assistive personnel (UAP)? 1. Playing with an infant who had a seizure 1 hour ago 2. Bathing a child with an intravenous line and a patient-controlled analgesia (PCA) pump 3. Taking vital signs from a child who received a PRN albuterol nebulizer treatment 15 minutes ago 4. Feeding an infant with a respiratory rate of 60 breaths/min who underwent cardiac surgery 1 day ago

2. Bathing a child with an intravenous line and a patient-controlled analgesia (PCA) pump The UAP may bathe a child with an intravenous line and patient-controlled analgesia; neither intervention prohibits bathing, and the activity is within the realm of the UAP's job description. Stimulating a client who experienced a seizure 1 hour ago is not good nursing practice; the child could experience another seizure. Clients who receive as-needed treatments should be followed up and assessed by the registered nurse, not the UAP. A respiratory rate of 60 breaths/min in an infant is too high for bottle feeding, and the child underwent surgery just 1 day ago, making this client the least likely to be cared for by the UAP.

A parent arrives in the emergency clinic with a 3-month-old baby and says, "My baby stopped breathing for a while!" The infant continues to have difficulty breathing, with prolonged periods of apnea. Which assessment data should prompt the nurse to suspect shaken baby syndrome (SBS)? 1. Birth occurred before 32 weeks' gestation 2. Lack of stridor and adventitious breath sounds 3. Previous episodes of apnea lasting 10 to 15 seconds 4. Retractions and use of accessory respiratory muscles

2. Lack of stridor and adventitious breath sounds One common sign of SBS is apnea without stridor or adventitious sounds, the result of central nervous system trauma. The age of the infant is beyond the time that respiratory distress caused by immaturity would occur. Short periods of apnea, lasting less than 15 seconds, are expected at any age. Retractions and use of accessory respiratory muscles are indicative of laryngotracheobronchitis, which is common in children younger than 5 years of age but would not be expected at 3 months.

A nurse is discussing the care of an infant with colic. What should the nurse explain to the parents is the cause of colicky behavior? 1. Inadequate peristalsis 2. Paroxysmal abdominal pain 3. An allergic response to certain proteins in milk 4. A protective mechanism designed to eliminate foreign proteins

2. Paroxysmal abdominal pain The traditional efforts to explain and treat colic center on the paroxysmal abdominal pain; multiple factors appear to be involved, including immaturity of the intestinal nervous system and lack of normal intestinal flora. Peristalsis is effective because these infants thrive physically and gain weight. The origin of colic is unknown at this time.

A nurse is assessing an infant with talipes equinovarus (clubfoot) who has had a corrective boot cast applied. Which peripheral vascular assessment cannot be performed while the cast is in place? 1. Color 2. Pulse 3. Warmth 4. Blanching

2. Pulse The pedal pulse cannot be palpated under a boot cast. Assessments of the color, warmth, and blanching of the toes are all appropriate neurovascular checks.

A nurse is conducting an assessment of a young infant who is dehydrated. Which clinical sign is the most important indication of an accurate degree of dehydration? 1. Dry skin 2. Weight loss 3. Sunken fontanel 4. Decreased urine output

2. Weight loss Loss of fluid as a result of dehydration is most objectively assessed by weighing the infants daily because total body water accounts for approximately 75% of an infant's body weight. One liter of fluid weighs approximately 2.2 lb (1 kg). Dry skin may be indicative of conditions other than dehydration. A sunken fontanel is a clinical sign of dehydration, but does not indicate the degree of dehydration and is not an accurate measurement of dehydration. Decreased urine output cannot always be measured accurately in infants and children who are not toilet trained.

One day in the well-child clinic a parent asks at what age the baby should first be able to drink from a cup. The nurse responds: 1. "Around 5 months." 2. "Around 7 months." 3. "Around 12 months." 4. "Around 18 months."

3. "Around 12 months." By 12 months of age a child can usually drink from a cup, although fluid may spill and a bottle may be preferred at times. The child is just beginning to exert lip control at 5 months and cannot handle a cup. At 7 months a child can handle a bottle but not a cup. This skill is present at 12 months, and by 18 months most children are quite proficient.

When picked up by a parent or the nurse, an 8-month-old infant screams and seems to be in pain. After observing this behavior, what should the nurse discuss with the parent? 1. Accidents and the importance of their prevention 2. Limiting playtime with other children in the family 3. Any other behaviors that the parent might have noticed 4. Food and specific vitamins that should be given to infants

3. Any other behaviors that the parent might have noticed When a health history is being taken, all areas of behavior should be explored fully before the nurse decides how to address the problem. The nurse should gather more data to determine the basis for the problem before recommendations can be made. The data are insufficient for the nurse to focus on nutrition as the cause of the problem.

A newborn is found to have Down syndrome. The nurse knows that Down syndrome is usually accompanied by several problems. Which assessment should the nurse perform during the physical examination? 1. Reflex responses for hypotonicity 2. Eye examination for congenital cataracts 3. Sensory stimulation for muscle flaccidity 4. Cardiac irregularities for congenital heart disease

4. Cardiac irregularities for congenital heart disease Children with Down syndrome have a high incidence of congenital heart defects, indicated by altered heart sounds. Without treatment a heart defect may become life threatening. The other options are expected but are not life threatening.

A nurse is caring for an infant with a cleft lip and palate. What information should the nurse include when teaching the parents about this diagnosis? 1. Anticipation that these children will have psychological problems 2. Emphasis that the two defects follow the laws of Mendelian genetics 3. Assurance that the defect is rare and probably will not occur twice in the same family 4. Expectation that these children will have no other defect and otherwise will be healthy

4. Expectation that these children will have no other defect and otherwise will be healthy Children with a cleft lip and palate are otherwise healthy, and once a successful feeding technique is established they feed, gain weight, and thrive as expected, even without corrective surgery. The way in which the young child responds to these defects depends on parental responses. Mendelian laws of inheritance do not apply to these defects. These defects are familial; however, an exact pathogenesis has not been identified.

An infant is admitted to the hospital with gastroenteritis. The infant vomits shortly after admission. Under standard precautions, what protective equipment should the nurse wear when cleaning the infant after the vomiting episode? 1. Mask 2. Gown 3. Face shield 4. Pair of gloves

4. Pair of gloves Gloves should be worn when the nurse is exposed to blood and body fluids; this provides a barrier and protects the nurse. A mask, face shield, or goggles are not required unless the vomiting is projectile in nature. A gown is necessary only if there is a risk of contamination of the nurse's clothing.