Peds Unit 2 (Chapt. 3-7)

The nurse is assessing the 18-month-old infant. The nurse notes that the anterior fontanel (fontanelle) has closed. What initial action by the nurse is indicated?

- Document the findings as normal **The anterior fontanel (fontanelle) most often closes between 12 and 24 months of age. The closure of the fontanel (fontanelle) at 18 months of age does not signal any health issues for the infant.

A 3-year-old child is seen at the clinic for a checkup. When collecting information, the child's parent reports concern about the child's stools because sometimes the child passes what appears to be undigested food. What response by the nurse is appropriate?

- "At this age, the digestive tract is not completely mature and children may pass undigested food." **The digestive systems of 3-year-old children are not fully mature and they may sometimes pass pieces of undigested food. This is a normal occurrence. The reason for this occurrence should be explained to the child's parent. When the nurse asks the parent "Why," this is demonstrating poor therapeutic communication skills and will cause the parent to become defensive. The symptoms of pain or straining would be indicative of constipation, not passing undigested food. There is no indication that the diet being ingested is not appropriate.

The parents of a toddler ask the nurse about disciplining their 2-year-old toddler. What suggestions will the nurse provide? Select all that apply.

- "It is better to praise correct behavior than to punish wrong behavior." - "If you allow an unwanted behavior one time at this age, it is difficult to reverse later." - "Try using time-out, assigning 1 minute per year of your toddler's age." **Parents should begin to instill some sense of discipline early in life because part of it involves safety limits. Two general rules to follow include the need to be consistent and the use of praise for correct behavior rather than punishment for wrong behavior so that the child can learn the rules. Parents should implement consistent discipline early. Once an unwanted behavior is allowed, it is difficult to reverse as the child grows older. Time-out is an effective technique to help children learn that actions have consequences. One minute per year of the child's age is the common standard. Physical punishment is not recommended. Having a consistent caregiver is important for reducing separation anxiety.

In working with the toddler, which statement would be most appropriate to say to the toddler to decrease the behavior known as negativism?

- "It is time for lunch. I am going to put your bib on." **Negativism is very typical of the toddler years. It is best to avoid questions with a yes or no answer because the answer will always be no. Limiting the number of questions asked of the toddler and making a statement, rather than asking a question or giving a choice, is helpful in decreasing the number of negative responses from the child. Instead of asking questions like "Do you want help getting in your chair?" make the statement "Get in your chair." The toddler years are also ones where the child becomes a picky eater or "grazes" instead of eating a full meal so the toddler may not actually know if he or she is hungry.

A nurse is discussing safety measures with the parents of a toddler. What would the nurse emphasize to address the most frequent type of accident in toddlers?

- "Keep all cleaning products and drugs out of the reach of your child." **Although all the instructions are important, accidental ingestions (poisoning) are the most frequent accident in toddlers. Therefore, it is imperative to focus on keeping all poisonous substances, drugs, and small objects securely out of the reach of children. Burns, motor vehicle accidents, and falls such as from a tricycle occur frequently in toddlers. However, they occur less frequently than poisonings.

During the toddler years, the child attempts to become autonomous. Which statement by a 3-year-old toddler's caregiver indicates that the toddler is developing autonomy?

- "My toddler uses the potty chair and is dry all day long." **During the toddler years, the toddler separates from his or her parents, recognizes one's own individuality and exerts autonomy. Being toilet trained is an example of the toddler developing autonomy or independence. Having temper tantrums is a normal response of the toddler as it is a way the toddler expresses frustration of being tired or not being able to accomplish a task. Having the parent pick up the child after the child falls is a security and emotional need. All children need this, so it is not indicative of toddlerhood or autonomy. Having the same routine for bedtime each night provides security but it does not demonstrate autonomy.

During a visit to the pediatric clinic the mother of a 2-year-old tells the nurse that her husband is concerned that their son isn't potty trained yet. The mother states, "There is no way he could be potty trained. His bladder is too small." How should the nurse respond?

- "The bladder of a 2-year-old is actually the size of an adult's bladder, but there are a lot of variables to when a child is potty-trained." **Bladder and kidney function reach adult levels by 16 to 24 months of age, but there are many factors that determine when a child is ready to be potty-trained. The other options are misleading the parent regarding potty-training.

The mother of a 15-month-old is returning to work and wants to place her son in the day care close to work; however, they will only accept potty-trained children. Which response from the nurse will best address this situation in answering the mother's questions of how best to potty train her son?

- "Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained." **To be able to cooperated in toilet training, the child's anal and urethral sphincter muscles must have developed to the stage where the child can control them. Control of the anal sphincter usually develops first. The child must also be able to postpone the urge to defecate or urinate until reaching the toilet or potty and must be able to signal the need before the event. In addition, before toilet training can occur, the child must have a desire to please the caregiver by holding feces and urine rather than satisfying his/her own immediate need for gratification. This level of maturation seldom takes place before the age of 18 to 24 months.

A group of caregivers are discussing the form of discipline in which the child is placed in a "time-out" chair. Which statement made by these caregivers is appropriate related to this form of discipline?

- "When my child starts getting frustrated and aggressive, I remind the child throwing a fit will end up in a time-out." **A method for a young child who is not cooperating or who is out of control is to send the child to a "time-out" chair. This should be a place where the child can be alone but observed without other distractions. The duration of the isolation should be limited—1 minute per year of age is usually adequate. Caregivers should warn the child in advance of this possibility, but only one warning per event is necessary. The chair should be used for discipline, not because the child will not go take a nap. It can be used for all ages of young children.

The nurse is caring for an 18-month-old child who has had surgery. The medical record indicates the child weighs 23 pounds (10.45 kg). When monitoring his urinary output the nurse is aware that normal hourly output should be what value?

- 10 ml/hr **The normal urinary output for a toddler is approximately 1 ml/kg/hr. This child weighs 23 pounds. This is 10.45 kg. This is approximately 10 ml/hr.

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?

- 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 infant weighs 7 lb 4 oz (3,300 g) at birth. If the infant is following a normal pattern of growth, what would be expected weight for this child at the age of 12 months?

- 21 lb 12 oz (9.9 kg) **The average weight of a newborn is 7.5 lb (3400 g). The infant gains about 30 g each day. By 1 year of age, the infant has tripled the birth weight and has grown 10 to 12 in (25 to 30 cm). 7.25 lb x 3 = 21.75 lb or 21 lb 12 oz (9.9 kg)

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?

- 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 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?

- 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.

By what age should the child know his/her own gender?

- 3 years **Toddlers observe differences in both male and female body parts. They question their parents about the differences. By 3 years of age, toddlers can say their name, their age and their gender. This age group begins to understand and mimic social gender differences. A 1-year-old or 2-year-old child would be too young to make this distinction because these children are just identifying their own body parts. By 4 years of age the child should be able to identify body parts. If not, there may be some delay with the child.

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 mother places her newborn on its side after falling asleep. - A mother states all of her children like sleeping on their abdomen and this newborn likes it too. - A mother places the baby comforter her grandmother made over the newborn's body. - A mother states her baby looks too warm, so she is moving the bassinet in front of the air conditioner to cool him off. **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 parents of a 30-month-old toddler have brought the toddler into the emergency department because of a seizure. During the health history, the nurse learns that the toddler was frustrated and angry immediately preceding the seizure. The nurse suspects the toddler had a breath-holding spell. Which parental report suggests breath-holding?

- A tantrum preceded the event **Temper tantrums are the natural result of frustrations that toddlers experience. They continue to occur until the toddler is old enough to verbalize feelings. The fact that there was a precipitating event of frustration and anger points to the likelihood that this is a cyanotic breath-holding spell. Breath-holding spells never occur during sleep, nor do they feature postictal confusion. Unconsciousness is not definitive because it is common to both seizures and breath-holding spells.

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 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.

A nurse is preparing a presentation for a health fair discussing various aspects of preschoolers. Which example should the nurse use to best illustrate dramatic play?

- Acting out a troubling or stressful situation **Dramatic play allows a child to act out a troubling or stressful situation. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. During cooperative play, children play in an organized group with each other as in team sports or video games. Onlooker play occurs when there is observation without participation, such as watching television or videos.

The nurse is teaching the mother of a 5-month-old boy who is concerned about thumb sucking. What should be included in the teaching plan? Select all that apply.

- Advising the mother this behavior is a form of self-comfort - Assuring the mother this behavior won't cause malocclusion - Informing the mother that thumb sucking occurs more often during periods of stress - Telling the mother this behavior usually decreases by 6 to 9 months of age **All are accurate and should help the mother better understand and accept the behavior.

A parent tells the nurse that the 6-year-old child has been biting his fingernails since beginning first grade. After analysis, the cause is determined to be increased stress. What advice would the nurse give the parent regarding this behavior?

- Allow some time every day for the child to talk about new experiences **The developmental task of the school-age child is industry. They are busy learning, achieving, and exploring. With school comes separation from the parents, new people, new activities. Beginning school can be a time of extreme stress for children. Biting the nails can be a symptom that something is concerning the child. Spending time with the child and allowing the child time to discuss these new experiences of school helps the child to put experiences in perspective and begin to deal with them. Allowing the child a reward for not biting the nails does not address the underlying issue of why the child is biting the nails in the first place. The underlying issue is emotionally based, so adding milk or providing a distraction will not correct the problem.

The nurse is promoting language and cognitive development to the parents of a 3-year-old boy. Which guidance about reading with their child will be most helpful?

- Ask the child questions as you read **Engage the child by asking him questions as he listens. This gives him a chance to contribute to the story. The child does not have to sit still. He may want to move around or even act out part of the story. Story time should happen regularly and not be just a reward. Even if the child can tell the story, he may wish to hear it read again because he enjoys the repetition and familiarity.

The nurse is assessing a 2-year-old boy during a well-child visit. The nurse correctly identifies the child's current stage of Erikson's growth and development as:

- Autonomy versus shame and doubt **The Erikson stage of development for the toddler is autonomy versus shame and doubt. During this period of time the child works to establish independence. Trust versus mistrust is the stage of infancy. Initiative versus guilt is the stage for the preschooler. Industry versus inferiority is the stage for school-aged children.

The nurse is caring for an 18-month-old child. The nurse is aware that the child is which stage according to Erikson?

- Autonomy vs shame and doubt **Erikson defines the toddler period as a time of autonomy versus shame and doubt. Erikson defines Initiative versus guilt as the preschool period. Erikson defines trust versus mistrust as the infancy period and industry versus inferiority as the school age period

When performing neurological reflexes on the infant, which primitive reflex will be present longest?

- 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 nurse is providing client education to the parent about bathing the infant. What would be important to instruct the parent?

- 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.

A newborn requires skin care that includes bathing. Besides hygiene, what is another reason for bathing the newborn?

- Bathing is a time for bonding with parents **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. Bathing can help prevent infection, but it is a secondary response. Using soaps on the skin tends to dry the skin, not moisten it. After bathing, lotion can be applied. It is soothing to the baby and keeps the skin softened.

The parents of an 8-year-old boy report their son is being bullied and teased by a group of boys in the neighborhood. Which response by the nurse is best?

- Bullying can have lifelong effects on the self-esteem of a child **The child can be permanently scarred by negative experiences such a bullying. Activities such as self-defense and sports can promote a sense of accomplishment but don't relate directly to the problem of bullying. There is no indication the child in the scenario will become a bully.

What information would the nurse include when teaching the parents of an infant about colic?

- Colic symptoms will probably fade at 3 months of age. **Colic is defined as inconsolable crying that lasts 3 hours or longer per day and which it has no physical cause. Colic symptoms typically fade around 3 months of age. This is an age when infants are better able to console themselves. Colic can be very stressful for parents and lead to sleep deprivation. Many infants need to be carried at all times to reduce crying. Some do well with non-nutritive sucking and others need white noise or motion to help them soothe. Because colic has no physical cause, telling the parents about follow up for "nervous stomach" is not necessary. The infant should be placed in a position of comfort to reduce the crying. Every infant has his or her own position that helps; don't just place the infant on his or her back. Doubling up the formula will not help colic and may actually cause more problems because it can cause abdominal pain and increased weight gain.

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.

- Cow's milk - Peanut butter - Strawberries **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 preparing a list of abilities of 10-month-olds to use in teaching a parenting group. Which ability should appear at this age?

- 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 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?

- 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.

The nurse is providing anticipatory guidance to the parents of an 18-month-old child. Which recommendation should be the most helpful to the parents?

- Describe proper behavior when the child misbehaves **Stopping the child when misbehaving and describing proper behavior sets limits and models good behavior. This will be the most helpful advice to the parents. At 18 months, the child is too young to use time out or extinction (ignoring the child's behavior) as discipline. Slapping the child's hand, even done carefully with two fingers, is corporal punishment, which has been found to have negative effects on child development.

Nursing students reviewing information about discipline demonstrate a need for additional education when they identify what information as correct?

- Discipline and punishment are interchangeable. **Discipline and punishment are not interchangeable. Discipline refers to setting rules or road signs so children know what is expected of them. Punishment is a consequence that results from a breakdown in discipline, from a child's disregard of rules that were learned.

A nurse is teaching a group of parents of preschoolers about safety. Which information would the nurse include? Select all that apply.

- Do not refer to medicines as candy - Do not allow your child to approach strange dogs - Have your child hold hands with a grown-up in parking lots - Role-model bicycle safety by wearing a helmet too **Appropriate safety measures include not referring to medicines as candy, not allowing the child to approach strange dogs, having the child continue to ride in the back seat of the car, ensuring that the child holds an adult's hand when in parking lots, and role-modeling bicycle safety by wearing a helmet themselves.

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?

- 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 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.

- Drooling and biting - Increased sucking on hands - Irritability and awakening from sleep - Refusing to eat **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.

A single mother with three young children is reluctant to leave her crying and upset 16-month-old daughter overnight in the hospital but needs to go home to care for the other children. Which suggestion from the nurse will best address the fears and concerns of both the child and mother?

- Encourage the mother to give the child a personal item of the mother's to hold on to until she returns and to tell the child a specific time she will return, such as "when breakfast comes in the morning." **When the family caregiver must leave the toddler, it may be helpful for the adult to give the child some personal item to keep until the adult returns. The caregiver can tell the child he or she will return "when the cartoons come on TV" or "when your lunch comes." These are concrete times that the toddler will probably understand. The toddler is too young to understand that staying is important for her recovery. Distracting the child while the mother leaves may increase the child's anxiety when she realizes her mother is gone. Although the child will be watched closely in the hospital setting, toddlers explore their environment wherever they are.

The nurse is providing anticipatory guidance for a mother regarding the respiratory development of her 4-week-old daughter. Which action is accurate?

- 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.

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.

- Food is so expensive. I can't afford for my child to leave any food on the plate - I have tried at least 10 times with every green vegetable and I can't get my son to like them - 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 **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.

What is a true statement regarding the developmental milestones of the 30-month-old child?

- Full set of primary teeth **Developmental milestones of a 30-month-old child include acquiring a full set of primary or baby teeth. A child at this age is developing a sense of humor, can put on clothes, wash hands and brush teeth. The 12-month-old child should double the birth weight. The anterior fontanel (fontanelle) closes at 18 to 24 months. Head circumference equals chest circumference at 12 months.

The nurse is teaching a group of school-aged children about physical development. Which statement made by one of the children indicates the correct understanding of the teaching?

- Girls typically experience a rapid growth spurt before boys. **Girls typically experience a rapid growth spurt before boys, and are usually taller by about 2 in (5 cm) or more than preadolescent boys. During the school-age years, the child will grow approximately 1 to 2.5 in (2.5 to 6.25 cm) per year. As puberty approaches, there will be significant differences in development between boys and girls. The first sign of puberty for girls is breast changes, not menarche.

The nurse finds the diet of a 30-month-old girl to be low in calcium. What suggestion can significantly increase this toddler's calcium intake?

- Give her slices of cheddar cheese as a snack. **Two and one-half ounces of cheddar cheese provides the toddler's daily requirement of 500 mg of calcium. Chocolate milk provides calcium but the sugar it contains should not be a regular part of a toddler diet. Applesauce provides fiber, not calcium. Spinach and dark greens do contain calcium, but that calcium has limited bioavailability.

The pediatric nurse is careful to monitor and assess the growth and development of all clients. Which characteristic should the nurse prepare to assess in the infants?

- Grows and develops skills more rapidly than at any other time in their life. **The infant grows and develops skills more rapidly than he or she ever will again. The toddler insists he or she can do things one minute and then becomes dependent the next minute. The preschool age child soaks in information and asks "why" and "how" over and over. The school-age child has a longer attention span and can become absorbed in a craft or activity for several hours.

The nurse is examining a 6-month-old girl who was born 8 weeks early. Which finding is cause for concern?

- Head size has increased 5 in (12 cm) since birth. **The child's head size is large for his adjusted age of 4 months, which would be cause for concern. Normal growth would be 3.6 in (9 cm). At 10 lb, 2 oz (12 cm), the child is the right weight for a 4-month-old adjusted age. Palmar grasp reflex disappears between 4 and 6 months adjusted age, so this would not be a concern yet. The child is of average weight for a 4-month-old adjusted age.

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?

- 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.

The parents of a 4-year-old child tell the school nurse that they are worried that their child will fall behind other children academically because they are not able to afford expensive toys like computer games and handheld electronic devices. Which are acceptable response(s) by the nurse? Select all that apply.

- I understand how this can be frustrating, but rest assured this does not place your child at a disadvantage academically. - All of these expensive toys that are advertised and purchased by some people are not necessary for preschoolers. Simple toys like chalk and Legos are great. - Do you play with your child and provide means of play through things like dolls, puzzles, crayons, and child-safe modeling clay? These are the types of toys suggested for preschoolers. **Expensive and elaborate toys do not place a child at an academic or developmental advantage. Simple toys that require interactive rather than passive play, and that may include the involvement of the parent, are recommended to foster development. The nurse should not question a family's finances nor recommend the family ask for financial assistance. These statements are judgmental and infer the family is not able to provide for the child, which is not the case.

A nurse in a pediatrician's office is educating a parent of a 2-month-old infant about developmental milestones. The parent requires further education when the parent states:

- I will be able to play games like peek-a-boo with my infant when they are 4 months old - My infant should be able to sit on their own by 3 months - At 6 months, my baby should be able to feed themselves **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.

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.

- I will not be concerned if my newborn has stools that begin to have a yellowish color to them - I understand it is normal for newborns to lose 5% to 10% of their bodyweight after birth - 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.

Which action is appropriate to enhance a toddler's self-esteem?

- Include the child in activities that interest the adult. **Parents who give the toddler love and respect regardless of the child's gender, behavior or capabilities are helping to lay the foundation for self-esteem. Toddlers need familiarity with the daily routine to enhance self-esteem development. Routines and rituals not only help develop self-esteem but help develop a conscience. Strategies for enhancing self-esteem encompass including the child in activities that interest the adult. Belittling techniques should not be used. Negative criticism should be avoided. Applauding for unsuccessful attempts as well as successes should be reinforced.

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?

- 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 the extrusion of the tongue. The parent may think that infant does not want the food and is spitting it out intentionally, but the extrusion reflex is still present.

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?

- 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 mother of an 18-month-old girl voices concerns about her child's social skills. She reports that the child does not play well with others and seems to ignore other children who are playing at the same time. What response by the nurse is indicated?

- It is normal for children to engage in play alongside other children at this age. **The social skills of the toddler at this age include parallel play. During parallel play children will play alongside each other rather than cooperatively. There is no indication that the aggression level of the child needs to be investigated. There is no indication the child needs increased socialization with other children.

A client who is breastfeeding asks the nurse if she can give the newborn a pacifier. Which nursing response is most appropriate?

- 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 speaking to a parent of a 4-year-old. The parent states that she has trouble getting her child to go to bed at night. Which is the best response by the nurse?

- It's just as important to establish a morning wake-up time as it is as establishing a bedtime. Children tend to do better when they have a normal routine to follow. **Establishing a bedtime routine is important for preschool children. This includes establishing a morning wake-up time as well. Avoiding stimulating activities before bedtime; not allowing children to watch television in bed; and providing a nightlight in the child's bedroom are all appropriate pieces of education to provide on establishing bedtime routines.

A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia. The child's condition has improved, and the child is much more active and eager to play. Which toy should the nurse offer the child?

- Large piece puzzle **An appropriate toy for a 3-year-old child is a large piece puzzle. Board games are more appropriate for preschool and school-aged children; fabric books and squeaky toys are more appropriate for older infants and younger toddlers (10 to 18 months of age)

When the nurse discharges a new mom and infant, the nurses notices that the car seat is in the front seat of the car. What is the appropriate response for the nurse to make regarding the car seat?

- Let me go over car seat safety with you, so you can install your car seat properly. **The nurse should notice this is not the proper place for a car seat. The car seat should be rear-facing and in the center of the back seat of the car. The nurse would review car seat safety with the mother and have her install the seat properly. The nurse should provide written materials if available. The other responses are not appropriate and do not ensure that proper installation will occur and that infant safety will be maintained.

The parents of a 3-year-old boy tell the nurse that they are having another baby in several months. They ask the nurse for suggestions to help their son adapt to the new baby. What would the nurse suggest?

- Let the child participate in caring for the new baby **Young children who are involved in a newborn's care adapt better than those who are not and thus have fewer feelings of sibling rivalry. During this time, it is wise not to introduce any new developmental tasks such as toilet training, weaning from a nighttime bottle, or changing from a crib to a toddler bed. Encourage parents to spend extra alone time with the child to decrease sibling rivalry. If the child does something to make the new baby cry, the parents should investigate the reason behind the action and talk to the child about it, rather than discipline the child.

A staff nurse is talking about Piaget's theory with a nursing student. Infants are in the sensorimotor stage of cognitive development during which object permanence is mastered. An example of an infant displaying this ability is:

- Looking for a toy in her crib at the last place she saw it. **Looking for the toy where it was last seen indicates object permanence. The infant knows the object still exists even though she cannot see it. All the rest of the infant's behaviors show use of her senses and motor activity but do not illustrate object permanence.

The nurse is assessing the oral cavity of a 6-month-old child. When palpating the location in which the first primary teeth erupt, which location is being assessed?

- Lower central gumline **The lower central incisors are usually the first to appear, followed by the upper central incisors.

The student nurse is reviewing the records of a pediatric client. Which statement about the client's progress indicates the need for further instruction?

- 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.

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?

- 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 interacting with several parents of infants. Which parent statement would alert the nurse to refer the infant for further evaluation by the health care provider?

- My 9-month-old infant is beginning to track objects when we show her favorite objects **Infants should be tracking objects by 7 months of age, so an older infant who is just "beginning to track objects" would warrant further evaluation. The newborn shows preference for items with contrast, such as black and white stripes so this is a normal finding. The newborn's eyes may cross and wander and this is a normal finding for this age. Distance vision develops by 7 months of age, so a younger child would not be expected to have developed distance vision yet.

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?

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

During the toddler years, the child attempts to become autonomous. Which statement by a 3-year-old toddler's caregiver indicates that the toddler is developing autonomy?

- My toddler uses the potty chair and is dry all day long. **During the toddler years, the toddler separates from his or her parents, recognizes one's own individuality and exerts autonomy. Being toilet trained is an example of the toddler developing autonomy or independence. Having temper tantrums is a normal response of the toddler as it is a way the toddler expresses frustration of being tired or not being able to accomplish a task. Having the parent pick up the child after the child falls is a security and emotional need. All children need this, so it is not indicative of toddlerhood or autonomy. Having the same routine for bedtime each night provides security but it does not demonstrate autonomy.

The nurse is assessing the newborn. Which would the nurse assess to be an abnormal finding?

- Natal teeth noted in the mouth that are loose **The presence of 1 or 2 teeth at birth (natal teeth) is a finding that may be benign or may point to other congenital abnormalities. The neck should be short, thick and mobile. The gluteal folds should be symmetrical. It is normal for the newborn to startle to loud sounds.

The nurse is assessing the oral cavity of a 4-month-old infant. Which finding is consistent with a child of this age?

- No teeth **Normally infants are not born with teeth. Occasionally there are one or more teeth at birth. These are termed natal teeth and are often associated with anomalies. The first primary teeth typically erupt between the ages of 6 and 8 months.

The parents of a 10-year-old tell the clinic nurse that they are concerned because they noticed that their child has gained about 10 pounds over the past 2 years. What is the best response by the nurse?

- Normal growth and development for this age results in an average weight gain of 7 pounds per year. **Children of school-age grow an average of 2.5 inches (6 to 7 centimeters) per year and gain an average of 7 pounds per year; therefore, the 10 pounds over 2 years is normal and it is important for the parents to know this, regardless if they are not overweight. Simply comparing them to other children seen in the clinic doesn't mean it is a normal expectation. While activity is important, the nurse must first address the parent's concern.

The nurse is assessing a 3-year-old child. The nurse notes the child is able to understand that objects hidden from sight still exist. The nurse correctly documents that the child is displaying:

- Object permanence **Object permanence means that the child knows that objects that are out of sight still exist.

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?

- 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.

The nurse is presenting an in-service training to a group of pediatric nurses on the topic of play. The nurse determines the session is successful when the group correctly chooses which example as best displaying toddlers playing?

- Playing independently and are side by side **Parallel play occurs when the toddler plays alongside other children but not with them. During cooperative play children play in an organized group with each other, as in team sports. Associative play occurs when children play together and are engaged in a similar activity but without organization, rules, or a leader—and each child does what she or he wishes. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity.

The nurse is supervising a play group of children on the unit. The nurse expects the toddlers will most likely be involved in which activity?

- Playing with the plastic vacuum cleaner and pushing it around the room **Playtime for the toddler involves imitation of the people around them such as adults, siblings, and other children. Push-pull toys allow them to use their developing gross motor skills. Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. The school-age child enjoys group activities and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities they can participate in with their peers.

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?

- 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.

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?

- 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?

- 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.

What gross motor developmental milestone is least likely for 2-year-old?

- Rides a tricycle **Gross motor developmental milestones for a 2-year-old include jumping in place, standing on tiptoes, kicking a ball, and running. At 3 years old, the child should be able to pedal a tricycle, run easily, and walk up and down the stairs with alternate feet. At 12 to 18 months of age, the child should be able to stand on one foot with help, walk independently, climb the stairs with assistance, and pull toys.

The nurse is teaching healthy eating habits to the parents of a 7-month-old girl. Which recommendation is the most valuable advice?

- 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.

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:

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

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?

- 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.

Which milestone would the nurse expect an infant to accomplish by 8 months of age?

- 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.

At what age would it be okay to introduce carrots to an infant's diet?

- Solid food can be introduced at 4 to 6 months of age **The tongue extrusion reflex is present until the infant is 4 to 6 months of age. After this reflex disappears then solid food may be introduced. The infant's ability to swallow solid foods is not completely functional until this age nor are the enzymes present which are needed to process foods. The infant must be ready to handle spoon-feeding. By 7 months onward, the baby should be eating solid foods regularly and drinking from a cup in addition to breast or bottle feeds.

The nurse is assessing a healthy 2-year-old client. Which assessment finding most concerns the nurse?

- The child speaks in one-word sentences **A 2-year-old child not using at least two-word sentences is a sign of a potential developmental delay. Normal development for a 2-year-old child is standing on tiptoes and pointing to named body parts. Having difficulty with stairs is considered a potential delay in a 3-year-old, not a 2-year-old child.

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:

- 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.

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?

- 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 providing education to a parent about their 20-month-old child's growth. The parent states that their child seems to have such a big head. What information should the nurse include in the response?

- The heads of children at this age are large in proportion to the rest of their body. **Head circumference increases about 1 in (2.5 cm) between 1 and 2 years of age, then increases an average of 0.5 in (1.25 cm) per year until age 5. By 2 years of age, the child's head circumference is approximately 85% of their expected adult head circumference. The other responses would be incorrect.

What action shows an example of Erik Erikson's developmental task for the infant?

- 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.

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?

- 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 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?

- 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.

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?

- 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.

A parent asks the nurse what symptoms to expect with normal teething in the infant. How should the nurse respond?

- The infant's gumline will be tender **Infants experience discomfort as the tooth emerges through the periodontal membrane and from inflammation. When teething, some infants become irritable, have excessive drooling, and like to bite on hard surfaces. To relieve discomfort, the parent can apply ice to the gums or use an over-the-counter topical anesthetic for infants. Some infants will refuse to eat or have poor sleeping due to the pain in the gums. There is not a definitive time frame for this to occur, and it does not happen in all infants. Fever, diarrhea, and vomiting are signs of illness, not teething.

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?

- 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 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?

- 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.

The nurse is conducting a health screening for a 3-year-old boy as required by his new preschool. Which statement by the parents warrants further discussion and intervention?

- The school is quite structured and advocates corporal punishment. **The nurse needs to emphasize that there are number of reasons that a parent should not choose a preschool that utilizes corporal punishment. It may negatively affect a child's self-esteem as well as ability to achieve in school. It may also lead to disruptive and violent behavior in the classroom and should be discouraged. The other statements would not warrant further discussion or intervention.

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?

- 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.

The nurse is assessing speech development in the 2-year-old toddler whose family uses two languages in the home. What finding is of concern?

- The toddler speaks 15 words between the two languages. **Of concern is the toddler speaking only 15 words between the two languages spoken in the home. At 20 months, the bilingual child should use 20 words. The other findings fit the norms for a bilingual child.

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?

- 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 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?

- 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.

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?

- 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.

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?

- 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.

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?

- 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 examining an 8-month-old girl for appropriate development during a regular check-up. Which observation points to a developmental risk?

- 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.

A nurse is presenting a class on toilet training to a group of parents with toddlers. Which information would the nurse include in the class? Select all that apply.

- Using training pants that slide down easily and quickly - Praising the child when he or she urinates or defecates - Putting the child on the potty chair at regular intervals during the day **For effective toilet training, parents should allow 1 to 2 weeks to psychologically prepare the child for training, using training pants that slide down easily and quickly, praising the child when he or she urinates or defecates, limiting the time spent on the potty chair to no longer than 10 minutes (or less if the child is resistant), and putting the child on the potty chair at regular intervals during the day.

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?

- 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.

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?

- 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.

A parent asks the nurse if the 2-month-old infant can have bananas yet. The nurse would respond and educate the parent on the nutrition stages of infants by which response?

- You can try bananas 2 or 3 months from now. **The nurse will educate the parent to wait 2 to 3 months, because solid foods are not recommended for infants at 2 months of age. The age of 4 to 6 months is when it is recommended to introduce solid foods. In 1 month, the infant will be only 3 month of age. The other responses will not help the parent determine the appropriate answer.

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?

- 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 enters a client's room to find the new mother crying softly. The client states, "I had my heart set on breastfeeding but my infant was born with a cleft lip. My dreams of breastfeeding are destroyed." Which response by the nurse is appropriate?

- You may still breastfeed your infant. I will show you appropriate techniques to use. **The nurse should be therapeutic and reassure the mother that breastfeeding may still be an option. Infants with cleft lips may still successfully breastfeed once appropriate techniques are learned and implemented. A supplemental nursing system is used to provide supplemental milk to breastfeeding babies. Telling the client to speak with a lactation consultant does not address the client's current concern.

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?

- 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?

- 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.

A parent of a 2-year-old child asks the nurse, "What would be a good between-meal snack?" What food(s) is appropriate for the nurse to suggest? Select all that apply.

- apple slices - orange slices - cheese - yogurt **Good choices for between-meal snacks include fruits (e.g., pieces of apples or orange slices) and high-protein foods (e.g., cheese or pieces of chicken). Cheese as well as yogurt provide calcium. Cookies and other high-carbohydrate foods should be avoided because they promote dental caries.

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?

- 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.

The nurse is educating the mother of a newborn about feeding practices. The nurse correctly advises the mother that:

- 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.

A parent brings their 2-year-old child in for a well visit. The nurse assesses their growth since the last appointment. Which finding should concern the nurse?

- total weight gain of 15 lb (6.8 kg) in the past year **A child gains only about 5 lb (2.3 kg) and 5 in (13 cm) a year during the toddler period, much less than the rate of growth during the infant year. Because the weight gain of the child in this scenario is much greater than normal, the nurse should be concerned that the child is overweight or obese. All of the other findings listed are normal for a 2-year-old child.

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?

- 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 examining a 2-year-old girl for speech and language development. Which finding would suggest a delay in speech development?

-The child does not use the names of familiar objects **By 24 months most children will name objects familiar to them in their daily lives. Not doing so is strong evidence that a speech delay may exist. Repeating words heard or phrases out of context (echolalia) is normal and a way to practice words and incorporate them in the vocabulary. At 2 years, most children understand much more than they can clearly repeat. Using two-word sentences is a development expectation at this age.