Ch. 15 Care of Newborn & Infants

A mother calls a clinic nurse to ask if her infant born prematurely should receive the seasonal influenza vaccine. The nurse's next question should be: A. "How old is your baby?" B. "How premature was your baby?" C. "Does your baby have any allergies?" D. "Did your baby have any respiratory problems?"

A. "How old is your baby?" Rationale: Flu vaccine and all other vaccines are administered according to chronological age. Flu vaccine is recommended for all infants at 6 months of age and given yearly thereafter.

The nurse is providing teaching to the parents of a newborn prior to a heelstick. The nurse is describing the procedure and recommending various methods for the parents to help comfort their baby. Which statement by the parents indicates a need for further teaching? A. "It's better if we are not in the room for this." B. "We can use skin-to-skin kangaroo care before and after." C. "We hope you are using a very tiny needle." D. "We can offer him nonnutritive sucking to calm him."

A. "It's better if we are not in the room for this."

The public health nurse is discussing immunizations with a group of caregivers of infants. One of the mothers asks the nurse why the child will need immunizations. Which statement would be the most appropriate for the nurse to make to this mother? A. "The infant is born with immunity to some diseases, but those immunities decrease over the first year of life." B. "The antibodies the fetus gets from the mother are in the placenta, so after birth they are no longer available to the infant." C. "The immunities that the infant is born with are not for the same diseases they will be immunized against." D. "Infants are unable to develop antibodies to protect them from diseases so they must be immunized."

A. "The infant is born with immunity to some diseases, but those immunities decrease over the first year of life."

The parents of a 12-month-old child tell the nurse the child has stopped walking and is now only crawling or sitting with support. How should the nurse respond? A. "This is a concern. Let's be sure the physician is aware of this change." B. "Children often regress in their developmental stages...no need to worry." C. "If you continue to notice these changes, we should follow up within the next 3 months." D. "Every child develops at different rates. Don't be alarmed. Just enjoy your child!"

A. "This is a concern. Let's be sure the physician is aware of this change."

Mnemonic to remember which vaccines should be given at/by 6 months of age.

6 BI DR. HIP At 6 months... B - Hepatitis B I - Influenza D - Diptheria Tetanus acellular pertussis (DTaP) R - Rotavirus (RV) H - Haemophilus Influenzae Type B (HiB) I - Inactivated Polio Virus (IPV) P - Pneumococcal (PCV)

To obtain an accurate heart rate in an infant, what would be most important for the nurse to do? A. Take the apical pulse. B. Count the pulse rate for 30 seconds. C. Use an electronic stethoscope. D. Take a radial pulse.

A. Take the apical pulse.

Which of the following developmental milestones is most likely to be seen beginning at age 9 months? A. Separation Anxiety B. Says first name C. Stacks Six Blocks D. Sit with support or tripod position E. Social smile F. Clenched hands

A. Separation Anxiety

An infant who is 4 months old continues to be seen at doctor visits for illness prevention. What would be the next scheduled appointment that this infant should attend to be evaluated? A. The next visit would be in 1 month. B. The next visit would be at 6 months. C. The next visit would be in 3 months. D. The next visit would be at 9 months.

B. The next visit would be at 6 months.

The nurse is preparing a presentation for a health fair illustrating the major milestones of infants as they grow and develop. Which fact should the nurse point out when illustrating an infant's teeth? A. The first tooth usually erupts by 6 months. B. The upper incisors are most often the first teeth to erupt. C. Fluoride should not be used on a child's teeth before 4 or 5 years of age. D. Swollen or inflamed gums during teething indicate a serious concern.

A. The first tooth usually erupts by 6 months.

A parent asks the nurse what symptoms to expect with normal teething in the infant. How should the nurse respond? A. The infant's gumline will be tender. B. The infant will not play or eat for 2 days. C. The infant will be constipated for 2 days. D. The infant's temperature may go as high as 102°F (38.9°C).

A. The infant's gumline will be tender.

A parent asks if her newborn's undescended testicles will need surgery to repair. What is the best response by the nurse? A. There is a chance the testicles will descend on their own. B. This problem needs to be corrected immediately in the newborn period. C. If the infant is having swelling or pain, then surgery will be performed. D. Surgery is not needed for this type of problem.

A. There is a chance the testicles will descend on their own. Rationale: The Association of American Physicians recommends surgery at 1 year of age if the testicles have not descended on their own. There is a chance they may descend on their own prior to 1 year of age.

The nurse is assessing a newborn child. The mother asks why the feet are blue. What is the best response by the nurse? A. "A blue tint to skin means that there is a lack of oxygen. I will need to notify the physician of this immediately." B. "When a foot or hand is blue, it's called peripheral cyanosis. Peripheral cyanosis is not normal in newborns." C. "Blueness of hands and feet is a common finding in newborns. It is a result of their circulatory system switching from being in the womb to life outside the mom's body." D. "Blueness in the feet of a newborn is called pallor. This is a normal finding in babies up to several days old."

C. "Blueness of hands and feet is a common finding in newborns. It is a result of their circulatory system switching from being in the womb to life outside the mom's body."

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

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

Which of the following social/cognitive milestones is most likely to be seen at age 2 months? A. Facial expressions for emotions B. Stranger Anxiety Develops C. Social Smile D. Cries when parents leave E. Plays games F. Parallel play

C. Social Smile

Which of the following developmental milestones is most likely to be seen at age 9 months? A. Rides Tricycle B. Stacks Three Blocks C. Starts Cruising D. Walks Up/Down Steps with Alternating Feet E. Two-Finger Pincer Grasp F. Stacks Six Blocks

C. Starts Cruising Explanation: Babies should be crawling by eight months old, and then may begin cruising, or standing up and moving while holding on to furniture for support, by nine months old.

The nurse is caring for a term neonate suffering from meconium aspiration in the nursery. The nurse reviews orders for a peripherally inserted central catheter (PICC) line placement and intubation. Which statement demonstrates the nurse's knowledge of painful procedures as related to a neonate? A. Newborns are rarely subjected to painful procedures without anesthesia. B. The newborn does not have fully developed pain receptors, and therefore needs little or no pain medication. C. The newborn's pain pathway components are developed enough at birth to experience pain. D. The newborn will not remember pain and does not need analgesia for painful procedures.

C. The newborn's pain pathway components are developed enough at birth to experience pain.

Which of the following developmental milestones is most likely to be seen beginning at age 9 months? A. Holds a rattle B. Track Objects Past Midline C. Three-Finger Pincer Grasp D. Track Objects To Midline E. Rides Tricycle F. Push Off Stomach to Elbows

C. Three-Finger Pincer Grasp

Which of the following fine motor milestones is most likely to be seen at age 2 months? A. Pulls to Stand B. Tracks Objects to the Midline C. Imitate you drawing a cross D. Three-Finger Pincer Grasp E. Draw straight lines and circles F. Hold crayons using the thumb and fingers

E. Draw straight lines and circles

Which of the following language milestones is most likely to be seen at age 2 months? A. Try imitating speech sounds B. Turn and look in the direction of sounds C. Stranger Anxiety Develops D. Starts Sounding "Mama" or "Dada" E. Understand simple instructions, such as "Come here" F. Coos

F. Coos

True or False: In candida infections of the diaper area, the skin is erythematous and excoriated but the skin folds are not affected.

False

True or False: Infants are at risk for tooth decay and dental caries beginning at 12 months of age.

False

Which of the following developmental milestones is most likely to be seen at 2 months of age?

Holds head up but unsteady

The nurse is talking to the parents of a 2-month-old infant who has been admitted to the hospital with sepsis. The parents report being confused since their older children also had the flu but they recovered without incident. What information can the nurse provide to the parents? Select all that apply. A. Infants have fewer white blood cells available to fight infection. B. Passive immunity does not protect the child from infection if the mother has not had the particular infection. C. Children this young do not have mature immune systems to fight infection. D. Infants do not have adequate amounts of immunoglobulin G (IgG) to fight infections.

C. Children this young do not have mature immune systems to fight infection. Rationale: Sepsis can affect any age group but infants less than 3 months of age have a higher risk. Neonates and young infants have a higher susceptibility due to their immature immune system, inability to localize infections, and lack of immunoglobulin M (IgM), which is necessary to protect against bacterial infections.

True or False: A pinna that sits below the imaginary line between the outer canthus of the eye could indicate chromosomal abnormalities.

True

True or False: An infant who does not turn his or her head toward sound should be evaluated.

True

Mnemonic to remember which vaccines should be given at/by 12 months of age.

12 VP HAM At 12 months... V- Varicella P - Pneumococcal (PCV) H - Haemophilus Influenzae Type B (HiB) A - Hepatitis A M - Measles, Mumps, Rubella (MMR)

Mnemonic to remember which vaccines should be given at/by 2 months of age.

2 B DR. HIP At 2 months... B - Hepatitis B D - Diptheria Tetanus acellular pertussis (DTaP) R - Rotavirus (RV) H - Haemophilus Influenzae Type B (HiB) I - Inactivated Polio Virus (IPV) P - Pneumococcal (PCV)

Mnemonic to remember which vaccines should be given at/by 4 months of age.

4 DR. HIP At 4 months... D - Diptheria Tetanus acellular pertussis (DTaP) R - Rotavirus (RV) H - Haemophilus Influenzae Type B (HiB) I - Inactivated Polio Virus (IPV) P - Pneumococcal (PCV)

Mnemonic to remember which vaccines should be given at/by 4-6 years of age.

4 I DMV At 4 years of age... I - Inactivated Polio Virus (IPV) D - Diptheria Tetanus acellular pertussis (DTaP) M - Measles, Mumps, Rubella (MMR) V - Varicella

Which of the following cognitive/social milestones is most likely to be seen at 2 months of age? A. Starts Sounding "Mama" or "Dada" B. Recognizes Parents C. Parallel play D. Facial expressions for emotions E. Stranger Anxiety Develops F. Cries when parents leave

B. Recognizes Parents

Which of the following developmental milestones is most likely to be seen beginning at age 9 months? A. Says first name B. Waves Bye C. Social smile D. Track Objects Past Midline E. Clenched hands F. Stacks Six Blocks

B. Waves Bye

Which of the following developmental milestones is most likely to be seen beginning at age 9 months? A. Pretend Play B. Plays Pat-A-Cake C. Holds a rattle D. Social smile E. Rolling Over F. First Steps

B. Plays Pat-A-Cake

The nurse is observing a novice nurse measure the head circumference of a 9-month-old infant. The nurse determines that the novice nurse is performing the skill correctly based on which action? A. Measuring from the hairline in front to the hairline in back. B. Measuring from the center of the forehead to the posterior fontanel (fontanelle). C. Measuring from above the eyebrows through the prominent part of the occiput. D. Measuring from the middle of the forehead through the parietal prominences.

C. Measuring from above the eyebrows through the prominent part of the occiput.

True or False: On average, an infant's weight should double by 12 months of age.

False

Which vaccine is to be given immediately after birth?

Hepatitis B

Which vaccine do you start getting yearly at 6 months?

Influenza

A _______ pattern of growth and development refers to the attainment of skills beginning at the head and moving downward.

cephalocaudal

Due to vasomotor instability, newborns may present with bluish hands and feet, which is a condition known as _________.

acrocyanosis

A(n) _________ spot is a bluish discoloration on the sacral area and is more common in infants with darker skin.

mongolian

With the development of object _______ during the sensorimotor stage, an infant comes to understand that just because an object cannot be seen does not mean the object is gone.

permanence

Misalignment of the eyes, also known as ________, is common in the newborn up to 6 months of age.

strabismus

Which of the following developmental milestones is most likely to be seen beginning at age 9 months? A. Holds Bottle or Cup B. Sit with support or tripod position C. Rolling Over D. Says first name E. Rides Tricycle F. First Steps

A. Holds Bottle or Cup

Which of the following developmental milestones is most likely to be seen beginning at age 9 months? A. Stacks Six Blocks B. Track Objects To Midline C. Track Objects Past Midline D. Starts Sounding "Mama" or "Dada" E. Says first name F. First Steps

D. Starts Sounding "Mama" or "Dada"

Which vaccine can be given at 15-18 months?

DTaP dose

Which of the following developmental milestones is most likely to be seen at age 9 months? A. Pulls to Stand B. Stacks Six Blocks C. Pretend Play D. Two-Finger Pincer Grasp E. Holds Head Up, But Unsteady F. Rides Tricycle

A. Pulls to Stand

A 6-month-old has fanning of the toes and dorsiflexion of the big toe seen on physical exam. Based on this finding the nurse should: A. document as a normal finding. B. refer for further evaluation. C. educate the parent about the abnormal finding. D. teach parent to have child wear hard-soled shoes.

A. document as a normal finding. Rationale: Some infants will demonstrate a flaring Babinski sign until 2 years of age. In the absence of other neurologic findings this is a normal response.

The nurse is assessing reflexes on a neonate. When assessing, which reflex is the nurse most correct to clap during the assessment technique? A. the Moro reflex B. the plantar reflex C. the rooting reflex D. the Babinski reflex

A. the Moro reflex Rationale: The Moro or startle reflex is tested by making a loud sound or moving the crib. The infant will extend and flex arms quickly.

An 8-month-old infant in being held by her mother and the nurse needs to obtain the infant's vital signs. Which approach would most likely ensure accurate readings? A. Place the infant on the examination table, take the temperature rectally and listen to the heart rate and note respirations. B. Allow the mother to continue to hold the infant, listen to the child's heart rate, count respirations by the abdominal rise, then take an axillary temperature. C. Have the mother hold the infant in her lap lying down, take a rectal temperature, and listen to heart and breath sounds from there. D. Lay the infant on the examination table, have the mother help hold the infant still, and take an axillary temperature and count both heart rate and respiratory rate by auscultation.

B. Allow the mother to continue to hold the infant, listen to the child's heart rate, count respirations by the abdominal rise, then take an axillary temperature.

A mother is concerned about her infant's spitting up. Which suggestion would be most appropriate? A. "Put the infant in an infant seat after eating." B. "Limit burping to once during a feeding." C. "Feed the same amount but space out the feedings." D. "Keep the baby sitting up for about 30 minutes afterward."

D. "Keep the baby sitting up for about 30 minutes afterward."

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

D. 19 lb 8 oz (8825 g) Rationale: 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.