ch 9

At what age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? 1 month 2 months 3 months 4 months

ANS: B At age 2 months, the infant has a social, responsive smile. A reflex smile is usually present at age 1 month. The 3-month-old can recognize familiar faces. At age 4 months, the infant can enjoy social interactions. p 314

A nurse is assessing a 6-month-old infant. The nurse recognizes the posterior fontanel usually closes at which age? 6 to 8 weeks 10 to 12 weeks 4 to 6 months 8 to 10 months

ANS: A The bones surrounding the posterior fontanel fuse and close by age 6 to 8 weeks; 10 to 12 weeks, 4 to 6 months, and 8 to 10 months are too late. The posterior fontanel is usually closed by age 8 weeks. p 301

The nurse is guiding parents in selecting a daycare facility for their infant. Which is especially important to consider when making the selection? Health practices of facility Structured learning environment Socioeconomic status of children Cultural similarities of children

ANS: A Health practices should be most important. With the need for diaper changes and assistance with feeding, young children are at increased risk when hand washing and other hygienic measures are not adhered to. A structured learning environment is not suitable for this age child. The socioeconomic status of children should have little effect on the choice of facility. Cultural similarities of children may be important to the families, but the health care practices of the facility are more important. p 315

A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. How should the nurse interpret this action? Normal development Significant developmental lag Slightly delayed development due to prematurity Suggestive of a neurologic disorder such as cerebral palsy

ANS: A Holding a rattle but not voluntarily grasping it is indicative of normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. The infant is expected to be able to perform this task by age 3 months. If the child's age is corrected because of being 2 weeks preterm, the child is at the midpoint of the range for this developmental task and the behavior is age appropriate. No evidence of neurologic dysfunction is present. p 306

A 4-month-old was born at 35 weeks of gestation. She seems to be developing normally, but her parents are concerned because she is a "more difficult" baby than their other child, who was term. What should the nurse's explanation include? a. Infants' temperaments are part of their unique characteristics. b. Infants become less difficult if they are not kept on scheduled feedings and structured routines. c. The infant's behavior is suggestive of failure to bond completely with her parents. d. The infant's difficult temperament is the result of painful experiences in the neonatal period.

ANS: A Infant temperament has a strong biologic component. Together with interactions with the environment, primarily the family, the biologic component contributes to the infant's unique temperament. Children perceived as difficult may respond better to scheduled feedings and structured caregiving routines than to demand feedings and frequent changes in routines. The infant's temperament has been created by both biologic and environmental factors. The nurse should provide guidance in parenting techniques that are best suited to the infant's temperament. p 314

Which would be the best play activity for a 6-month-old infant to provide tactile stimulation? Allow to splash in bath. Give various colored blocks. Play music box, tapes, or CDs. Use infant swing or stroller.

ANS: A The feel of the water while the infant is splashing will provide tactile stimulation. Various colored blocks would provide visual stimulation for a 4- to 6-month-old infant. Music box, tapes, and CDs provide auditory stimulation. Swings and strollers provide kinesthetic stimulation. p 309

The nurse notices that a 10-month-old infant being seen in the clinic is wearing expensive, inflexible, high-top shoes. The nurse should explain that: soft and flexible shoes are generally better. high-top shoes are necessary for support. inflexible shoes are necessary to prevent in-toeing and out-toeing. this type of shoe will encourage the infant to walk sooner.

ANS: A The main purpose of the shoe is protection. Soft, well-constructed, athletic-type shoes are best for infants and children. High-top shoes are not necessary for support but may help to keep the child's foot in the shoe. Inflexible shoes can delay walking and can aggravate in-toeing and out-toeing and impede development of the supportive foot muscles. p 323

The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. How should the nurse interpret this finding? Normal finding Finding requiring a referral Abnormal finding Normal finding, but requires rechecking in 1 month

ANS: A This is a normal finding. The anterior fontanel closes between ages 12 and 18 months. No further intervention is required. p 301

A parent asks the nurse "when will my infant start to teethe?" The nurse responds that the earliest age at which an infant begins teething with eruption of lower central incisors is _____ months. a. 4 b. 6 c. 8 d. 12

ANS: B Teething usually begins at age 6 months with the eruption of the lower central incisors; 4 months is too early for teething. By age 8 months, the infant has the upper and lower central incisors. At age 12 months, the infant has six to eight deciduous teeth. p 317

According to Piaget, the 6-month-old infant should be in which developmental stage? Use of reflexes Primary circular reactions Secondary circular reactions Coordination of secondary schemata

ANS: C Infants are usually in the secondary circular reaction stage from ages 4 to 8 months. This stage is characterized by a continuation of the primary circular reaction for the response that results. Shaking is performed to hear the noise of the rattle, not just for shaking. The use of reflexes is primarily during the first month of life. Primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from ages 1 to 4 months. The fourth sensorimotor stage is coordination of secondary schemata. This is a transitional stage in which increasing motor skills enable greater exploration of the environment. p 310

By which age should the nurse expect an infant to be able to pull to a standing position? 6 months 8 months 11 to 12 months 14 to 15 months

ANS: C Most infants can pull themselves to a standing position at age 9 months. Infants who are not able to pull themselves to standing by age 11 to 12 months should be further evaluated for developmental dysplasia of the hip. At 6 months, infants have just obtained coordination of arms and legs. By age 8 months, infants can bear full weight on their legs. Any infant who cannot pull to a standing position by age 1 year should be referred for further evaluation. p 306

Place in order the expected sequence of fine motor developmental milestones for an infant beginning with the first milestone achieved and ending with the last milestone achieved. a. Voluntary palmar grasp b. Reflex palmar grasp c. Puts objects into a container d. Neat pincer grasp e. Builds a tower of two blocks, but fails

ANS:b, a, d, c, e Grasping occurs during the first 2 to 3 months as a reflex and gradually becomes voluntary. By 5 months, infants are able to voluntarily grasp objects. Gradually, the palmar grasp (using the whole hand) is replaced by a pincer grasp (using the thumb and index finger). By 8 to 10 months of age, infants use a crude pincer grasp, and by 11 months, they have progressed to a neat pincer grasp. By 11 months, they put objects into containers and like to remove them. By age 1 year, infants try to build towers of two blocks but fail. p 307

Which is an appropriate play activity for a 7-month-old infant to encourage visual stimulation? Playing peek-a-boo Playing pat-a-cake Imitating animal sounds Showing how to clap hands

ANS: A Because object permanence is a new achievement, peek-a-boo is an excellent activity to practice this new skill for visual stimulation. Pat-a-cake and showing how to clap hands will help with kinetic stimulation. Imitating animal sounds will help with auditory stimulation. p 314

The parents of a 4-month-old infant tell the nurse that they are getting a microwave oven and will be able to heat the baby's formula faster. What should the nurse recommend? Never heat a bottle in a microwave oven. Heat only 10 ounces or more. Always leave bottle top uncovered to allow heat to escape. Shake bottle vigorously for at least 30 seconds after heating.

ANS: A Bottles cannot be heated safely in microwave ovens even if safe guidelines are followed and regardless of the amount to be heated due to uneven heating and possible burns. p 319

Which depicts an expected developmental milestone for a 7-month-old infant? bearing weight on their legs with assistance stand holding onto furniture while standing, infant takes a deliberate step crawling

ANS: A By 6 to 7 months of age, infants are able to bear all their weight on their legs with assistance. Infants can stand holding on to furniture at 9 months. While standing, the infant takes a deliberate step at 10 months. Crawling (propelling forward with the belly on the floor) progresses to creeping on hands and knees (with the belly off of the floor) by 9 months.

In terms of fine motor development, what should the infant of 7 months be able to do? Transfer objects from one hand to the other and bang cubes on a table. Use thumb and index finger in crude pincer grasp and release an object at will. Hold a crayon between the fingers and make a mark on paper. Release cubes into a cup and build a tower of two blocks.

ANS: A By age 7 months, infants can transfer objects from one hand to the other, crossing the midline, and bang objects on a hard surface. The crude pincer grasp is apparent at about age 9 months, and releasing an object at will is seen around 8 months. The child can scribble spontaneously at age 15 months. At age 12 months, the child can release cubes into a cup and build a small tower. p 306

Which information could be given to the parents of a 12-month-old child regarding appropriate play activities? a. Give large push-pull toys for kinetic stimulation. b. Place cradle gym across crib to facilitate fine motor skills. c. Provide child with finger paints to enhance fine motor skills. d. Provide stick horse to develop gross motor coordination.

ANS: A The 12-month-old child is able to pull to standing and walk holding on or independently. Appropriate toys for a child this age include large pull toys for kinesthetic stimulation. A cradle gym should not be placed across the crib. Finger paints are appropriate for older children. A 12-month-old child does not have the stability to use a stick horse. p 314

In terms of gross motor development, which should the nurse expect a 5-month-old infant to do? (Select all that apply.) a. Roll from abdomen to back. b. Put feet in mouth when supine. c. Roll from back to abdomen. d. Sit erect without support. e. Move from prone to sitting position. f. Adjust posture to reach an object.

ANS: A, B Rolling from abdomen and to back and placing the feet in the mouth when supine are developmentally appropriate for a 5-month-old infant. The ability to roll from back to abdomen usually occurs at 6 months old. Sitting erect without support is a developmental milestone usually achieved by 8 months. The 10-month-old infant can usually move from a prone to a sitting position. The 8-month-old infant adjusts posture to reach an object. p 308

The nurse is teaching parents about appropriate pacifier selection. Which characteristics should the pacifier have? (Select all that apply.) Easily grasped handle One-piece construction Ribbon or string to secure to clothing Soft, pliable material Sturdy, flexible material

ANS: A, B, E A good pacifier should be easily grasped by the infant. One-piece construction is necessary to avoid having the nipple and guard separate. The material should be sturdy and flexible. If the pacifier is too pliable, it may be aspirated. No ribbon or string should be attached. This poses additional risks. p 316

A nurse is teaching a parent about administration of iron supplements to a 7-month-old infant. Which should the nurse include in the teaching session? (Select all that apply.) a. Administer the iron supplement with a dropper toward the side and to the back of the mouth b. Administer the iron supplement with feedings. c. Your infant's stools may look tarry green. d. your infant may have some diarrhea initially e. follow the iron supplements with 4 ounces of juice

ANS: A, C, E Liquid iron supplements may stain the teeth; therefore, administer them with a dropper toward the back of the mouth (side). Ideally, iron supplements should be administered between meals for greater absorption. Avoid administration of liquid iron supplements with whole cow's milk or milk products because they bind free iron and prevent absorption. Educate parents that iron supplements will turn stools black or tarry green. Iron supplements may cause transient constipation, not diarrhea. In older children, follow liquid iron supplement with a citrus fruit or juice drink (no more than 3 to 4 oz). p 318

2. The nurse is assessing a 6-month-old healthy infant who weighed 7 pounds at birth. The nurse should expect the infant to now weigh approximately how many pounds? a. 10 b. 15 c. 20 d. 25

ANS: B Birth weight doubles at about age 5 to 6 months. At 6 months, a child who weighed 7 pounds at birth would weigh approximately 15 pounds; 10 pounds is too little. The infant would have gone from the 50th percentile at birth to below the 5th percentile; 20 to 25 pounds is too much. The infant would have tripled the birth weight at 6 months. p 301

The nurse is discussing development and play activities with the parent of a 2-month-old. Recommendations should include giving a first rattle at about which age? a. 2 months b. 4 months c. 7 months d. 9 months

ANS: B It is recommended that a brightly colored toy or rattle be given to the child at age 4 months. Grasping has begun as a deliberate act, and the infant grasps, holds, and begins shaking to hear a noise; 2 months is too young. The infant still has primarily reflex grips; 7 to 9 months is too old for the first rattle. The child should be given toys that provide for further exploration. p 314

Which information should the nurse give a mother regarding the introduction of solid foods during infancy? a. Solid foods should not be introduced until 8 to 10 months, when the extrusion reflex begins to disappear. b. Foods should be introduced one at a time, at intervals of 4 to 7 days. c. Solid foods can be mixed in a bottle to make the transition easier for the infant. d. Fruits and vegetables should be introduced into the diet first.

ANS: B One food item is introduced at intervals of 4 to 7 days to allow the identification of food allergies. Solid foods can be introduced earlier than 8 to 10 months. The extrusion reflex usually disappears by age 6 months. Mixing solid foods in a bottle has no effect on the transition to solid food. Iron-fortified cereal should be the first solid food introduced into the infant's diet. p 319

What is the best age for solid food to be introduced into the infant's diet? a. 2 to 3 months b. 4 to 6 months c. when birth weight has tripled d. when tooth eruption has started

ANS: B Physiologically and developmentally, the 4- to 6-month-old infant is in a transition period. The extrusion reflex has disappeared, and swallowing is a more coordinated process. In addition, the gastrointestinal tract has matured sufficiently to handle more complex nutrients and is less sensitive to potentially allergenic food. Infants of this age will try to help during feeding; 2 to 3 months is too young. The extrusion reflex is strong, and the child will push food out with the tongue. Infant birth weight triples at 1 year. Solid foods can be started earlier. Tooth eruption can facilitate biting and chewing; most infant foods do not require this ability. p 319

The clinic is lending a federally approved car seat to an infant's family. The nurse should explain that the safest place to put the car seat is: front facing in back seat. rear facing in back seat. front facing in front seat with air bag on passenger side. rear facing in front seat if an air bag is on the passenger side.

ANS: B The rear-facing car seat provides the best protection for an infant's disproportionately heavy head and weak neck. The middle of the back seat is the safest position for the child. The infant must be rear facing to protect the head and neck in the event of an accident. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat. p 325

A nurse is teaching a parent about introduction of solid foods into an infant's diet. Which should the nurse include in the teaching session? (Select all that apply.) a. Solid food introduction can be started at 2 months of age. b. Rice cereal is introduced first. c. Begin the introduction of solid foods by mixing with formula in the bottle. d. Introduce egg white in small quantities (1 tsp) toward the end of the first year. e. Introduce one food at a time, usually at intervals of 4 to 7 days.

ANS: B, D, E Rice cereal, because of its low allergenic potential, is the first solid food introduced to an infant at 4 to 6 months of age. Introduce one food at a time, usually at intervals of 4 to 7 days, to identify food allergies. Introduce egg white in small quantities (1 tsp) toward the end of the first year to detect an allergy. Solid food introduction should be started at 4 to 6 months of age. Never introduce foods by mixing them with the formula in a bottle. p 319

A parent asks the nurse "at what age do most infants begin to fear strangers?" The nurse should give which response? 2 months 4 months 6 months 12 months

ANS: C Between ages 6 and 8 months, fear of strangers and stranger anxiety become prominent and are related to the infant's ability to discriminate between familiar and unfamiliar people. At 2 months, infants are just beginning to respond differentially to the mother. At age 4 months, the infant is beginning the process of separation individuation when the infant begins to recognize self and mother as separate beings. Twelve months is too late and requires referral for evaluation if the child does not fear strangers at this age. p 313

A nurse is conducting a teaching session for parents of infants. The nurse explains that which behavior indicates that an infant has developed object permanence? Recognizes familiar face, such as mother Recognizes familiar object, such as bottle Actively searches for a hidden object Secures objects by pulling on a string

ANS: C During the first 6 months of life, infants believe that objects exist only as long as they can see them. When infants search for an object that is out of sight, this signals the attainment of object permanence, whereby an infant knows an object exists even when it is not visible. Between ages 8 and 12 weeks, infants begin to respond differentially to the mother. They cry, smile, vocalize, and show distinct preference for the mother. This preference is one of the stages that influences the attachment process but is too early for object permanence. Recognizing familiar objects is an important transition for the infant, but it does not signal object permanence. The ability to understand cause and effect is part of secondary schemata development. p 313

At what age can most infants sit steadily unsupported? 4 months 6 months 8 months 10 months

ANS: C Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months, an infant can sit with support. At age 6 months, the infant will maintain a sitting position if propped. By 10 months, the infant can maneuver from a prone to a sitting position. p 306

The parent of a 2-week-old infant, exclusively breastfed, asks the nurse if fluoride supplements are needed. What is the nurse's best response? "She needs to begin taking them now." "They are not needed if you drink fluoridated water." "She may need to begin taking them at age 4 months." "She can have infant cereal mixed with fluoridated water instead of supplements."

ANS: C Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at age 4 months if the child is not drinking adequate amounts of fluoridated water. The amount of water that is ingested and the amount of fluoride in the water are taken into account when supplementation is being considered. p 321

A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. What should the nurse recommend the infant be given? Skim milk Whole cow's milk Commercial iron-fortified formula Commercial formula without iron

ANS: C For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, then iron-fortified commercial formula should be used. Cow's milk should not be used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron-deficiency anemia. p 319

A nurse is assessing a 12-month-old infant. Which statement best describes the infant's physical development a nurse should expect to find? Anterior fontanel closes by age 6 to 10 months. Binocularity is well established by age 8 months. Birth weight doubles by age 5 months and triples by age 1 year. Maternal iron stores persist during the first 12 months of life.

ANS: C Growth is very rapid during the first year of life. The birth weight has approximately doubled by age 5 to 6 months and triples by age 1 year. The anterior fontanel closes at age 12 to 18 months. Binocularity is not established until age 15 months. Maternal iron stores are usually depleted by age 6 months. p 302

The nurse should teach parents that which age is safe to give infants whole milk instead of commercial infant formula? 6 months 9 months 12 months 18 months

ANS: C The American Academy of Pediatrics does not recommend the use of cow's milk for children younger than 12 months. At 6 and 9 months, the infant should be receiving commercial infant formula or breast milk. At age 18 months, milk and formula are supplemented with solid foods, water, and some fruit juices. p 318

At what age does an infant start to recognize familiar faces and objects, such as a feeding bottle? 1 month 2 months 3 months 4 months

ANS: C The child can recognize familiar objects at approximately age 3 months. For the first 2 months of life, infants watch and observe their surroundings. The 4-month-old infant is able to anticipate feeding after seeing the bottle. p 314

Parents tell the nurse that their 1-year-old son often sleeps with them. They seem unconcerned about this. The nurse's response should be based on which statement? a. Children should not sleep with their parents. b. Separation from parents should be completed by this age. c. Daytime attention should be increased. d. This is a common and accepted practice, especially in some cultural groups.

ANS: D Co-sleeping, or sharing the family bed, in which the parents allow the children to sleep with them, is a common and accepted practice in many cultures. Parents should evaluate the options available and avoid conditions that place the infant at risk. Population-based studies are currently under way; no evidence at this time supports or condemns the practice for safety reasons. Co-sleeping is a cultural practice. One year is the age at which children are just beginning to individuate. Increased daytime activity may help decrease sleep problems in general, but co-sleeping is a culturally determined phenomenon. p 321

The parents of a 12-month-old child ask the nurse whether the child can eat hot dogs. The nurse's reply should be based on which statement? Child is too young to digest hot dogs. Child is too young to eat hot dogs safely. Hot dogs must be sliced into sections to prevent aspiration. Hot dogs must be cut into small, irregular pieces to prevent aspiration.

ANS: D Hot dogs are of a consistency, diameter, and round shape that may cause complete obstruction of the child's airway. If given to young children, the hot dog should be cut into small irregular pieces rather than served whole or in slices. The child's digestive system is mature enough to digest hot dogs. To eat the hot dog safely, the child should be sitting down, and the hot dog should be appropriately cut. p 325

Austin, age 6 months, has six teeth. How should the nurse interpret this finding? Normal tooth eruption Delayed tooth eruption Unusual and dangerous Earlier-than-normal tooth eruption

ANS: D Six months is earlier than expected. Most infants at age 6 months have two teeth. Although unusual, it is not dangerous. p 316

The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. What knowledge should the nurse's response should be based? a. Unacceptable because of the risk of sudden infant death syndrome (SIDS) b. Unacceptable because it does not encourage achievement of developmental milestones c. Acceptable to encourage fine motor development d. Acceptable to encourage head control and turning over

ANS: D These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs and then be placed on their abdomens when awake to enhance development of milestones such as head control. The face-down position while awake and on the back for sleep are acceptable because they reduce risk of SIDS and allow achievement of developmental milestones. These position changes encourage gross motor, not fine motor, development. p 306

The parents of a 9-month-old infant tell the nurse that they have noticed foods such as peas and corn are not completely digested and can be seen in their infant's stools. The nurse's explanation of this is based on which statement? Child should not be given fibrous foods until digestive tract matures at age 4 years. Child should not be given any solid foods until this digestive problem is resolved. This is abnormal and requires further investigation. This is normal because of the immaturity of digestive processes at this age.

ANS: D The immaturity of the digestive tract is evident in the appearance of the stools. Solid foods are passed incompletely broken down in the feces. An excess quantity of fiber predisposes the child to large, bulky stools. This is normal for the child and is a normal part of the maturational process; no further investigation is necessary. p 306