Chapter 25: Growth and Development of the Newborn and Infant
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? An infant at this age should have regular respirations. The respirations of a 1-month-old infant are normally irregular and periodically pause. The irregularity of the infant's respirations are concerning; I will notify the physician. The normal respiratory rate for an infant at this age is between 20 and 30 breaths per minute.
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. The respiratory patterns of the 1-month-old infant are irregular. There may normally be periodic pauses in the rhythm. By 1 year of age the rate will be 20 to 30 breaths per minute.
Which reflex, if found in a 4-month-old infant, would cause the nurse to be concerned? A) Plantar grasp B) Step C) Babinski D) Neck righting
B) Step
The nurse is assessing a 4-month-old boy during a scheduled visit. Which of the following findings might suggest a developmental problem? A) The child does not coo or gurgle. B) The child does not babble or laugh. C) The child never squeals or yells. D) The child does not say dada or mama.
B) The child does not babble or laugh.
The nurse is teaching a new mother about the development of sensory skills in her newborn. Which of the following would alert the mother to a sensory deficit in her child? A) The newborn's eyes wander and occasionally are crossed. B) The newborn does not respond to a loud noise. C) The newborn's eyes focus on near objects. D) The newborn becomes more alert with stroking when drowsy.
B) The newborn does not respond to a loud noise.
When performing neurological reflexes on the infant, which primitive reflex will be present longest? Babinski Moro step rooting
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 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? The child has a regular, scheduled bedtime. If she is safe, they lie her down and leave. They put her to bed when she falls asleep. They sing to her before she goes to sleep.
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.
The nurse caring for newborns knows that infants exhibit phenomenal increases in their gross motor skills over the first 12 months of life. Which of the following statements accurately describe the typical infant's achievement of these milestones? Select all answers that apply. A) At 1 month the infant lifts and turns the head to the side in the prone position. B) At 2 months the infant lifts head and looks around. C) At 6 months the infant pulls to stand up. D) At 7 months the infant sits alone with some use of hands for support. E) At 9 months the infant crawls with the abdomen off the floor. F) At 12 months the infant walks independently.
A) At 1 month the infant lifts and turns the head to the side in the prone position. D) At 7 months the infant sits alone with some use of hands for support. E) At 9 months the infant crawls with the abdomen off the floor. F) At 12 months the infant walks independently.
The parent of a 6-month old infant asks the nurse for advice about his son's thumb sucking. What would be the nurse's best response to this parent? A) "Thumb sucking is a healthy self-comforting activity." B) "Thumb sucking leads to the need for orthodontic braces." C) "Caregivers should pay special attention to the thumb sucking to stop it." D) "Thumb sucking should be replaced with the use of a pacifier."
A) "Thumb sucking is a healthy self-comforting activity."
The nurse is providing anticipatory guidance to the mother of a 9-month-old girl during a well-baby visit. Which of the following topics would be most appropriate? A) Advising how to create a toddler-safe home B) Warning about small objects left on the floor C) Cautioning about putting the baby in a walker D) Telling about safety procedures during baths
A) Advising how to create a toddler-safe home
At which age would the nurse expect to find the beginning of object permanence? A) 1 month B) 4 months C) 8 months D) 12 months
B) 4 months
The nurse is providing client education to the parent about bathing the infant. What would be important to instruct the parent? Infants need a daily bath Never use soap on an infant's hair Bath time provides an opportunity for play Soap lubricates and oils an infant's skin
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.
An infant has been brought to the clinic for a well-child check. The infant is 12 months of age. The child's birth weight was 6 pounds, 7 ounces. What is the anticipated weight for the child at this visit? 21 pounds, 9 ounces 19 pounds, 5 ounces 20 pounds 18 pounds
19 pounds, 5 ounces Most infants double their birth weight by 4 months of age and triple their birth weight by the time they are 1 year old.
A new mother expresses concern to the nurse that her baby is crying and grunting when passing stool. What is the nurse's best response to this observation? A) "This is normal behavior for infants unless the stool passed is hard and dry." B) "This is normal behavior for infants due to the immaturity of the gastrointestinal system." C) "This indicates a blockage in the intestine and must be reported to the physician." D) "This is normal behavior for infants unless the stool passed is black or green."
A) "This is normal behavior for infants unless the stool passed is hard and dry."
The nurse is assessing the respiratory system of a newborn. Which of the following anatomic differences place the infant at risk for respiratory compromise? Select all answers that apply. A) The nasal passages are narrower. B) The trachea and chest wall are less compliant. C) The bronchi and bronchioles are shorter and wider. D) The larynx is more funnel shaped. E) The tongue is smaller. F) There are significantly fewer alveoli.
A) The nasal passages are narrower D) The larynx is more funnel shaped. F) There are significantly fewer alveoli.
The nurse is educating a first-time mother who has a 1-week-old boy. Which of the following is the most accurate anticipatory guidance? A) Describing the effect of neonatal teeth on breastfeeding B) Explaining that the stomach holds less than 1 ounce C) Informing that fontanels will close by 6 months D) Telling that the step reflex persists until the child walks
B) Explaining that the stomach holds less than 1 ounce
The nurse is helping a new mother prepare for breastfeeding her infant. During which of the following newborn states of consciousness would the nurse recommended attempting the feeding? A) Light sleep B) Drowsiness C) Quiet alert state D) Active alert state
C) Quiet alert state
The best way for an infant's parent to help the child complete the developmental task of the first year is to: expose the infant to many caregivers to help the infant learn variability. respond to the infant consistently. keep the infant stimulated with many toys. talk to the infant at a special time each day.
respond to the infant consistently. The developmental task of an infant is gaining a sense of trust. The infant develops this sense from the caretakers who respond to the child's needs, such as feeding, changing diapers, being held. It is a continuous process. A sense of trust is difficult to learn if things are constantly changing. Consistently responding to an infant's needs helps to build a sense of trust. An infant is too young to have variability in caretakers. This causes mistrust. The parents or caretakers do not need a special time to talk to the infant each day. It should be done with each interaction. Providing too much stimulus before the infant develops gross motor skills causes frustration from the child and not enjoyment.
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 growth of a 5-month-old the growth of a 2-month-old the development of a 3-month-old the development of a 10-week-old
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 counseling the mother of a newborn who is concerned about her baby's constant crying. What teaching would be appropriate for this mother? A) Carrying the baby may increase the length of crying. B) Reducing stimulation may decrease the length of crying. C) Using vibration, white noise, or swaddling may increase crying. D) Using a swing or car ride may increase the incidence of crying episodes
B) Reducing stimulation may decrease the length of crying.
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 imitates her father's cough The infant squeals with pleasure The infant coos, babbles, and gurgles The infant says "da-da" when looking at her father
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 educating the mother of a 6-month-old boy about the symptoms for teething. Which symptom would the nurse identify? running a mild fever or vomiting frequent loose stools choosing soft foods over hard foods increased biting and sucking
Encourage "tummy time" when awake. Limit car seat use when not in car. Encourage tilting head to the other side when sleeping and resting. The child is showing signs of mild plagiocephaly (flattening of the back of the head) from the sleep position on one side of the head. The sleep position should still be on the back, but parents should be encouraged to limit pressure on that part of the head during awake times, by limiting time in the car seat and varying positions. The parents should provide plenty of "tummy time" for the child. They should also try to get the child to tilt the head to the other side, often achieved through positioning in the opposite direction in the crib.
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 infant is awake but appears drowsy. The newborn's eyes are open and no body movements are noted. The newborn's eyes are open and he is smacking his lips. The infant's eyes are partially open and there are small movements in the extremities.
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 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? upper lateral gumline upper central gumline lower lateral gumline lower central gumline
lower central gumline The lower central incisors are usually the first to appear, followed by the upper central incisors.
The nurse is performing a health assessment of a 3-month-old Black American boy. For what condition should this infant be monitored based on his race? A) Jaundice B) Iron deficiency C) Lactose intolerance D) Gastroesophageal reflux disease (GERD)
C) Lactose intolerance
The infant measured 20 in (50 cm) at birth. If the infant is following a normal pattern of growth, which range would be an expected height for this child at the age of 12 months? 36 to 38 in (91 to 96 cm) 26 to 28 in (66 to 71 cm) 30 to 32 in (76 to 81 cm) 40 to 42 in (102 to 107 cm)
30 to 32 in (76 to 81 cm) The average newborn is 20 in (50 cm) in length. The infant grows more quickly in length during the first 6 months of life than the last 6 months of their first year. By 12 months the infant's length has increased 50%. That would mean a 20-in (50-cm) infant would have grown approximately 10 in (25 cm) in 1 year, making the normal length be 30 to 32 in (76 to 81 cm).
The nurse assesses a 4-month-old child during a well-child visit (above). Which assessment finding should the nurse report to the primary health care provider? not smiling or tracking faces occasionally spitting up after breastfeeding not rolling over waking 3 times per night to feed
not smiling or tracking faces Preterm infants should be assessed developmentally based on their corrected age. For a 2-month-old infant, corrected waking at night, spitting up, and not rolling over are all normal findings. Not smiling or tracking faces are concerning findings that could indicate problems with vision. This requires follow-up by the health care provider.
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 nurse is providing discharge teaching regarding formula preparation for a new mother. Which of the following guidelines would the nurse include in the teaching plan? A) Always wash bottles and nipples in hot soapy water and rinse well; do not wash them in the dishwasher. B) Store tightly covered ready-to-feed formula can after opening in refrigerator for up to 24 hours. C) Warm bottle of formula by placing bottle in a container of hot water, or microwaving formula. D) Do not add cereal to the formula in the bottle or sweeten the formula with honey
D) Do not add cereal to the formula in the bottle or sweeten the formula with honey
The student nurse is reviewing the records of a pediatric client. Which statement about the client's progress indicates the need for further instruction? "Development refers to the increase in skills the child demonstrates as they grow and age." "Both growth and development are influenced by heredity." "Maturation refers to the child's increases in body size." "Increases in body size are referred to as growth."
"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.
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." "Breast milk can be given cold, so there is no need to heat it." "Make sure that you test the milk on your wrist before feeding." "You should only give fresh breast milk to an infant."
"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.
The nurse is providing anticipatory guidance to a mother of a 5-month-old boy about introducing solid foods. Which statement by the mother indicates that effective teaching has occurred? A) "I'll start with baby oatmeal cereal mixed with low-fat milk." B) "The cereal should be a fairly thin consistency at first." C) "I can puree the meat that we are eating to give to my baby." D) "Once he gets used to the cereal, then we'll try giving him a cup."
B) "The cereal should be a fairly thin consistency at first."
The nurse is caring for a 4-week-old girl and her mother. Which of the following is the most appropriate subject for anticipatory guidance? A) Promoting the digestibility of breast milk B) Telling how and when to introduce rice cereal C) Describing root reflex and latching on D) Advising how to choose a good formula
B) Telling how and when to introduce rice cereal
The nurse measures the head circumference of a 6-month-old infant. Which measurement would the nurse interpret as most appropriate? A) 33 cm B) 35 cm C) 43.5 cm D) 47 cm
C) 43.5 cm
The nurse is teaching a new mother the proper techniques for breastfeeding her newborn. Which of the following is a recommended guideline that should be implemented? A) Wash the hands and breasts thoroughly prior to breastfeeding. B) Stroke the nipple against the baby's chin to stimulate wide opening of the baby's mouth. C) Bring the baby's wide-open mouth to the breast to form a seal around all of the nipple and areola. D) When finished the mother can break the suction by firmly pulling the baby's mouth away from the nipple.
C) Bring the baby's wide-open mouth to the breast to form a seal around all of the nipple and areola
The nurse is providing anticipatory guidance to a mother to help promote healthy sleep for her 3-week old baby. Which of the following recommended guidelines might be included in the teaching plan? A) Place the baby on a soft mattress with a firm flat pillow for the head. B) Place the head of the bed near the window to provide fresh air, weather permitting. C) Place the baby on his or her back when sleeping. D) If the baby sleeps through the night, wake him or her up for the night feeding.
C) Place the baby on his or her back when sleeping.
The nurse is examining a 10-month-old boy who was born 10 weeks early. Which of the following findings is cause for concern? A) The child has doubled his birthweight. B) The child exhibits plantar grasp reflex. C) The child's head circumference is 19.5 inches. D) No primary teeth have erupted yet.
C) The child's head circumference is 19.5 inches.
The nurse is promoting a healthy diet to guide a mother when feeding her 2-week-old girl. Which of the following is the most effective anticipatory guidance? A) Encouraging breastfeeding until the sixth month B) Advocating iron supplements with bottle-feeding C) Advising fluid intake per feeding of 5 or 6 ounces D) Discouraging the addition of fruit juice to the diet
D) Discouraging the addition of fruit juice to the diet
The nurse is assessing the 18-month-old infant. The nurse notes the anterior fontanel (fontanelle) has closed. What initial action by the nurse is indicated? Review the birth records of the infant to see if there were any other anomalies. Notify the infant's health care provider. Measure the infant's head circumference. Document the findings as normal.
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.
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. Increased sucking on hands Refusing to eat Fever and diarrhea Drooling and biting Irritability and awakening from sleep
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.
What action shows an example of Erik Erikson's developmental task for the infant? The infant smiles as people walk past the crib. The infant cries and the caregiver picks the child up. The infant plays the game peek-a-boo. The infant cries when they have a wet diaper.
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.
The nurse is completing a developmental assessment on a 6-month-old infant. Which findings indicate the need for additional follow-up? Select all that apply. The infant seems disinterested in the surrounding environment. The infant babbles. The infant has frequent episodes of crossed eyes. The infant does not pay attention to noises behind him. The infant is unable string together 2 word sentences.
The infant does not pay attention to noises behind him. The infant has frequent episodes of crossed eyes. The infant seems disinterested in the surrounding environment. Warning signs that may indicate problems with sensory development include the following: young infant does not respond to loud noises; child does not focus on a near object; infant does not start to make sounds or babble by 4 months of age; infant does not turn to locate sound at age 4 months; infant crosses eyes most of the time at age 6 months. Language development at this stage of development does not include stringing together 2-word sentences.
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. pushing a spoon from her high chair tray to the floor. smiling at herself in the mirror. shaking a rattle to enjoy the sound.
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 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 an infant at this age is between 20 and 30 breaths per minute. The irregularity of the infant's respirations are concerning; I will notify the physician. An infant at this age should have regular respirations.
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 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? "My baby will most likely have his upper middle teeth come in first." "My baby's first tooth will likely appear between 5 and 6 months." "The first teeth that will likely appear are the lower incisors." "By 1 year my baby should have about three teeth."
"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 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 has lost a bit more than the normal amount." "Your infant's weight loss is within the expected range." "Your infant has lost too much weight and may need to be hospitalized." "All infants lose a substantial amount of weight after birth."
"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.
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? 13 lb (5900 g) 19 lb 8 oz (8825 g) 15 lb 4 oz (6920 g) 10 lb 8 oz (4760 g)
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 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? 30.5 in (77.5 cm) 27.5 in (70 cm) 32 in (81 cm) 29 in (74 cm)
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.
A new mother shows the nurse that her baby grasps her finger when she touches the baby's palm. How might the nurse respond to this information? A) "This is a primitive reflex known as the plantar grasp." B) "This is a primitive reflex known as the palmar grasp." C) "This is a protective reflex known as rooting." D) "This is a protective reflex known as the Moro reflex."
B) "This is a primitive reflex known as the palmar grasp."
The nurse is assessing a 12-month-old boy with an English-speaking father and a Spanish-speaking mother. The boy does not say mama or dada yet. Which of the following is the priority intervention? A) Performing a developmental evaluation of the child B) Encouraging the parents to speak English to the child C) Asking the mother if the child uses Spanish words D) Referring the child to a developmental specialist
C) Asking the mother if the child uses Spanish words
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? Read age-appropriate books to the infant daily. Respond promptly when the infant cries. Appropriately enunciate words when speaking to the infant. Praise the infant when a new milestone is reached.
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.
At what age would it be okay to introduce carrots to an infant's diet? Solid food can be introduced whenever the child seems ready. Solid food can be introduced after 9 months of age. Solid food can be introduced at 7 to 9 months of age. Solid food can be introduced at 4 to 6 months of age.
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
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 weight assessment is blatantly inaccurate. the child weighs more than expected for age. the child weighs the expected amount for age. the child weighs less than expected for age.
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 nurse is teaching a new mother about the drastic growth and developmental changes her infant will experience in the first year of life. Which of the following describes a developmental milestone occurring in infancy? A) By 6 months of age the infant's brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth. B) Most infants triple their birthweight by 4 to 6 months of age and quadruple their birthweight by the time they are 1 year old. C) The head circumference increases rapidly during the first 6 months: the average increase is about 1 inch per month. D) The heart triples in size over the first year of life; the average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old.
A) By 6 months of age the infant's brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth.
The nurse is caring for a 7-month-old girl during a well-child visit. Which of the following interventions is most appropriate for this child? A) Discussing the type of sippy cup to use B) Advising about increased caloric needs C) Explaining how to prepare table meats D) Describing the tongue extrusion reflex
A) Discussing the type of sippy cup to use
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? Recommend the mother offer smaller and more frequent feedings. Describe the capacity of a 5-week-old infant's stomach. Observe the mother while she feeds and burps her infant. Offer assurance that spitting up is normal.
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 in a community clinic is caring for a 6-month-old boy and his mother. Which of the following is the priority intervention to promote adequate growth? A) Monitoring the child's weight and height B) Encouraging a more frequent feeding schedule C) Assessing the child's current feeding pattern D) Recommending higher-calorie solid foods
A) Monitoring the child's weight and height
The mother of an infant is confused after being told by her dentist not to let her baby go to bed with a bottle of milk. She does not agree with that suggestion. Which response should the nurse prioritize when addressing this situation with the mother? "You could occasionally give your baby a bottle of water at bedtime." "Giving a bottle of milk when the infant goes to bed can lead to obesity." "Bottles given at bedtime can cause erosion of the enamel on the teeth." "Giving your baby a pacifier at bedtime will satisfy the need to suck."
"Bottles given at bedtime can cause erosion of the enamel on the teeth." The sugar from formula or sweetened juice coats the infant's teeth for long periods and causes erosion of the enamel on the deciduous teeth. While giving water in a bottle at bedtime is acceptable and a pacifier will satisfy the sucking need, the most appropriate response is to warn of possible enamel erosion. Giving a bottle at bedtime is not a factor that leads to obesity.
A client who is breastfeeding asks the nurse if she can give the newborn a pacifier. Which nursing response is most appropriate? "I know a lot of people who breastfed and also gave their newborns a pacifier." "It is recommended to wait until breastfeeding is well-established before introducing a pacifier." "This decision should be made by you and your partner based on your personal preferences." "I will request the lactation consultant come talk to you about pacifier usage while breastfeeding."
"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 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? "When newborns begin to cry, they are in need of parental interaction." "You should interact with your newborn when the eyes are open wide and bright." "Newborns prefer to have verbal interaction as they enter a drowsy state." "Interaction has the best effect on bonding when the newborn is in a quiet sleep state."
Correct response: "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 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? Sits from standing position Uses two or three words with meaning Feeds self with spoon (but spills) Cruises around furniture
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.
The neonatal nurse assesses newborns for iron-deficiency anemia. Which of the following newborns is at highest risk for this disorder? A) A postterm newborn B) A term newborn with jaundice C) A newborn born to a diabetic mother D) A premature newborn
D) A premature newborn
A parent has a 3-year-old child and a 4-month-old infant who both have gastroenteritis. The 3-year-old child is well enough to be cared for at home, but the 4-month-old infant requires hospitalization. How does the nurse explain the difference between these outcomes to the family? The 4-month old infant has a greater proportion of extracellular fluid, which increases risk of dehydration. The 4-month-old infant has not yet had all of their vaccinations and is more prone to severe illness. The 3-year-old child is taking solid foods they can be fed at home, but the 4-month-old infant requires greater nutritional support. The 3-year-old child has a milder case of the illness, and the 4-month-old infant has a more severe case.
The 4-month old infant has a greater proportion of extracellular fluid, which increases risk of dehydration. The extracellular fluid accounts for approximately 35% of an infant's body weight. Intracellular fluid accounting for approximately 40%, in contrast to adult proportions of 20% and 40%, respectively. This proportional difference increases an infant's susceptibility to dehydration from illnesses, such as diarrhea, because the loss of extracellular fluid could result in the loss of more than one-third of an infant's body fluid.
The parent of an infant asks the nurse when to begin brushing the infant's teeth. What would be the nurse's best response? as soon as the infant begins to eat fruit when weaning is complete as soon as the first tooth erupts by 12 months of age
as soon as the first tooth erupts Before tooth eruption occurs, parents should clean the infant's gums after feeding with a damp wash cloth. After the first tooth erupts, parents can use a soft bristle tooth brush. Dental hygiene should be part of the infant's everyday care. The American and Canadian Dental Associations recommend the first dental checkup to occur around 1 year of age. Infants should not go to bed with bottles or sippy cups to prevent dental caries.
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? "We will need to check this out since any delays related to prematurity should be resolved by the time a child is 6 months old." "You should talk with the doctor about getting your son tested." "All children mature and develop at different rates so it is unwise to compare them in this way." "Delays are normal when a child is premature."
"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 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 place toys into a box or container and take them out?" "Is he able to hold a pencil and scribble on paper?" "Does he move a toy back and forth from one hand to the other when you give it to him?" "Is he able to drink with a cup by himself?"
"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 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. "I plan on encouraging my son to cook with me when he is old enough so that he will enjoy a variety of foods and learn how to cook too." "I try to eat healthy in front of my daughter so she will hopefully pick up good eating habits." "I have tried at least 10 times with every green vegetable and I can't get my son to like them." "Food is so expensive. I can't afford for my child to leave any food on the plate." "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."
"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.
The nurse is reinforcing teaching with a group of caregivers related to the nutritional needs of the infant. One caregiver asks why the 6-month-old infant needs to have solid foods when breast milk is such a good source of nutrition. What would be the best response by the nurse? "Milk will not fully provide the child's needs for iron, which is found in solid foods." "The extrusion reflex must be developed and feeding solid foods will help the child to develop this reflex." "Breastfeeding will become painful when the child gets more teeth, so the infant needs to eat solid foods." "By this age the child becomes interested in trying new skills."
"Milk will not fully provide the child's needs for iron, which is found in solid foods." At about 4 to 6 months of age, the infant's milk consumption alone is not likely to be sufficient to meet caloric, protein, mineral, and vitamin needs. In particular, the infant's iron supply becomes low, and supplements of iron-rich foods are needed. It is also around 4 to 6 months when the infant is able to swallow solids effectively and has the necessary enzymes necessary to digest them. It is true that the child becomes interested in new skills, but this is not the primary rationale for introducing solids. Few parents will understand the "extrusion reflex" so using that term is not effective in teaching. The nurse should, however, describe the reflex to the parents. Breastfeeding does not become painful when the child develops teeth. Many mothers nurse for long after their infants develop teeth.
Which activity is most beneficial in the development of the newborn? laying on his back with a mobile overhead being sung to by his mother placement in an infant swing in a position to allow observation of the family's activities listening to classical music
being sung to by his mother Interaction between the newborn and his parents is the most beneficial activity. Later, toys and music may have a good influence but initially the parental interaction is best.
The nurse comes into an infant's room on the pediatric floor. The nurse wants to try to feed the infant for the first time since her surgery. How does the nurse know what state the infant is in by what the mother says, and that it's fine to try and feed the infant? "She has been crying every time someone picks her up." "She is so quiet today; that is not like her." "She is still sleeping; I guess she is worn out." "She has been a chatterbox and smiles just like her brother."
"She has been a chatterbox and smiles just like her brother." The best time to feed an infant is when the child is in the active alert state. This infant is talking and smiling, which shows she is calm and actively awake. In the active alert state the infant has normal respirations, limited movement, and eyes that are bright and shiny and attentive. The other choices put the infant in a crying state, quiet alert or deep sleep, or drowsing. These stages are not optimal for interacting with the child.
The nurse is admitting a 12-month-old to the medical unit. During the admission process the parents tell the nurse that their child is very advanced because he says "ball" when he picks up a football. How should the nurse respond? "That is great that he is recognizing objects and is able to name them. He is right on target for language skills." "Parents usually think their child is far more advanced than other children." "If he were advanced in language skills he would be putting several words together to form short sentences." "He really isn't any more advanced than most 12-month-old children."
"That is great that he is recognizing objects and is able to name them. He is right on target for language skills." Recognizing the parents' excitement about their child's language skills while still letting them know that this is what the expected level is for language is a polite and accurate way to respond. The other responses do not give notice to the parents' pride and would likely make the parents feel defensive about their child's skill.
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? "Recognition of faces and voices will come with time." "Don't worry. He knows you are his mother." "Since about 4 weeks of age your child has been able to recognize those who are around him often." "Recognition of this type begins around 8 weeks of age."
"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.
A 6-month-old girl weighs 14.7 pounds during a scheduled check-up. Her birth weight was 8 pounds. Which of the following is the priority nursing intervention? A) Talking about solid food consumption B) Discouraging daily fruit juice intake C) Increasing the number of breastfeedings D) Discussing the child's feeding patterns
D) Discussing the child's feeding patterns
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." "We should get some rest in about 1 month when the newborn starts sleeping through the night." "I plan to add a little rice cereal to my breast milk so my newborn will sleep longer at night." "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."
"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." "I will not be concerned if my newborn has stools that begin to have a yellowish color to them." 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.
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 is normal with infant stool formation." "We will need to collect a stool specimen for analysis." "Is he in pain?"
"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.
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? "I'm not sure a 4-week-old infant can tell their mother from another woman's smell." "You may be right, since infants can sense their mother's smell as early as 7 days old." "Babies really can't tell the difference between people at that age." "Maybe she just knows your voice better than your mother's."
"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 observes an infant interacting with his parents. Which of the following are normal social behavioral developments for this age group? Select all answers that apply. A) Around 5 months the infant may develop stranger anxiety. B) Around 2 months the infant exhibits a first real smile. C) Around 3 months the infant smiles widely and gurgles when interacting with the caregiver. D) Around 3 months the infant will mimic the parent's facial movements, such as sticking out the tongue. E) Around 3 to 6 months of age the infant may enjoy socially interactive games such as patty-cake and peek-a-boo. F) Separation anxiety may also start in the last few months of infancy.
B) Around 2 months the infant exhibits a first real smile. C) Around 3 months the infant smiles widely and gurgles when interacting with the caregiver. D) Around 3 months the infant will mimic the parent's facial movements, such as sticking out the tongue. F) Separation anxiety may also start in the last few months of infancy.
The parents of a 5-month-old child are concerned that the child has a slightly flat spot on one side of the back of the head. The child sleeps on their back with the head tilted to one side. What will the nurse recommend? Select all that apply. Encourage tilting head to the other side when sleeping and resting. Hold child upright with pressure off head. Place child on stomach to sleep. Encourage "tummy time" when awake. Limit car seat use when not in car.
Encourage "tummy time" when awake. Limit car seat use when not in car. Encourage tilting head to the other side when sleeping and resting. The child is showing signs of mild plagiocephaly (flattening of the back of the head) from the sleep position on one side of the head. The sleep position should still be on the back, but parents should be encouraged to limit pressure on that part of the head during awake times, by limiting time in the car seat and varying positions. The parents should provide plenty of "tummy time" for the child. They should also try to get the child to tilt the head to the other side, often achieved through positioning in the opposite direction in the crib.
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? By 8 months of age, the child's skill level will vary greatly and cannot be predicted. The infant will likely show the skills of an infant with the adjusted age of 7 months. The infant will most likely present with developmental skills consistent with a 6-month-old infant. The infant can be expected to display developmental skills consistent with a 8-month-old infant.
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 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. Let the baby cry during the night and she will eventually fall back to sleep. Put the baby to bed at various times of the evening. Wake the baby from afternoon naps after 1 hour to ensure she is sleepy by nighttime.
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.