Pediatrics Study Guide Exam 2

Which enzyme is contained in human milk?

Lipase

A nurse is educating new parents about risk factors for sudden infant death syndrome (SIDS). Which of the following statements should indicate to the nurse the need for additional teaching?

Appropriate Statements: - If your child is born​ premature, the risk for SIDS increases. - If your child is exposed to smoke in the​ home, the risk for SIDS increases. - If your child shares your bed during​ sleep, the risk for SIDS increases. - If your family has a history of​ SIDS, the risk for SIDS increases.

A nurse is completing a pain assessment on an infant. Which of the following pain scales the nurse should use? a. FACES b. FLACC c. Oucher d. Non-Communicating Children's Pain Checklist

b. FLACC The FLACC scale is an appropriate tool for infants and young children who cannot self-report pain.

A nurse is conducting education classes for parents of infants. The nurse plans to discuss sudden infant death syndrome (SIDS). Which risk factors should the nurse include as increasing an infant's risk of a sudden infant death syndrome incident? (Select all that apply.) a. Breastfeeding b. Low Apgar scores c. Male sex d. Birth weight in the 50th or higher percentile e. Recent viral illness

b. Low Apgar scores c. Male sex e. Recent viral illness Certain groups of infants are at increased risk for SIDS: low birth weight, low Apgar scores, recent viral illness, and male sex. Breastfed infants and infants of average or above average weight are not at higher risk for SIDS.

Stroking the newborn's cheek along the side of the mouth causes the newborn to turn the head toward that side and begin to suck. This is which reflex? a.Perez b.Sucking c.Rooting d.Extrusion

c.Rooting Stroking the newborn's cheek along the side of the mouth causes the newborn to turn the head toward that side and begin to suck is a description of the rooting reflex, which usually disappears by ages 3 to 4 months but may persist for up to 12 months. The Perez reflex involves stroking the newborn's back when prone; the child flexes extremities, elevating head and pelvis. It disappears at ages 4 to 6 months. The newborn begins strong sucking movements in response to circumoral stimulation. The reflex persists throughout infancy, even without stimulation. Newborns force their tongues outward, when the tongue is touched or depressed. This reflex usually disappears by age 4 months.

A nurse is assessing a 6 month old infant. Which of the following reflexes should the infant exhibit? A. Moro B. Plantar grasp C. Stepping neck D. Tonic Neck

B. Plantar grasp discovered between birth to 8 months

Which of the following ways can a nurse obtain an accurate urine output in a high risk newborn

By calculating the difference in weight between a dry diaper and a soiled diaper

Which type of birthmark involves deep vessels in the dermis, is bluish-red color, and has poorly defined margins?

Cavernous venous hemangioma

Both the anterior and posterior fontanels should feel _________ and well demarcated against the bony edges of the skull

Flat and firm

What is the primary objective in the care of high risk infants

To establish and maintain respiration

A neonatal nurse who encourages parents to hold their baby and provides opportunities for Kangaroo Care most likely is demonstrating concern for which aspect of the infant's psychosocial development? a. Attachment b. Assimilation c. Centration d. Resilience

a. Attachment

A nurse caring for an infant notices that the infant has a weight gain of 32g in 24hrs, periorbital edema, tachycardia, and crackles in lungs auscultation. What do these findings suggest? a. Dehydration b. Adequate hydration c. Overhydration d. Edema

c. Overhydration

A nurse assess the height and weight measurements on an infant and documents these measurements at the 75th percentile. The nurse notes that the previous measurements two months ago were 25th percentile. Which interpretation by the nurse is the most accurate? 1. The infant is not gaining enough weight. 2. The infant has gained a significant amount of weight. 3. The previous measurements were most likely inaccurate. 4. These measurements are most likely inaccurate.

2. The infant has gained a significant amount of weight. Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile are at risk for being overweight. Children who are greater than or equal to the 95th percentile are considered overweight. Children whose BMI is between the 10th and 75th percentiles are within normal limits.

A nurse is talking to the mother of an exclusively breastfed African American 3-month-old infant who was born in late fall. Which supplement will the nurse recommend for this infant? 1. Iron 2. Vitamin D 3. Fluoride 4. Calcium

2. Vitamin D An infant's iron stores are usually adequate until about 4 to 6 months of age. The infant should be receiving sufficient amounts of calcium from breast milk, and fluoride supplementation, if needed, does not begin until the child is approximately 6 months old. This infant will have limited exposure to sunlight and thus vitamin D because of the infant's dark skin and decreased sun exposure in the fall and winter months.

While teaching the parents of a newborn about infant care and feeding, which instruction by the nurse is the most appropriate? 1. Delay supplemental foods until the infant is 4 to 6 months old. 2. Delay supplemental foods until the infant reaches 15 pounds or greater. 3. Begin diluted fruit juice at 2 months of age, but wait 3 to 5 days before trying a new food. 4. Add rice cereal to the nighttime feeding if the infant is having difficulty sleeping after 2 months of age.

1. Delay supplemental foods until the infant is 4 to 6 months old. Four to six months is the optimal age to begin supplemental feedings because earlier feeding of nonformula foods is not needed by the infant and does not promote sleep. Earlier feeding of nonformula foods, regardless of the infant's weight, is more likely to cause the development of food allergies. Also, early feeding is not well tolerated by infants because the necessary tongue control is not well developed and they lack the digestive enzymes to take in and metabolize many food products.

The nurse is teaching the parents of a 4-month-old infant about good feeding habits. The nurse emphasizes the importance of holding the baby during feeding and not letting the infant go to sleep with the bottle. Which disorder is associated with propped feedings and going to sleep with the bottle? 1. Otitis media 2. Aspiration 3. Malocclusion problems 4. Sleeping disorders

1. Otitis media It has been shown in numerous studies that allowing an infant to fall asleep with a bottle in his or her mouth causes pooling of the formula in the mouth, which increases the risk of both dental caries and otitis media. There has been limited data to date showing a positive correlation between bottle propping and increased risk of aspiration, malocclusions, and sleeping disorders.

The nurse is preparing to perform a heel stick on a neonate. Which complementary therapy is appropriate for the nurse to use decrease pain during this quick but painful procedure? 1. Swaddling 2. Sucrose pacifier 3. Massage 4. Holding the infant

2. Sucrose pacifier Sucrose provides short-term natural pain relief and is most appropriate for use in neonates to decrease pain associated with a quick procedure. The other measures are more appropriate following the procedure or as an adjunct to pain medication for ongoing pain or distress.

The nurse is instructing a parent of a newborn on the foods that are to be started based on age. The nurse instructs the parent that the first food given to a newborn is rice cereal. What statement by the parent suggests appropriate understanding of the next food that can be introduced? 1. "Chicken can be given next." 2. "Eggs can be given next." 3. "Fruits should be given next." 4. "Whole milk should be started."

3. "Fruits should be given next." Chicken is not given until 8 to 10 months, eggs are not given until 12 months, whole milk is given at 12 months. Fruits are given after rice cereal.

A new mother is worried about a "soft spot" on the top of her newborn infant's head. The nurse informs her that this is a normal physical finding called the anterior fontanel. At what age will the nurse educate the mother that the soft spot will close? 1. 2 to 3 months of age 2. 6 to 9 months of age 3. 12 to 18 months of age 4. Approximately 2 years of age

3. 12 to 18 months of age The anterior fontanel is located at the top of the head and is the opening at the intersection of the suture lines. As the infant grows, the suture lines begin to fuse, and the anterior fontanel closes at 12 to 18 months of age.

A mother ask which developmental milestone she can expect when her baby is 6 months old. Which response by the nurse is the appropriate 1. Lifts head momentarily when prone 2. Has well-developed pincer grasp 3. Transfers objects from one hand to the other 4. Rolls from front to back

3. Transfers objects from one hand to the other - Maternal iron stores are usually depleted by age 6 months. - Birth weight doubles at about age 5 to 6 months. At 6 months - At age 6 months, the infant will maintain a sitting position if propped. - During the first 6 months of life, infants believe that objects exist only as long as they can see them. - The ability to roll from back to abdomen usually occurs at 6 months old - At 6 months, the infant has just obtained coordination of arms and legs. - 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 nonfamiliar people - Most infants at age 6 months have two teeth.

The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. How would the nurse interpret this finding? a. A normal finding. b. A questionable finding—the infant should be rechecked in 1 month. c. An abnormal finding—indicates the need for immediate referral to a practitioner. d. An abnormal finding—indicates the need for developmental assessment.

A. a normal finding Because the anterior fontanel normally closes between ages 12 and 18 months, this is a normal finding, and no further intervention is required.

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: a. 10 pounds. b. 15 pounds. c. 20 pounds d. 25 pounds.

B. 15 pounds Birth weight doubles at about age 5 to 6 months. At 6 months, an infant who weighed 7 pounds at birth would weigh approximately 15 pounds. Ten pounds is too little; the infant would have gone from the 50th percentile at birth to below the 5th percentile. Twenty pounds or more is too much; the infant would have tripled the birth weight at 6 months.

The nurse enters the room to find the infant in the bassinet with a bottle propped up while the mother is on the phone. What nursing interventions is the most important for the nurse to provide in this situation?

Educate the mother on the dangers of bottle propping

A nurse is palpating a newborn's fontanels. The nurse documents the posterior fontanel in which shape?

Triangle

What is an infant with severe jaundice at risk for developing? a. Encephalopathy b. Bullous impetigo c. Respiratory distress d. Blood incompatibility

a. Encephalopathy Unconjugated bilirubin, which can cross the bloodbrain barrier, is highly toxic to neurons. An infant with severe jaundice is at risk for developing kernicterus or bilirubin encephalopathy. Bullous impetigo is a highly infectious bacterial infection of the skin. It has no relation to severe jaundice. A blood incompatibility may be the causative factor for the severe jaundice.

The parent of an infant with colic tells the nurse, All this baby does is scream at me; it is a constant worry. What is the nurses best action? a. Encourage the parent to verbalize feelings. b. Encourage the parent not to worry so much. c. Assess the parent for other signs of inadequate parenting. d. Reassure the parent that colic rarely lasts past age 9 months.

a. Encourage the parent to verbalize feelings. Colic is multifactorial, and no single treatment is effective for all infants. The parent is verbalizing concern and worry. The nurse should allow the parent to put these feelings into words. An empathetic, gentle, and reassuring attitude, in addition to suggestions about remedies, will help alleviate the parents anxiety. The nurse should reassure the parent that he or she is not doing anything wrong. The infant with colic is experiencing spasmodic pain that is manifested by loud crying, in some cases up to 3 hours each day. Telling the parent that it will eventually go away does not help him or her through the current situation.

A nurse is preparing to accompany a medical mission's team to a third world country. Marasmus is seen frequently in children 6 months to 2 years in this country. Which symptoms should the nurse expect for this condition? a. Loose, wrinkled skin b. Edematous skin c. Depigmentation of the skin d. Dermatoses

a. Loose, wrinkled skin Marasmus is characterized by gradual wasting and atrophy of body tissues, especially of subcutaneous fat. The child appears to be very old, with loose and wrinkled skin, unlike the child with kwashiorkor, who appears more rounded from the edema. Fat metabolism is less impaired than in kwashiorkor; thus, deficiency of fat-soluble vitamins is usually minimal or absent. In general, the clinical manifestations of marasmus are similar to those seen in kwashiorkor with the following exceptions: With marasmus, there is no edema from hypoalbuminemia or sodium retention, which contributes to a severely emaciated appearance; no dermatoses caused by vitamin deficiencies; little or no depigmentation of hair or skin; moderately normal fat metabolism and lipid absorption; and a smaller head size and slower recovery after treatment.

While assessing the development of a 9-month-old infant, the nurse asks the mother if the child actively looks for toys when they are placed out of sight. The nurse is determining if the infant has developed a. Object permanence b. Centration c. Transductive reasoning d. Conservation

a. Object permanence

A nurse is assessing a child with kwashiorkor disease. Which assessment findings should the nurse expect? a. Thin wasted extremities with a prominent abdomen b. Constipation c. Elevated hemoglobin d. High levels of protein

a. Thin wasted extremities with a prominent abdomen The child with kwashiorkor has thin, wasted extremities and a prominent abdomen from edema (ascites). Diarrhea (persistent diarrhea malnutrition syndrome) not constipation commonly occurs from a lowered resistance to infection and further complicates the electrolyte imbalance. Anemia and protein deficiency is a common finding in malnourished children with kwashiorkor.

Recommendations for hepatitis B (HBV) vaccine include which statement? a.First dose is given between birth and age 2 days. b.First dose is given between ages 12 and 15 months. c.It is not recommended for neonates who are at low risk for hepatitis B. d.It is not recommended for neonates whose mothers are positive for HBV surface antigen.

a.First dose is given between birth and age 2 days To reduce the incidence of HBV in children and its serious consequences in adulthood, the first of three doses is recommended soon after birth and before hospital discharge. Between 12 and 15 months is too late. The recommendation is for the first dose to be given soon after birth. It is recommended for all newborns. Newborns born to mothers who are HBV surface antigen positive should be given the vaccine within 12 hours of birth. They also should be given hepatitis B immune globulin.

The nurse is caring for a newborn whose mother is diabetic. Which clinical manifestations should the nurse expect to see?

a.Hypoglycemic, large for gestational age

What is an important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS)? a. Discourage the parents from making a last visit with the infant. b. Make a follow-up home visit to the parents as soon as possible after the childs death. c. Explain how SIDS could have been predicted and prevented. d. Interview the parents in depth concerning the circumstances surrounding the childs death

b. Make a follow-up home visit to the parents as soon as possible after the childs death. A competent, qualified professional should visit the family at home as soon as possible after the death. Printed information about SIDS should be provided to the family. Parents should be allowed and encouraged to make a last visit with their child. SIDS cannot always be prevented or predicted, but parents can take steps to reduce the risk (e.g., supine sleeping, removing blankets and pillows from the crib, and not smoking). Discussions about the cause only increase parental guilt. The parents should be asked only factual questions to determine the cause of death.

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: a. front facing in back seat. b. rear facing in back seat. c. front facing in front seat with air bag on passenger side. d. rear facing in front seat if an air bag is on the passenger side.

b. rear facing in back seat. 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.

The nurse is assessing a 3-day-old, breastfed newborn who weighed 7 pounds, 8 ounces at birth. The newborn's mother is now concerned that the newborn weighs 6 pounds, 15 ounces. Which is the most appropriate nursing intervention? a.Recommend supplemental feedings of formula. b.Explain that this weight loss is within normal limits. c.Assess child further to determine cause of excessive weight loss. d.Encourage mother to express breast milk for bottle feeding the newborn.

b.Explain that this weight loss is within normal limits. The newborn normally loses about 10% of the birth weight by age 3 or 4 days. The birth weight is usually regained by the tenth day of life. Because this is an expected occurrence, no further action is needed. The mother should be taught about normal newborn feeding and growing patterns.

The nurse is caring for a newborn who was born 24 hours ago to a mother who received no prenatal care. The newborn is a poor feeder but sucks avidly on his hands. Clinical manifestations also include loose stools, tachycardia, fever, projectile vomiting, sneezing, and generalized sweating. Which should the nurse suspect?

b.Narcotic withdrawal

At which age should the nurse expect most infants to begin to say mama and dada with meaning? a. 4 months b. 6 months c. 10 months d. 14 months

c. 10 months Beginning at about age 10 months, an infant is able to ascribe meaning to the words mama and dada. Four to 6 months is too young for this behavior to develop. At 14 months, the child should be able to attach meaning to these words. By age 1 year, the child can say three to five words with meaning and understand as many as 100 words

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

c. 12 months 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.

At which age can most infants sit steadily unsupported? a. 4 months b. 6 months c. 8 months d. 12 months

c. 8 months 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.

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? a. Recognizes familiar face, such as mother b. Recognizes familiar object, such as bottle c. Actively searches for a hidden object d. Secures objects by pulling on a string

c. Actively searches for a hidden object 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.

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

c. Birth weight doubles by age 5 months and triples by age 1 year. 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.

What is an appropriate action when an infant becomes apneic? a. Shake vigorously. b. Roll the infants head to the side. c. Gently stimulate the trunk by patting or rubbing. d. Hold the infant by the feet upside down with the head supported.

c. Gently stimulate the trunk by patting or rubbing. If an infant is apneic, the infants trunk should be gently stimulated by patting or rubbing. If the infant is prone, turn onto the back. Vigorous shaking, rolling of the head, and hanging the child upside down can cause injury and should not be done.

What should the nurse suggest to the parents of an infant who has a prolonged need for middle-of-the-night feedings? a. Decrease daytime feedings. b. Allow child to go to sleep with a bottle. c. Offer last feeding as late as possible at night. d. Put infant to bed after asleep from rocking.

c. Offer last feeding as late as possible at night. To manage an infant who has a prolonged need for middle-of-the-night feedings parents should be taught to offer last feeding as late as possible at night. Parent should increase daytime feeding intervals to 4 hours or more (may need to be done gradually), offer no bottles in bed, put to bed awake and when child is crying, check at progressively longer intervals each night; reassure child but do not hold, rock, take to parent's bed, or give bottle or pacifier.

The nurse should expect the apical heart rate of a stabilized newborn to be in which range? a.60 to 80 beats/min b.80 to 100 beats/min c.120 to 140 beats/min d.160 to 180 beats/min

c.120 to 140 beats/min The pulse rate of the newborn varies with periods of reactivity. Usually the pulse rate is between 120 and 140 beats/min; 60 to 100 beats/min is too slow for a neonate and 160 to 180 beats/min is too fast for a neonate

The nurse is caring for a very low birth weight (VLBW) newborn with a peripheral intravenous infusion. Which statement describes nursing considerations regarding infiltration?

c.Hypertonic solutions can cause severe tissue damage if infiltration occurs.

A nurse says to the mother of a 6-month-old infant, "Does the baby sit without assistance, and is the baby crawling?" Which process is the nurse using in this interaction? a. Health promotion b. Health maintenance c. Disease surveillance d. Developmental surveillan

d. Developmental surveillan

A nurse is preparing to feed a 12-month-old infant with failure to thrive. Which intervention should the nurse implement? a. Provide stimulation during feeding. b. Avoid being persistent during feeding time. c. Limit feeding time to 10 minutes. d. Maintain a face-to-face posture with the infant during feeding.

d. Maintain a face-to-face posture with the infant during feeding. The nurse preparing to feed an infant with failure to thrive should maintain a face-to-face posture with the infant when possible. Encourage eye contact and remain with the infant throughout the meal. Stimulation is not recommended; a quiet, unstimulating atmosphere should be maintained. Persistence during feeding may need to be implemented. Calm perseverance through 10 to 15 minutes of food refusal will eventually diminish negative behavior. Although forced feeding is avoided, "strictly encouraged" feeding is essential. The length of the feeding should be established (usually 30 minutes); limiting the feeding to 10 minutes would make the infant feel rushed.

A nurse is doing an assessment on a newborn. Which is characteristic of a newborn's vision at birth and an expected finding during the assessment? a. Ciliary muscles are mature. b. Blink reflex is absent. c. Tear glands function. d. Pupils react to light.

d. Pupils react to light. Although at birth the eye is still structurally incomplete, the pupils do react to light. The ciliary muscles are immature, limiting the eyes' ability to focus on an object for any length of time. The blink reflex is responsive to minimal stimulus. The tear glands do not begin to function until ages 2 to 4 weeks.

Rickets is caused by a deficiency in what? a. Vitamin A b. Vitamin C c. Folic acid and iron d. Vitamin D and calcium

d. Vitamin D and calcium Fat-soluble vitamin D and calcium are necessary in adequate amounts to prevent rickets. No correlation exists between rickets and folic acid, iron, or vitamins A and C.

A nurse is palpating a newborn's fontanels. The nurse documents the anterior fontanel is which shape? a.Circle b.Triangle c.Square d.Diamond

d.Diamond The anterior fontanel is diamond-shaped and measures from barely palpable to 4 to 5 cm. Neither of the fontanels is a circle or a square. The triangle is the shape of the posterior fontanel.