Peds Ch 3 PrepU
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." "Maturation refers to the child's increases in body size." "Increases in body size are referred to as growth." "Both growth and development are influenced by heredity."
"Maturation refers to the child's increases in body size." Explanation: 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.
After the nurse provides education to new parents about appropriate sleeping habits for infants, which statement by a parent would indicate to the nurse that teaching needs to reoccur? "My husband gave the baby a special bear that I will place in the crib." "By keeping the room at a neutral temperature, I do not have to use blankets." "I will place my infant on the back to sleep every night." "I have a crib in my room so that I can breastfeed my baby."
"My husband gave the baby a special bear that I will place in the crib." Explanation: The nurse should reinforce that stuffed animals, blankets, pillows, and soft mattresses are suffocation hazards for infants.
The nurse goes in to check on a new mother to see how breastfeeding is going with her new son. The nurse observes the infant is on the mother's lap with the blanket unwrapped, and the mother is washing his face, and gently stroking the baby. The mother has had trouble breastfeeding the last few times. What is the appropriate response from the nurse? "You will never get him to eat all unwrapped like that." "That is not how you get him to eat." "You are doing a wonderful job attempting to wake the baby." "Maybe you should watch the breastfeeding video again."
"You are doing a wonderful job attempting to wake the baby." Explanation: The nurse should be emotionally supportive to the new mom. The mom's techniques are commonly used in breastfed infants who are sleeping. The encouragement from the nurse will support the mom through this learning period. The other responses do not emotionally support the mom or contribute to a positive learning environment.
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? "Babies 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." "I'm not sure a 4-week-old has developed a sense of smell yet."
"You may be right, since infants can sense their mother's smell as early as 7 days old." Explanation: 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 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 sing to her before she goes to sleep. They put her to bed when she falls asleep.
They put her to bed when she falls asleep. Explanation: 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 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 increased biting and sucking frequent loose stools choosing soft foods over hard foods
increased biting and sucking Explanation: The nurse would advise the mother to watch for increased biting and sucking. Mild fever, vomiting, and diarrhea are signs of infection. The child would more likely seek out hard foods or objects to bite on.
The nurse is assessing the oral cavity of a 4-month-old infant. Which finding is consistent with a child of this age? 1 to 3 natal teeth no teeth 1 upper tooth 1 to 2 lower teeth
no teeth Explanation: Normally infants are not born with teeth. Occasionally there are one or more teeth at birth. These are termed natal teeth and are often associated with anomalies. The first primary teeth typically erupt between the ages of 6 and 8 months.
The best way for an infant's parent to help the child complete the developmental task of the first year is to: talk to the infant at a special time each day. respond to the infant consistently. expose the infant to many caregivers to help the infant learn variability. keep the infant stimulated with many toys.
respond to the infant consistently. Explanation: 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.
Which developmental milestone would the nurse expect an 11-month-old infant to have achieved? turning a doorknob walking independently building a tower of four cubes sitting independently
sitting independently Explanation: Infants typically sit independently, without support, around 8 or 9 months. Walking independently may be accomplished as late as age 15 months and still be within the normal range. Few infants walk independently by age 11 months. Building a tower of three or four blocks is a milestone for an 18-month-old child. Turning a doorknob is a milestone for a 24-month-old child.
The nurse is educating the mother of a newborn about feeding practices. The nurse correctly advises the mother that: most newborns need to eat about 4 times per day. the best feeding schedule offers food every 4 to 6 hours. demand scheduled feeding is associated with increased difficulty getting the baby to sleep through the night. the newborn's stomach can hold between 0.5 oz and 1 oz.
the newborn's stomach can hold between 0.5 oz and 1 oz. Explanation: The capacity of the normal newborn's stomach is between 0.5 oz and 1 oz. The recommended feeding plan is to use a demand schedule. Newborns may eat as often as 1.5 to 3 hours. Demand scheduled feedings are not associated with problems sleeping at night.
The nurse is assessing an infant at the 6-month well-baby check-up. The nurse notes that at birth the baby weighed 8 lb (3600 g) and was 20 in (50.8 cm) in length. Which finding is consistent with the normal infant growth and development? weight of 16 lb (7300 g) and length of 26 in (66.0 cm) weight of 20 lb (9100 g) and length of 30 in (76.2 cm) weight of 18 lb (8200 g) and length of 28 in (71.1 cm) weight of 14 lb (6400 g) and length of 24 in (61.0 cm)
weight of 16 lb (7300 g) and length of 26 in (66.0 cm) Explanation: The average newborn weighs 7.5 lb (3400 kg) at birth. Most infants double their birth weight at 4 to 5 months and will triple by the time they are 1 year old. If this infant was 8 lb (3600 kg) at birth, then it is most likely now 16 lb (7300 g). The average newborn is 20 in (50 cm) long at birth. They grow more quickly in length over the first 6 months, than during the second 6 months. By 12 months of age, the infant's length has increase by 50%. At 1 year, this infant will most likely be 30 in (76.2 cm) in length; however, since most of the growth occurs in the first 6 months, it is possible for the infant to grow an additional 6 in (15 cm) during that time.
A nurse in a pediatrician's office is educating a parent of a 2-month-old infant about developmental milestones. Drag words from the choices below to fill in each blank in the following sentence. The parent requires further education when the parent states _____, _____, and _____. Client Statements "My infant should be able to support themselves on elbows and wrists when lying on stomach" "My infant should be able to sit on their own by 3 months." "I will be able to play games like peek-a-boo with my infant when they are 4 months old." "My infant should be able to crawl by 9 months." "At 6 months, my baby should be able to feed themselves."
"My infant should be able to sit on their own by 3 months." "I will be able to play games like peek-a-boo with my infant when they are 4 months old." "At 6 months, my baby should be able to feed themselves." Explanation: An infant is not able to sit on their own until 6 months of age. An infant is able to feed themselves with a cup and a spoon by 12 to 18 months of age. At 9 months of age, an infant can play games such as "peek-a-boo," not at 4 months of age. A 4-month-old infant should be able to support themselves on their elbows and wrists when lying on their stomach. An infant should be able to crawl by 9 months of age.
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? "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."
"You should warm the milk under warm water instead." Explanation: 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 parent of 1-week-old infant voices concerns about the infant's weight loss since birth. At birth the infant weighed 7 lb (3.2 kg); the infant currently weighs 6 lb 5 oz (2.9 kg). Which response by the nurse is most appropriate? "Your infant's weight loss is within the expected range." "Your infant has lost too much weight and may need to be hospitalized." "Your infant has lost a bit more than the normal amount." "All infants lose a substantial amount of weight after birth."
"Your infant's weight loss is within the expected range." Explanation: 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 nurse in a community clinic is assessing a 2-month-old infant. The parent asks if the infant is developing normally. The nurse refers to which finding as suggestive of normal development in infants from birth to 2 months of age? The infant transfers objects from one hand to the other. The infant stays seated in the tripod position. The infant laughs aloud and responds to name. The infant raises head and chest while on stomach.
The infant raises head and chest while on stomach. Explanation: Infants have gained some neck control and can independently raise head and chest by 2 months of age. Transferring objects from one hand to another is expected at 7 months of age. Laughing aloud and responding to his or her name is expected between 4 to 5 months of age. Sitting in the tripod position is not expected until 6 months of age.
The nurse is making a home visit and observes the 7-month-old pulling the family dog's hair and ears. Which parenting skill does the nurse determine is most effective? The parent places the child in time-out and explains the reason for the time-out The parent tells the child "no" with a stern voice and pulls the child's hand away from the dog The parent spanks the child while taking the child into another room away from the dog The parent allows the child to continue pulling at the dog and states, "If the dog bites her she will learn."
The parent tells the child "no" with a stern voice and pulls the child's hand away from the dog Explanation: Providing a safe environment, redirection away from undesirable behaviors, and saying "no" in appropriate instances are effective forms of discipline for an infant's developmental level. Infants are at an increased risk for injury from spanking and do not understand the reason for the spanking. Infants do not understand time-outs or the reason for this type of discipline.
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? Wake the baby from afternoon naps after 1 hour to ensure she is sleepy by nighttime. Let the baby cry during the night and she will eventually fall back to sleep. Use the crib for sleeping only, not for play activities. Put the baby to bed at various times of the evening.
Use the crib for sleeping only, not for play activities. Explanation: 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.
A 9-month-old has been brought to the clinic for a well-child visit. The mother reports her son was born 6 weeks prematurely. During the data collection, the child's mother reports her son seems to be a few months "behind" what she recalls from her older children. What is the best response by the nurse? "Delays are normal when a child is premature." "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." "All children mature and develop at different rates so it is unwise to compare them in this way." "You should talk with the doctor about getting your son tested."
"Delays are normal when a child is premature." Explanation: 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 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? "We will need to collect a stool specimen for analysis." "Grunting is normal with infant stool formation." "Is he in pain?" "What does his stool look like?"
"What does his stool look like?" Explanation: 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.
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? 15 lb 4 oz (6920 g) 13 lb (5900 g) 19 lb 8 oz (8825 g) 10 lb 8 oz (4760 g)
19 lb 8 oz (8825 g) Explanation: The average newborn weighs 7.5 lb (3400 g). The average newborn loses 10% of birth weight over the first week of life but regains it in about 10 to 14 days. Most infants double their birth weight by 4 to 6 months of age and triple their birth weight by the time they are 1 year old. If the newborn weighed 6 lb 8 oz (2,950 g) at birth and tripled that weight at 12 months, the infant should weigh 19 lb 8 oz (6.5 lb × 3 = 19.5 lb) or 8825 g.
The infant weighs 7 lb 4 oz (3300 g) at birth. If the infant is following a normal pattern of growth, what would be the expected weight for this child at the age of 12 months? 21 lb 12 oz (9.9 kg) 25 lb (11.3 kg) 14 lb 8 oz (6.6 kg) 28 lb 4 oz (12.8 kg)
21 lb 12 oz (9.9 kg) Explanation: The average weight of a newborn is 7.5 lb (3400 g). The infant gains about 30 g each day. By 1 year of age, the infant has tripled the birth weight and has grown 10 to 12 in (25 to 30 cm). 7.25 lb × 3 = 21.75 lb or 21 lb 12 oz (9.9 kg)
Which client will the nurse assess first after receiving 0700 shift report? A 1-month-old infant with positive Moro and root reflexes A 1-day-old newborn who just passed a black, sticky stool A 6-month-old infant with a respiratory rate of 44 breaths/minute A 12-month-old infant with a blood pressure of 60/40 mm Hg
A 12-month-old infant with a blood pressure of 60/40 mm Hg Explanation: The nurse will first assess the 12-month-old infant with a blood pressure of 60/40 mm Hg. This is the expected blood pressure in an infant; however, by 12 months of age the blood pressure should rise to around 100/60 mm Hg. The normal respiratory rate of an infant is 30 to 60 breaths/minute. It is expected for a 1-month-old infant to still have Moro and rooting reflexes. These should diminish over the first few months of life. Stools are dark green to black and sticky for the first few days of life.
The nurse is providing client education to the parent about bathing the infant. What would be important to instruct the parent? Soap lubricates and oils an infant's skin Bath time provides an opportunity for play Never use soap on an infant's hair Infants need a daily bath
Bath time provides an opportunity for play Explanation: The work of children is play. Play provides a natural way for the infant to learn. In early infancy infants prefer their parents rather than toys. Parents can talk and sing to infants during feeding, bathing, and changing diapers. Infants do not need a daily bath as long as the diaper area is washed with diaper changes. Soap is actually drying to an infant's skin. Washing the hair with soap can help remove excess oil.
A newborn requires skin care that includes bathing. Besides hygiene, what is another reason for bathing the newborn? Bathing can prevent infection. Bathing is a time for bonding with the parents. Bathing helps moisten the skin. Bathing is a great time to apply lotion.
Bathing is a time for bonding with the parents. Explanation: The parents can use bath time for bonding with their newborn. This can be done with talking, cooing, and singing. Bath time should be slow-paced and nonstressful. Newborns prefer interacting with parents over toys and they love to watch people's faces. Bathing can help prevent infection, but it is a secondary response. Using soaps on the skin tends to dry the skin, not moisten it. After bathing, lotion can be applied. It is soothing to the baby and keeps the skin softened.
The pediatric nurse is careful to monitor and assess the growth and development of all clients. Which characteristic should the nurse prepare to assess in the infants? Grows and develops skills more rapidly than at any other time in their life. Has an increased attention span and can be interested in an activity for a long length of time. Takes in new information at a rapid rate and asks "why" and "how". Insists they can "do it" and the next moment they revert to being dependent.
Grows and develops skills more rapidly than at any other time in their life. Explanation: The infant grows and develops skills more rapidly than he or she ever will again. The toddler insists he or she can do things one minute and then becomes dependent the next minute. The preschool age child soaks in information and asks "why" and "how" over and over. The school-age child has a longer attention span and can become absorbed in a craft or activity for several hours.
The parent of a 3-month-old infant is concerned because the infant does not yet sit by oneself. Which statement best reflects average sitting ability? Most infants sit steadily at 4 months; this infant is normal. Sitting ability and the age of first tooth eruption are correlated. Most infants do not sit steadily until 8 months; this infant is normal. Most infants sit steadily at 3 months; this infant is slightly delayed.
Most infants do not sit steadily until 8 months; this infant is normal. Explanation: At 3 months of age the infant should be able to raise the head about 45 degrees when in the prone position. The infant does yet have the developmental skills for sitting. Most infants are unable to sit steadily until 8 months of age. Gross motor skill development does not correlate with tooth eruption. The nurse should reassure the parent that this infant is on tract developmentally.
The nurse is assessing the neurological status of a 10-month-old infant. Which finding(s) does the nurse determine to be abnormal when performing this assessment? Select all that apply. With sudden extension of the infant's head, the arms abduct and move upward and the hands form a "C". The infant fans and extends the toes when the nurse strokes along the lateral aspect of the sole and across the plantar surface of the foot. The infant demonstrates reflexive sucking when nipple or finger is placed in infant's mouth. The infant turns to the right side, searching with mouth, when the right side of the cheek is stroked. The infant reflexively grasps when the nurse touches the palm.
The infant turns to the right side, searching with mouth, when the right side of the cheek is stroked. The infant demonstrates reflexive sucking when nipple or finger is placed in infant's mouth. The infant reflexively grasps when the nurse touches the palm. With sudden extension of the infant's head, the arms abduct and move upward and the hands form a "C" .Explanation: The primitive reflexes (root, suck, palmar grasp, moro) should be absent by 10 months of age. A positive Babinski sign normally persists until 12 months of age so the presence of this sign would be considered a normal finding in the 10-month-old.
The nurse is performing an assessment on a 8-month-old infant. The infant's medical history notes that he was born at 32 weeks' gestation. The infant is progressing normally. At what adjusted age should the nurse expect the infant's developmental accomplishments? The infant will likely show the skills of an infant with the adjusted age of 7 months. By 8 months of age, the child's skill level will vary greatly and cannot be predicted. 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. Explanation: 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 mother of a 9-month-old 18-pound (8.2 kg) infant asks the nurse about choosing the best car seat. What should the nurse recommend? a forward-facing convertible booster a rear-facing 5-point harness restraint a rear-facing booster seat a forward-facing 5-point harness restraint
a rear-facing 5-point harness restraint Explanation: An infant until 2 years of age should be in a rear-facing car seat. The 5-point harness seat is made for children up to 40 pounds (18 kilograms) and the booster seat for children from 40 to 80 pounds (18 to 36 kilograms).
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 first tooth erupts by 12 months of age when weaning is complete as soon as the infant begins to eat fruit
as soon as the first tooth erupts Explanation: 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.
The nurse conducting a 6-month well-baby check-up assesses for the presence/absence of the asymmetric tonic neck reflex. At this age the reflex: is a protective reflex and retained for life. is expected to appear within 1 month. should be pronounced and easy to elicit. should have disappeared.
should have disappeared. Explanation: This primitive (not protective) reflex should be present at birth and disappear around age 4 months.
