Peds The Infant and Family
A 6-month-old infant's parent asks the nurse, "What is the best alternative to breastfeeding?" What appropriate response should the nurse give to the infant's parents?
"Commercial iron-fortified formula is an alternative." Reason: It is like human milk and contains all nutrients required by the infant for the first 6 months. Skim milk and imitation milk have limited digestibility, increased risk for contamination, and lack of nutrients needed for appropriate growth. Pasteurized whole cow's milk is deficient in iron, zinc, and vitamin C. It has a high renal solute load, which makes it undesirable for infants younger than 12 months and therefore is not a good alternative.
The nurse is educating a group of parents about safety promotion and injury prevention in the infant. Which statement made by a parent indicates effective teaching?
"Diaper pins should be kept closed and away from the infant." Reason: Pins = injury plastic covered mattresses and latex balloons increase chances of suffocation, and microwaving formula could burn the child.
The nurse advises the parents of a 2-year-old child to vaccinate their child with the influenza vaccine (inactivated influenza vaccine [IIV]). The child's parents ask the nurse, "My child had the same vaccine last year. Why does my child need another one?" Which response should the nurse give to the child's parent?
"Different strains of influenza are used to manufacture the vaccine each year." Reason: The child does not require booster shots up to the age of 12 years. Effectiveness of influenza vaccine does NOT reduce after 6 months; it is effective even after 6 months. The vaccine is administered yearly.
The parent of a 12-month-old infant says to the nurse, "He pushes the teaspoon right out of my hand when I feed him. I can't let him feed himself; he makes too much of a mess." The nurse's best response is:
"Feeding himself will help foster his growth and development. Perhaps we can discuss ways to make the messes more tolerable." Reason: At 12 months, the child should be self-feeding. Because children this age eat primarily FINGER FOODS, it is useful to offer the parent suggestions for keeping the mess to a minimum.
The nurse is teaching nursing students about vaccine administration. Which statement made by the nursing student indicates effective learning?
A 16-mm (5/8-inch) length needle is used to administer the vaccine to newborns. Reason: A 16-mm (5/8-inch) length needle is used for vaccine administration in newborn infants; this will ensure the needle gets into the muscle *influenza vaccines should be administered to patients with asthma because they are at higher risk of developing influenza *vapocoolant spray should be applied to the skin 15 seconds BEFORE the vaccination for minimizing pain, not after. *all vaccines should not be administered to adults by using 25-mm (1") length needle.
The nurse is educating a group of parents about the dental health for infants. Which statement made by the parent indicates effective learning?
A damp cloth can be used to wipe the child's teeth. Reason: Tooth decay is a common problem during the early childhood. The nurse should suggest that the parents use a damp cloth to clean the child's teeth by wiping. It prevents accumulation of plaque and keeps the teeth clean. *a milk bottle in bed = dental caries *fruit juices should NOT be given before 6 months due to tooth decay *fluoridated toothpaste should not be used for the child because infants may swallow the toothpaste, which can cause fluoride toxicities.
The primary health care provider (PHP) prescribed HepB (Recombivax HB) vaccine for a child. Which question should the nurse ask the child's parents to ensure it is safe to administer the vaccine? "Does your child have a history of:
Being hypersensitive to yeast Reason: It could cause anaphylaxis since the HepB (Recombivax HB) vaccine is prepared from yeast cultures.
Which strategy might be recommended for an infant with failure-to-thrive to increase caloric intake?
Being persistent through 10-15 minutes of food refusal. Reason: Calm perseverance is important. Parents often fail to persist through the child's refusals. Feeding times should have a non-stimulating environment so that the focus is on the meal. Solids should be introduced slowly to decrease dependence on the bottle. A daily schedule should be structured to provide consistency for the child.
Apnea of infancy has been diagnosed in an infant who will soon be discharged with home monitoring. When teaching the parents about the infant's care, what is the most important information the nurse should include in the discharge teaching plan?
CPR Reason: CPR is essential for parents and caregivers to know.
What is the most probable reason for hyponatremia in an infant?
Excessive intake of water Reason: Excessive intake of water may cause water intoxication and result in electrolyte disturbances (low sodium in the plasma --> dilution hyponatremia). *administration of overdose of vitamin D causes hypercalcemia *vitamin B12 deficiency would cause pernicious anemia
The mother of a 3-month-old breastfed infant asks about giving her baby water because it is summer and very warm. The nurse should recommend that:
Fluids in addition to breast milk are not needed. Reason: Supplemental water should not be given for the first 6 months of life. Supplements are only necessary if there is a medical condition. Clear juices do not provide sufficient caloric or nutrient intake and may interfere with breastfeeding.
An infant is hospitalized; however, none of the family members are able to stay with the infant. Which interventions does the nurse perform to provide psychological comfort for the infant?
Follow a routine to which the infant is accustomed. Reason: Very young infants gain security and psychological comfort from having their needs met consistently. *assigning one nurse to care for the infant is ideal but not possible every time. *the infant does not have any attachment with a staff member, so their constant presence might not help *hearing parents voices over the phone doesn't provide psychological comfort
The most appropriate recommendation for relief of teething pain is to instruct the parents to...
Give child a cold teething ring to relieve inflammation Reason: Self explanatory. Gums should not be rubbed with aspirin. It can be dangerous if the child aspirates aspirin. Hydrogen peroxide is not effective. Cold, not warmth, reduces inflammation.
Which activity does the nurse expect to observe in a 4-month-old infant? The infant:
Grasps an object by using both hands Reason: A 4-month-old infant has the ability to grasp objects with both hands. However, a 4-month-old infant does not have the muscle coordination nor: 1. the fine motor skills to secure an object by pulling on a string -- this occurs at 8 months. 2. the developmental skills to transfer objects from one hand to the other-- this occurs at 7 months. 3. the developmental skills to compare two cubes by bringing them together -- this occurs at 9 months.
The nurse is teaching a nursing student about how to administer the HepB vaccination to a newborn. Which statement made by the nursing student indicates effective learning? "The vaccine should be given:
In the vastus lateralis site via IM route (fastest absorption that's not IV) Reason: These muscles are the most developed in NEWBORNS. HepB virus vaccine is not administered in the dorsogluteal site in newborns nor in adults. This site is associated with low antibody seroconversion rates, so it reduces the immune responses. The deltoid site is used in OLDER infants for the HepB vaccine since it's more developed.
Which activities are indicative of the teething process in an infant? Select all that apply.
Infant rubbing on the gums Infant biting on hard objects Increased sucking on fingers Reason: Teething is a physiologic process. The infant may have discomfort as the crown of the tooth breaks through the periodontal membrane. *the pain from teething disturbs the sleep cycle and leads to LESS sleep *the infant may also refuse to eat solid foods because of the pain
Which route should the nurse use to administer vaccines that contain adjuvants?
Intramuscular Reason: An adjuvant is found in some vaccines to increase the body's immune response. Adjuvant-containing vaccines should be given deep (IM) into the muscle to prevent local reactions. (Intradermal, subcutaneous, and intracutaneous injection of the adjuvant-containing vaccines can cause local irritation, inflammation, or abscess formation.)
A mother observes that her 7-month-old infant bears full weight on the feet when held in a standing position. What is the reason for this?
It indicates that the child's growth and development is normal. Extra Info: By 8 months the infant can readily bear weight on legs when supported and may stand holding onto furniture. However, this does not indicate that the infant may begin walking within 2 months. A 12-month-old infant can walk with one hand held. The observation does not indicate that the infant's physical development is slow. Nor do the assessment findings reflect that the infant's upper physical development has not occurred properly.
The parents of a 7-month-old infant report to the nurse that the solid food they feed to the baby passes through the gastrointestinal tract unchanged. Which response of the nurse would help to relieve the parent's anxiety?
It is a normal finding at this age Reason: In a 7-month-old infant, the digestive processes are immature and solid food is not completely digested. **by the end of the first year, the infant will be able to digest food. Therefore it is not a symptom of an intestinal infection, nor does it indicate that the infant has metabolic disorder or slow development.
A parent of an 8-month-old infant tells the nurse that the baby cries and screams whenever he or she is left with the grandparents. The nurse's reply should be based on knowledge that:
It's normal Reason: stranger anxiety is normal for this age
Which activity of a 10-month-old infant indicates the development of object permanence?
Looking for a hidden object that the infant had seen earlier Reason: 9 to 10 months old = object permanence is developed in infants (cognitive development). Fine motor skills = grasping the feet and pulling them to the mouth, picking up a toy and putting it into the mouth, and transferring the objects from one hand to the other
A 9-month-old infant is seen in the emergency department after developing an urticaric rash with cough and wheezing. When collecting the history of events before the sudden onset of the rash with cough and wheezing, the mother states they were "feeding the baby new foods." Which food is the possible cause of this type of reaction in the infant?
Peanut butter Reason: Nuts of any type have a high allergy index in children and infants. The infant has demonstrated the cutaneous and respiratory type of reaction after possible ingestion of peanut butter. Potatoes, green beans, and spinach are not highly allergenic foods.
While assessing an infant, the nurse notices a typical bald spot, a symmetric distortion of the skull, and torticollis. What should the nurse interpret from this assessment?
Positional plagiocephaly Reason: Positional plagiocephaly is a condition in which the infant has an oblique or asymmetric head. The fontanels in the skull of an infant are not closed, which makes the skull pliable. The posterior occiput flattens over time if the infant is placed on his or her back during sleep. This leads to the development of an atypical bald spot, asymmetric distortion of the skull, and tightening of sternocleidomastoid muscle leads to torticollis in the infant. The symptoms of a bacterial infection are fever, malaise, and irritability. Most infant formulas are fortified with Vitamin C, so a deficiency is rare.
The nurse walks in the room of an infant and notices the baby is apneic; has pallor, cyanosis, and a change in muscle tone; and is gagging. Which condition is the infant exhibiting?
SIDS Reason: Apnea, pallor, cyanosis, change in muscle tone, and gagging are apparent life-threatening events, which put infants at high risk for SIDS. Failure to thrive = underweight and malnourished. Hepatitis A = fever, malaise, anorexia, nausea, abdominal discomfort, dark urine, and jaundice. Varicella-Zoster = skin rashes, nausea, loss of appetite, aching muscles, and headache.
The nurse is interviewing the parents of a 4-month-old male infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in his crib with a blanket over his head, lying face down in bloody fluid from his nose and mouth. They say he was "just fine" when they put him in his crib already asleep. The nurse should suspect his death was caused by:
SIDS Reason: Although the child was found under the blanket, the bloody fluid is consistent with SIDS, not suffocation.
A parent asks the nurse in the well-baby clinic, "Which toy should be given to the 3-month-old infant?" Which toy does the nurse suggest to the infant's parent?
Soft stuffed toy Reason: At this age, infants show more discriminate interest in stimuli and may begin to play alone with a soft stuffed toy. (An 18-month old's skills are well-developed and they can play with a push-pull toy or large plastic ball; not a 3 month old. Playing with a telephone helps to promote imitative play, but a 3-month-old infant is too young for a play telephone.)
The exhausted parents of a 2-month-old infant with colic ask the nurse what is the best method to promote comfort and sleep for the infant. The nurse's initial action is to:
Take a thorough, detailed history of usual daily events. Reason: The INITIAL step in managing colic is to take a thorough, detailed history of the usual daily events including: diet, time of day when child cries, presence of family members, type of cry, etc. *after the history is taken, you can suggest formula changes and medications. Convey an empathetic and compassionate attitude and reassure the parents that they are not doing anything wrong.
During the assessment of a 12-month-old infant, the nurse finds that the infant's head and chest circumference are equal, the length of the infant has increased by 50% since birth, and the weight is triple that of the birth weight. What does the nurse interpret from these findings?
The infant has normal development Reason: Normal for a 12-month old = equal head and chest circumference, increase in birth length by 50%, and increase in weight 3x that of birth weight. *Inability to gain weight indicates slow development.
The nurse educator instructs a nursing student that according to Erikson, infancy is concerned with acquiring a sense of:
Trust Reason: The task of infancy is the development of trust. Industry vs. inferiority = school-age children Initiative vs. guilt = preschoolers Separation = Piaget's sensorimotor stage
A 4-month-old infant is brought to the clinic by his parents for a well-baby checkup. What should the nurse include at this time concerning injury prevention?
When your baby learns to roll over, you must supervise him whenever he is on a surface from which he might fall. Reason: Rolling over from abdomen to back occurs between 4 and 7 months. *not shaking baby powder directly onto the infant = 1 month old guidance *not permitting the child to chew paint from window ledges and keeping appliance doors closed at all times = 9-month old guidance (pulling up & standing)
