Health promotion: General concepts, the newborn, and the infant

Question 1

The clinic administrator has asked each nurse to classify the nursing activities as a beginning step of clinic reorganization. Which of these strategies can be classified as health promotion and health maintenance? Select all that apply.
1. Instructing on how to use dental floss
2. Treating a child with a diagnosis of acute otitis media
3. Administering the flu vaccine to infants 6 to 23 months old
4. Working with new parents to create daily feeding schedules for infants
5. Conducting developmental screening examinations for toddlers

Answer 1

1. Instructing on how to use dental floss.
2. Administering the flu vaccine to infants 6-23 months old.
3. Working with new parents to create daily feeding schedules for infants.
4. Conducting developmental screening examinations for toddlers
   Explanation:
5. Administering flu vaccines, discussing feeding schedules, and instructing in oral health care are all health promotion and health maintenance topics.
6. Treating a child with an acute ear infection (otitis media) would not be a topic for health promotion or health maintenance because it is an acute illness.
7. Administering flu vaccines, discussing feeding schedules, and instructing adolescents in oral health care are all health promotion and health maintenance topics.
8. Administering flu vaccines, discussing feeding schedules, and instructing adolescents in oral health care are all health promotion and health maintenance topics.
9. Conducting developmental screening exams for toddler-age clients is an example of strategy that is classified as health promotion and maintenance.

Question 2

The mother of a newborn asks the nurse what the purpose of the first scheduled health maintenance visit will be. Which are appropriate responses by the nurse to this question? Select all that apply.
1. “To determine if your baby is being abused.”
2. “To determine compatibility between you and the provider.”
3. “To discuss policies related to provision of care.”
4. “To evaluate your understanding of the services offered.”
5. “To determine your baby’s risk for obesity.”

Answer 2

2. “To determine compatability between you and the provider.”
3. “To discuss policies related to provision of care.”
4. “To evaluate your understanding of the services offered.”
   Explanation:
5. Only under very unusual circumstances would the healthcare providers be able to determine whether the parents are potential child abusers.
6. The initial visit should help to acquaint the parents to office policies and services offered by the office, and to determine whether the parents and healthcare provider will get along well.
7. The initial visit should help to acquaint the parents to office policies and services offered by the office, and to determine whether the parents and healthcare provider will get along well.
8. The initial visit should help to acquaint the parents to office policies and services offered by the office, and to determine whether the parents and healthcare provider will get along well.
9. Only under very unusual circumstances would the healthcare providers be able to determine whether the parents will tend to overfeed the infant and place the infant at risk for obesity.

Question 3

During a health supervision visit, the nurse is attempting to develop a partnering relationship with the child and family. Which is the initial action by the nurse?
1. Telling the family what the child should be doing physically for the age level
2. Telling the family that the healthcare provider will answer any questions they might have related to their child’s growth and development
3. Setting goals for the family related to the child’s health
4. Discussing a plan with the family to address the child’s health needs

Answer 3

4. Discussing a plan with the family to address the child’s health needs.
   Explanation:
5. Not all children develop each skill at the same age. Telling the family what the child should be doing can cause feelings of fear, frustration, and concern for the family if the child is not doing all of the activities listed by the nurse.
6. Telling the family to direct their questions just to the healthcare provider will not allow any teaching opportunities by the nurse, and will not allow for the development of a trusting relationship with the family.
7. The nurse should not set the goals without family involvement.
8. Discussing and developing a plan with the family will actively involve the family members and will build more trust, as they are not just being told what to do.

Question 4

During a scheduled health maintenance visit for a 6-month-old infant the nurse asks, “Does the baby sit without assistance, and is the baby crawling?” Which process is the nurse using in this interaction?
1. Health promotion
2. Developmental surveillance
3. Health maintenance
4. Disease surveillance

Answer 4

2. Developmental surveillance
   Explanation:
3. While health promotion activities are related to developmental surveillance, this question is looking specifically at the milestones.
4. The question asked by the nurse is seeking information about developmental milestones; therefore, the nurse is involved in developmental surveillance.
5. While health maintenance activities are related to developmental surveillance, this question is looking specifically at the milestones.
6. These questions are not classified as disease surveillance questions.

Question 5

A parent says to a nurse, “How do you know when my baby needs these screening tests the doctor just mentioned?” Which response by the nurse is most appropriate?
1. “Screening tests are done in the newborn nursery, and from these results, additional screening tests are ordered throughout the first 2 years of life.”
2. “Screening tests are done at each office visit.”
3. “Screening tests are most often done when the doctor suspects something is wrong with the child.”
4. “Screening tests are administered at the ages when a child is most likely to develop a condition.”

Answer 5

4. “Screening tests are administered at the ages when a child is most likely to develop the condition.”
   Explanation:
5. This provides incorrect information to the parent. Abnormal newborn screening tests require immediate follow-up.
6. This provides incorrect information to the parent. Screening tests are not done at each office visit.
7. This provides incorrect information to the parent. Screening tests are done to detect the possibility of problems, and are not done when a problem is suspected.
8. “Screening tests are administered at ages when a child is most likely to develop a condition” provides a definition for screening tests.

Question 6

The nurse is working with first-time parents. Which activity will the nurse suggest to encourage the development of good muscle tone in their infant?
1. Placing the infant in an infant seat rather than lying down in a crib
2. Surrounding the infant with toys and other stimulating items to encourage motor movement
3. Swaddling the infant
4. Putting the infant to bed each night at 8 p.m., even if the infant protests with crying

Answer 6

2. Surrounding the infant with toys and other stimulating items to encourage motor movement.
   Explanation:
3. Placing the infant in an infant seat is more restrictive than lying in a crib, which allows free moment.
4. Encouraging movement best assists the infant to obtain good muscle tone.
5. Swaddling the infant, while calming for a young infant, restricts movement.
6. The bedtime has nothing to do with development of infant muscle tone.

Question 7

A mother who is bottlefeeding her newborn is discharged 48 hours postdelivery. When should the nurse schedule the first office visit for the newborn with the pediatrician?
1. Within 5 days of discharge
2. Within 7 days of discharge
3. Within 2 weeks of discharge
4. Within 3 weeks of discharge

Answer 7

1. Within 5 days of discharge
   Explanation:
2. A newborn who is discharged from the hospital within 48 to 72 hours postdelivery should have the first office visit scheduled with the pediatrician within 5 days of discharge.
3. Newborns who are discharged within 48 to 72 hours postdelivery should be seen by the pediatrician before 7 days of age.
4. Newborns who are discharged within 48 to 72 hours postdelivery should be seen by the pediatrician before 2 weeks of age.
5. Newborns who are discharged within 48 to 72 hours postdelivery should be seen by the pediatrician before 3 weeks of age.

Question 8

While interviewing the parents of a toddler-age client, the nurse notes that the mother is pregnant. At the end of the visit, the nurse decides to give a new pamphlet to the parents about car seat usage for newborns. Which is the purpose of this action by the nurse?
1. Secondary preventative health maintenance
2. Developmental health screening
3. Tertiary preventative health maintenance
4. Primary preventative health maintenance

Answer 8

4. Primary preventative health maintenance
   Explanation:
5. The secondary level of prevention is focused on diagnosis of a problem, usually medical in nature, in order to address it and make a plan of care.
6. This is education, and not a developmental screening to elicit data. The focus of the teaching is on an unborn child, so developmental level is not a current issue.
7. The tertiary level of preventative care is related to restoring a level of functioning that is below an expected level, such as in a rehabilitation situation.
8. The teaching regarding proper car seat use is an example of an activity that might decrease the opportunity for injury in a newborn; therefore, this is primary preventive health maintenance.

Question 9

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

Answer 9

2. The infant has gained a significant amount of weight.
   Explanation:
3. A comparison of these two sets of measurements shows that the infant has crossed 2 percentiles, going from the 25th to the 75th percentile, and has gained a significant amount of weight.
4. A comparison of these two sets of measurements shows that the infant has crossed 2 percentiles, going from the 25th to the 75th percentile, and has gained a significant amount of weight.
5. A comparison of these two sets of measurements shows that the infant has crossed 2 percentiles, going from the 25th to the 75th percentile, and has gained a significant amount of weight.
6. A comparison of these two sets of measurements shows that the infant has crossed 2 percentiles, going from the 25th to the 75th percentile, and has gained a significant amount of weight.

Question 10

The mother of a 2-year-old child becomes very anxious when the child has a temper tantrum in the medical office. Which response by the nurse to the mother is appropriate?
1. “Let’s ignore this behavior. It will stop sooner.”
2. “What do you usually do or say during a temper tantrum?”
3. “This is definitely a temper tantrum. I know exactly what you are feeling right now.”
4. “Pick up and cuddle your child now, please.”

Answer 10

2. “What do you usually do or say during a temper tantrum?”
   Explanation:
3. Ignoring the behavior is not an effective way to problem solve for temper tantrums.
4. Asking the mother to describe her usual behavior via an open-ended question will encourage the mother to talk about home management and will lead the nurse to assist the mother in making a plan of care for temper tantrums.
5. Sympathizing with the mother may make the mother feel better at that moment but does not help the mother improve her child’s behavior.
6. Cuddling the child will provide positive reinforcement to the child to continue that behavior. Providing a direct instruction to the mother in this manner is unlikely to elicit the mother’s trust in the nurse.

Question 11

Parents are in the pediatric clinic with their infant for a 1-month checkup. Which assessment question regarding immunizations should the nurse ask the infant’s parents?
1. “Did your baby receive the influenza vaccine prior to hospital discharge?”
2. “Did your baby receive the hepatitis B vaccine prior to hospital discharge?”
3. “Did your baby receive the rubella vaccine prior to hospital discharge?”
4. “Did your baby receive the rotavirus vaccine prior to hospital discharge?”

Answer 11

2. “Did your baby receive the hepatitis B vaccine prior to hospital discharge?”
   Explanation:
3. The influenza vaccine is not administered at birth.
4. Hepatitis B is given routinely at birth.
5. The rubella vaccine is not administered at birth.
6. The rotavirus vaccine is not administered at birth.

Question 12

A nurse is assessing an 11-month-old infant, and notes that the infant’s height and weight are at the 5th percentile on the growth chart; the infant was previously plotted at the 25th percentile. Psychosocial history reveals that the parents are separated and are planning to divorce. Which is the priority when planning this infant’s care?
1. Parental anxiety
2. Risk for failure to thrive
3. Excessive nutritional intake
4. Risk for injury

Answer 12

2. Risk for failure to thrive.
   Explanation:
3. While parental anxiety due to the situation may be occurring, this is not the priority when planning this infant’s care.
4. This infant’s growth curve indicates poor growth which places the infant at risk for failure to thrive.
5. Since height and weight are at the 5th percentile, there is no indication of increased nutritional intake.
6. While the infant may be at a risk for injury, the priority is risk for failure to thrive.

Question 13

Which observation in a health supervision visit leads the nurse to have concerns about the infant’s mental health?
1. A 1-month-old is swaddled by the parent because of crying after an immunization.
2. A 7-month-old infant grabs her mother and cries when the nurse attempts touch.
3. A 9-month-old avoids eye contact with parents and the nurse.
4. A 10-month-old reportedly sleeps about 12 hours total per night.

Answer 13

3. A 9-month-old avoids eye contact with parents and the nurse.
   Explanation:
4. Crying after a painful procedure, such as an immunization, is a normal reaction by the 1-month-old infant. Swaddling the infant for comfort is a normal reaction by the parent.
5. Grabbing for her mother and crying when the nurse attempts touch is a normal reaction for a 7-month-old infant.
6. The nurse should expect the 9-month-old to have eye contact with the parents and the nurse. If no eye contact is made, the nurse should implement a more detailed assessment of the infant’s mental health.
7. Sleeping 12 total hours per night is considered normal behavior for a 10-month-old infant.

Question 14

The nurse is assessing a small-for-gestational-age newborn who had an older sibling who died of sudden infant death syndrome (SIDS). Which should the nurse include in the newborns plan of care based on these data?
1. Encourage the parents to sleep with the newborn for close observation.
2. Encourage the parents to place the newborn on the abdomen to sleep.
3. Encourage the parents to place the newborn in a crib with a tight-fitting, firm mattress.
4. Encourage the parents to place the newborn in a crib with a soft mattress with extra blankets.

Answer 14

3. Encourage the parents to place the newborn in a crib with a tight-fitting, firm mattress.
   Explanation:
4. Cobedding is not encouraged because it is associated with an increased risk for SIDS.
5. A prone sleeping position is not encouraged because it is associated with an increased risk for SIDS.
6. Placing the infant in a crib with a tight-fitting, firm mattress will help keep the infant’s mouth free of obstructions. This is the recommended sleeping position and environment for all newborns but is especially important due to the history of SIDS.
7. Quilts, blankets, and other soft items are not recommended as these increase the risk for SIDS. Put the newborn in a blanket sleeper instead.

Question 15

Which nursing actions are appropriate for the 2-month-old infant during a scheduled health maintenance visit? Select all that apply.
1. Reviewing infant fluid needs with the parents
2. Reinforcing the importance of heating bottles with water versus the microwave
3. Demonstrating proper gum care to the parents
4. Educating the parents to begin introducing solid foods, such as rice cereal
5. Recommending that juice be introduced in a sippy cup

Answer 15

1. Reviewing infant fluid needs with the parents
2. Reinforcing the importance of heating bottles with water versus the microwave
3. Demonstrating proper gum care to the parents.
   Explanation:
4. It is appropriate for the nurse to review infant fluid needs with the parents during the 2-month health maintenance visit.
5. It is appropriate for the nurse to reinforce the importance of heating bottles with water versus the microwave with the parents during the 2-month health maintenance visit.
6. It is appropriate for the nurse to demonstrate proper gum care to the parents during the 2-month health maintenance visit.
7. The nurse would not educate the parents to begin introducing solid foods during the 2-month visit. Solid foods are not introduced until 6 months of age.
8. While juice should only be offered in a sippy cup, the nurse would not recommend this during the 2-month health maintenance visit. This subject is appropriate during the 6-month health maintenance visit.

Question 16

Which topics are appropriate for the nurse to include when teaching preventive disease strategies during infancy? Select all that apply.
1. Metabolic screenings
2. Hearing screenings
3. Risks of environmental smoke exposure
4. Stranger danger strategies
5. Bike safety

Answer 16

1. Metabolic screenings
2. Hearing screenings
3. Risks of environmental smoke exposure.
   Explanation:
4. It is appropriate for the nurse to include information regarding metabolic screening when teaching preventative disease strategies to the parents of an infant.
5. It is appropriate for the nurse to include information regarding hearing screening when teaching preventative disease strategies to the parents of an infant.
6. It is appropriate for the nurse to include information on the risks of environmental smoke exposure when teaching preventative disease strategies to the parents of an infant.
7. Stranger danger strategies are more appropriate for the parents of a preschool-age child.
8. Bike safety is more appropriate for the parents of preschool-age and school-age children.

Question 17

Which actions are appropriate when the nurse is performing general observations during the assessment process for an infant? Select all that apply.
1. Asking the family how they are adjusting to having the infant in the home
2. Monitoring the parents for clinical manifestations associated with fatigue
3. Assessing for behaviors that indicate appropriate bonding
4. Placing the infant on the scale for a weight and length assessment
5. Auscultating heart and lung sounds while the infant is asleep

Answer 17

1. Asking the family how they are adjusting to having the infant in the home.
2. Monitoring the parents for clinical manifestations
3. Assessing for behaviors that indicate appropriate bonding.
   Explanation:
4. When performing general observations during the assessment of an infant the nurse will ask the parents how they are adjusting to having an infant in the home.
5. When performing general observations during the assessment of an infant the nurse will monitor the parents for clinical manifestations associated with fatigue.
6. When performing general observations during the assessment of an infant the nurse will assess for behaviors that indicate appropriate bonding.
7. Placing the infant on the scale to measure height and weight is not an appropriate action when performing general observations during the assessment process.
8. Auscultating heart and lung sounds is not an appropriate action when performing general observations during the assessment process.

Question 18

What is the purpose of making general observations during the assessment process for an infant during a scheduled health maintenance visit? Select all that apply.
1. To invite discussion with the parents
2. To validate positive parenting efforts
3. To promote a partnership between healthcare providers and parents
4. To decrease the risk of communicable diseases
5. To meet standards required for The Joint Commission accreditation

Answer 18

1. To invite discussion with the parents.
2. To validate positive parenting efforts
3. To promote partnership between healthcare providers and parents
   Explanation:
4. One purpose for making general observations during the infant assessment process is to invite discussion with the parents.
5. One purpose for making general observations during the infant assessment process is to validate positive parenting efforts.
6. One purpose for making general observations during the infant assessment process is to promote a partnership between healthcare providers and parents.
7. Decreasing the risk for communicable diseases is not the purpose for making general observations during the assessment process for an infant.
8. Meeting The Joint Commission accreditation standards is not the purpose for making general observations during the assessment process for an infant.

Question 19

The nurse is preparing for a health maintenance visit for a 9-month-old infant. Which teaching topics are appropriate for the nurse to include during the scheduled visit? Select all that apply.
1. Using iron-fortified formula
2. Encouraging self-feeding of finger foods
3. Increasing the number of daily milk feedings
4. Encouraging cups for all feedings
5. Introducing burping techniques

Answer 19

1. Using iron-fortified formula
2. Encourage self-feeding of finger foods.
   Explanation:
3. The nurse should teach the parents the importance of continuing to use an iron-fortified formula until the infant reaches 12 months of age.
4. The nurse should encourage the parents to allow for self-feeding opportunities with finger foods.
5. The number of daily milk feedings should be decreased, not increased, at this stage of development.
6. While the cup should be introduced by 9 months of age, it is not appropriate for the nurse to encourage the use of a cup for all feedings until 12 months of age.
7. While it may be appropriate for the nurse to reinforce burping techniques through the first year of life, the nurse would not introduce this teaching at 9 months of age.

Question 20

The nurse is educating the parents of a 2-month-old infant when to contact the healthcare provider. Which statements by the parents indicate the need for further instruction? Select all that apply.
1. “We will contact the doctor if our baby does not have a bowel movement each day.”
2. “We will contact the doctor if our baby is vomiting.”
3. “We will contact the doctor if our baby has a temperature greater than 99°F.”
4. “We will contact the doctor if our baby does finish each bottle.”
5. “We will contact the doctor if our baby develops a skin rash.”

Answer 20

1. “We will contact the doctor if our baby does not have a bowel movement each day.”
2. “We will contact the doctor if our baby has a temp >99F”
3. “We will contact the doctor if our baby does finish each bottle”
   Explanation:
4. Each infant will develop a pattern for bowel movements; some infants will have several each day, while others may have a bowel movement once every couple of days. This parental statement indicates the need for further education.
5. Infants are prone to dehydration; therefore, it is appropriate for the parents to contact the healthcare provider for vomiting.
6. Parents are instructed to contact the healthcare provider for a temperature greater than or equal to 99.3°F. This parental statement indicates the need for further education.
7. Failure to eat is a reason to contact the healthcare provider; however, failure to finish each bottle is not a reason to contract the healthcare provider. This parental statement indicates the need for further education.
8. A skin rash is a reason to contact the healthcare provider. This statement indicates appropriate understanding of the information presented.