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Flashcards in Chapter 10 Deck (22):
1

Which has had the greatest impact on reducing infant mortality in the United States?
a. Improvements in perinatal care
b. Decreased incidence of congenital abnormalities
c. Better maternal nutrition
d. Improved funding for health care

Ans: A
Improvements in perinatal care, particularly respiratory care and care of the mother-baby dyad before delivery have had the greatest impact.
There has been a decrease in some congenital anomalies such as spina bifida, but this is not the greatest factor, because much of the decrease can be attributed to improvements in perinatal care.
Better maternal nutrition has had a positive influence but has not had the greatest overall impact.
Changes in funding have not had the greatest impact.

2

According to Piaget, at what stage of development do children typically solve problems through trial and error?
a. Sensorimotor stage
b. Preoperational stage
c. Formal operational stage
d. Concrete operational stage

Ans: A
During the sensorimotor stage, infants and young toddlers develop a sense of cause and effect.
Relational problem solving is characteristic of the preoperational stage.
Adolescents, in the formal operations stage, can test hypotheses.
Children in the concrete operations stage solve problems in a tangible, systematic fashion.

3

Which characteristic best describes the fine motor skills of a 5-month-old infant?
a. Transfers objects from one hand to another
b. Crude pincer grasp
c. Able to build a tower of two cubes
d. Able to grasp an object voluntarily

Ans: D
The ability to grasp objects voluntarily is an appropriate fine motor skill for a 5-month-old infant.
Transferring objects from one hand to another is an appropriate fine motor skill for a 7-month-old.
A crude pincer grasp is an appropriate fine motor skill for an 8- to 9-month-old.
The ability to build a tower of two cubes is an appropriate fine motor skill for a 15-month-old.

4

The nurse is assessing a 6-month-old infant who smiles, coos, and has strong head lag. Based on the nurse’s knowledge of growth and development, the nurse recognizes that
a. this is normal development for a 6-month-old.
b. the child is probably mentally retarded.
c. a developmental and neurologic evaluation is needed.
d. the parent needs to work with the infant to stop the head lag.

Ans: C
The head lag should be almost gone by 4 months of age. This child requires further evaluation to determine whether there is a developmental or neuromuscular deficit that needs to be addressed.
Smiling and cooing should have developed by 4 to 5 months of age. A 6-month-old should be imitating sounds, babbling, and vocalizing to toys and a mirror image.
Without further evaluation, no determination of mental retardation can be made based on three assessment findings alone.
Teaching the parents muscle strengthening exercises may be an intervention of choice once further evaluation is completed.

5

According to Erikson, infancy is concerned with acquiring a sense of
a. trust.
b. industry.
c. initiative.
d. separation.

Ans: A
The task of infancy is the development of trust. If the infant is not successful with this task, then mistrust develops.
Industry versus inferiority is the developmental task of school-age children.
Initiative versus guilt is the developmental task of preschoolers.
Separation occurs during the sensorimotor stage, as described by Piaget.

6

A parent of a 10-month-old infant tells the nurse that the baby cries and screams whenever the infant is left with the grandparents. Based on the nurse’s knowledge of growth and development, the nurse’s response is
a. the infant is most likely spoiled.
b. stranger anxiety is common for an infant of this age.
c. separation anxiety should have disappeared between 4 and 8 months of age.
d. the grandparents are not responsive to infant.

Ans: B
The infant is experiencing stranger anxiety, which is expected for an infant of this age. Stranger anxiety usually develops by between 6 and 8 months of age and begins to disappear at about 1 year of age.
The behavior the infant is exhibiting is normal and not indicative of a spoiled child.
Separation anxiety is common between 6 and 8 months of age.
There are no data to support the conclusion that the grandparents are not responsive to the infant.

7

At what age would the nurse expect an infant to be able to say "mama" and "dada" with meaning?
a. 4 months
b. 6 months
c. 10 months
d. 14 months

Ans: C
At 10 months of age, infants say sounds with meaning.
Consonants, such as n, k, g, p, and b, are made by an infant at 4 months of age.
Babbling resembling one-syllable sounds occurs at 6 months of age.
Age 14 months is late for the development of sounds with meaning. Between the age of 1 and 2 years, the number of words should increase from approximately 4 words to 300 words.

8

The parents of a 9-month-old infant tell the nurse that they are worried about their baby's thumb-sucking. What should the nurse’s reply be based on?
a. A pacifier should be substituted for the thumb.
b. Thumb-sucking should be discouraged by age 12 months.
c. Thumb-sucking should be discouraged when permanent teeth begin to erupt.
d. There is no need to restrain nonnutritive sucking during infancy.

Ans: C
Thumb-sucking reaches its peak at 18 to 20 months of age; it should be discouraged if it persists beyond 4 to 6 years of age.
Evidence is inconclusive over whether a pacifier or a thumb better satisfies sucking needs and what the impact of either is on tooth eruption.
Thumb-sucking reaches its peak at 18 to 20 months of age; it should be discouraged if it persists beyond 4 to 6 years of age.
Nonnutritive sucking reaches its peak at about 18 to 20 months of age. Most toddlers give up nonnutritive sucking on their own.

9

Which is the most appropriate recommendation for relief of teething pain?
a. Rub the gums with aspirin to relieve inflammation.
b. Apply hydrogen peroxide to the gums to relieve irritation.
c. Give the child a frozen teething ring to relieve inflammation.
d. Have the child chew on a warm teething ring to encourage tooth eruption

Ans: C
Cold reduces inflammation and should be used for relief of teething irritation.
Aspirin and aspirin products should never be used in infants and children for inflammation or pain relief.
Hydrogen peroxide will not be effective and may irritate the gums more.
Cold, not warm, reduces inflammation; therefore, heat is not effective for teething pain.

10

The mother of a 3-month-old breastfed infant asks about giving the baby water because it is summer and very warm. The nurse should recommend that
a. Fluids in addition to breast milk are not needed
b. Water should be given if the infant seems to nurse longer than usual
c. Water once or twice a day will make up for losses due to environmental temperature
d. Clear juices would be better than water to promote adequate fluid intake

Ans: A
The child will nurse according to its needs. Additional fluids are not necessary for a breastfed baby.
Water is not a replacement for breast milk. Infants should take as much breast milk as they desire, and this will meet their fluid requirements.
Breast milk will provide the fluids that the infant requires. Supplementation with water is not necessary.
Clear juices should not be given to 3-month-old infants. Breast milk will provide the necessary calories and fluid intake that they require, even in the warm summer months.

11

The parent of a 12-month-old 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 mess." The most appropriate response by the nurse is
a. "It's important not to give in to this kind of temper tantrum at this age."
b. "Maybe you need to try a different type of spoon, one designed for children."
c. "It's important to let him make a mess. Just don't worry about it so much."
d. "He is at the age when he should begin to feed himself. Let's think of ways to make the mess more tolerable."

Ans: D
At 12 months, children should be self-feeding. Because they eat primarily finger foods, providing some concrete strategies for the parent as to how to minimize the mess would be helpful.
The child is developmentally ready for self-feeding, and his behavior reflects his desire to be autonomous. Infants between the ages of 9 and 12 months begin to self-feed; therefore this behavior should be encouraged.
The child is developmentally ready for self-feeding, and this behavior should be encouraged. Most infants begin self-feeding with finger foods, so the use of a spoon is generally not required, limiting the "mess."
"It's important to let him make a mess. Just don't worry about it so much." minimizes the parents' concerns about the mess created by self-feeding, blocks communication, and misses a teaching–learning opportunity.

12

The parents of a 5-month-old child complain to the nurse that they are exhausted because the infant still wakes up as often as every 1 to 2 hours during the night. When the child awakens, they change the diaper and the mother nurses the child back to sleep. Which should the nurse suggest to help the parents deal with this problem?
a. Put the child in the parents' bed to cuddle.
b. Start putting the infant to bed while still awake.
c. Allow the infant to cry for 30 minutes, and then rock the infant back to sleep before putting the infant back in the crib.
d. Give the infant a bottle of formula instead of breastfeeding so often at night.

Ans: B
Parents need to develop bedtime rituals that involve putting the child in bed when awake. This will allow the infant to become accustomed to falling asleep somewhere besides the parent's arms or in the parent's presence.
The issue of a child sleeping with the parents should be discussed fully. Having the infant in bed with them may still interfere with their sleep and increases the risk of injury to an infant of this age.
The extinction of crying episodes should be done progressively, beginning with checking on the infant every 5 minutes during the first night and extending this interval by 5 minutes on subsequent nights. This will allow the infant to learn to self-soothe.
Providing formula in a bottle at night will contribute to bottle-mouth caries. Additionally, 5-month-old infants generally do not wake up during the night to feed but rather to be soothed. Using feeding as a mechanism to soothe begins a pattern that may lead to eating problems later in childhood.

13

Parents of a 4-month-old infant bring the infant to the clinic for a well-baby checkup. Which instruction should the nurse include at this time about injury prevention?
a. "Never shake baby powder directly on the infant because it can be aspirated into the lungs."
b. "Do not permit the child to chew paint from window ledges, because the child might absorb too much lead."
c. "When the child learns to roll over, you must offer supervision whenever the child is on a surface from which the child might fall."
d. "Keep doors of appliances closed at all times."

Ans: C
Rolling over from the abdomen to the back occurs between 4 and 7 months of age. This statement is the appropriate anticipatory guidance for this age related to the prevention of injuries.
"Never shake baby powder directly on the infant because it can be aspirated into the lungs" is appropriate guidance for a first-month well-baby checkup related to injury prevention.
Information on lead, and lead sources, should be included at the 9-month visit when the child is beginning to crawl and pull himself or herself to a standing position.
Guidance regarding appliances and keeping doors of appliances closed should be included at the 9-month visit when the child is beginning to crawl and pull himself or herself to a standing position.

14

Which infant is at risk for developing vitamin D–deficient rickets?
a. Lacto-ovovegetarians
b. Those who are breastfed exclusively
c. Those using yogurt as a primary source of milk
d. Those exposed to daily sunlight

Ans: C
Yogurt may not be supplemented with vitamin D; therefore, the infant may be at risk for the development of rickets.
Individuals who follow this diet include milk and its products and therefore receive vitamin D.
Breast milk provides sufficient vitamin D to the infant if the mother is not deficient in this vitamin.
Lack of sunlight contributes to vitamin D–deficient rickets.

15

Macrominerals refer to those minerals with daily intake requirements greater than 100 mg. Which is a macromineral?
a. Iron
b. Calcium
c. Fluoride
d. Vitamin D

Ans: B
Calcium is a macromineral.
Iron is a micromineral.
Fluoride is a micromineral.
Vitamin D is a micromineral.

16

Which food combination will generally provide the appropriate amounts of essential amino acids for an individual who is a vegetarian?
a. Grains and legumes
b. Grains and vegetables
c. Legumes and vegetables
d. Milk products and fruit

Ans: A
Grains and legumes form complete proteins when eaten together, providing appropriate amounts of essential amino acids.
Grains should be eaten with milk products or legumes to provide appropriate amounts of essential amino acids.
Legumes should be eaten with grains or seeds to provide appropriate amounts of essential amino acids.
Milk products should be eaten with grains to provide appropriate amounts of essential amino acids.

17

Which is the most descriptive of kwashiorkor?
a. Kwashiorkor has a multifactorial etiology.
b. Kwashiorkor occurs primarily in breastfed infants.
c. Kwashiorkor results from excessive amounts of vitamin K.
d. Kwashiorkor is related to inadequate calories, not adequate protein.

Ans: A
Cultural, environmental, and infectious components contribute to kwashiorkor, a deficiency of protein with an adequate supply of calories.
Kwashiorkor occurs in infants and children who are beyond the age of breastfeeding.
There is no correlation between excessive amounts of vitamin K and kwashiorkor.
Kwashiorkor is a disorder in which there are adequate calories but a deficiency of protein.

18

A 3-month-old bottle-fed infant is allergic to cow's milk. Which is the best substitute to teach the parents to use?
a. Goat's milk
b. Soy-based formula
c. Skim milk diluted with water
d. Casein hydrolysate milk formula

Ans: D
The milk protein is broken down in casein hydrolysate milk formulas, making them a safe alternative for the infant who has an allergy to cow's milk.
The milk protein in goat's milk cross-reacts with cow's milk protein, and goat’s milk is therefore not a safe alternative.
Soy-based formulas are avoided due to the cross-reaction with cow's milk protein; they are not a safe alternative.
Cow's milk protein is contained in skim milk, making it an unsafe alternative.

19

Which statement best describes colic to parents who are inquiring as to whether their infant is experiencing this alteration?
a. The infant will experience periods of abdominal pain, which result in weight loss.
b. Periods of abdominal pain and crying occur in infants primarily over age 6 months.
c. Infants with colic have paroxysmal abdominal pain or cramping manifested by episodes of loud crying.
d. Colic is usually the result of poor or inadequate mothering.

Ans: C
Colic, or paroxysmal abdominal pain, occurs primarily in infants under the age of 3 months and is manifested by episodes of excessive crying and the infant drawing the legs up toward the abdomen.
The infant with colic experiences abdominal pain but gains weight and usually thrives.
Colic most commonly occurs in infants under 3 months of age.
There is no identified relationship between mothering behavior and the development of colic.

20

Which intervention lowers the risk of sudden infant death syndrome (SIDS)?
a. Keeping the window open if one is smoking near the infant.
b. Placing the infant in the supine position for sleeping.
c. Letting the infant sleep with the parents instead of alone in the crib.
d. Making certain the infant is kept very warm while sleeping.

Ans: B
The Back to Sleep Campaign is credited with reducing the rate of SIDS in the United States.
Smoking increases the risk of SIDS by exposing the infant to pulmonary irritants.
Having the infant sleep with the parents (cosleeping) increases the risk of SIDS.
Overheating increases the risk of SIDS.

21

The nurse is instructing a group of parents about head injuries in children. The nurse should explain that infants are particularly vulnerable to acceleration-deceleration head injuries because the
a. anterior fontanel is not yet closed.
b. nervous tissue is not well developed.
c. scalp of head has extensive vascularity.
d. musculoskeletal support of head is insufficient.

Ans: D
The relatively large head size coupled with insufficient musculoskeletal support increases the risk to infants of acceleration-deceleration head injuries.
The lack of closure of the anterior fontanel is not relevant to the development of acceleration-deceleration head injuries in infants.
The lack of well-developed nervous tissue is not relevant to the development of acceleration-deceleration head injuries in infants.
The vascularity of the scalp is not relevant to the development of acceleration-deceleration injuries in infants.

22

When preparing to administer Hepatitis B vaccine to a newborn, the nurse should (select all that apply)
a. initiate an immunization record
b. confirm the hepatitis B status of the newborn’s mother
c. obtain a syringe with a 25-gauge, 5/8-inch needle.
d. assess the dorsogluteal muscle as the preferred site for injection.
e. confirm that the newborn’s mother has signed the informed consent.

Ans: A, B, C, E