Flashcards in Final Exam Chapter 11 Deck (38):
1. Recent studies indicate that a deficiency of which vitamin correlates with increased morbidity and mortality in children with measles?
d. Folic acid
Vitamin A deficiency is correlated with increased morbidity and mortality in children with measles. This vitamin deficiency also is associated with complications from diarrhea, and infections are often increased in infants and children with vitamin A deficiency. No correlation exists between vitamins C, niacin, or folic acid and measles.
2. Which vitamin is recommended for all women of childbearing age to reduce the risk of neural tube defects such as spina bifida?
d. Folic acid
The vitamin supplement that is recommended for all women of childbearing age is a daily dose of 0.4 mg of folic acid. Folic acid taken before conception and during pregnancy can reduce the risk of neural tube defects by 70%. No correlation exists between vitamins A, C, or folic acid and neural tube defects
3. A nurse is assessing a child with kwashiorkor disease. Which assessment findings should the nurse expect?
a. Thin wasted extremities with a prominent abdomen
c. Elevated hemoglobin
d. High levels of protein
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.
4. 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
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.
5. Rickets is caused by a deficiency in:
a. vitamin A.
b. vitamin C.
c. vitamin D and calcium.
d. folic acid and iron.
Fat-soluble vitamin D and calcium are necessary in adequate amounts to prevent the development of rickets. No correlation exists between vitamins A, C, folic acid, or iron and rickets.
6. A nurse is preparing to administer an oral iron supplement to a hospitalized infant. Which should not be given simultaneously with the iron supplement?
c. Fruit juice
d. Meat, fish, poultry
Many foods interfere with iron absorption and should be avoided when the iron is consumed. These foods include phosphates found in milk, phytates found in cereals, and oxalates found in many vegetables. Multivitamins may contain iron; no contraindication exists to taking the two together. Vitamin C–containing juices enhance the absorption of iron. Meat, fish, and poultry do not have an effect on absorption.
7. Parents report that they have been giving a multivitamin to their 1-year-old infant. The nurse counsels the parents that which vitamin can cause a toxic reaction at a low dose?
Hypervitaminosis of vitamin D presents the greatest problem because this fat-soluble vitamin is stored in the body. Vitamin D is the most likely of all vitamins to cause toxic reactions in relatively small overdoses. The water-soluble vitamins, primarily niacin, B6, and C, can also cause toxicity but not at the low dose that occurs with vitamin D.
8. The nurse is helping parents achieve a more nutritionally adequate vegetarian diet for their child. Which is most likely lacking in their particular diet?
c. Vitamins C and A
d. Complete protein
The vegetarian diet can be extremely healthy, meeting the overall nutrition objectives for Healthy People. Parents should be taught about food preparation to ensure that complete proteins are available for growth. When parents use a strict vegetarian diet, likelihood exists of inadequate protein for growth and calories for energy. Fat and vitamins C and A are readily available from vegetable sources. Plant proteins are available. Foods must be combined to provide complete proteins for growth.
9. Which describes marasmus?
a. Deficiency of protein with an adequate supply of calories
b. Not confined to geographic areas where food supplies are inadequate
c. Syndrome that results solely from vitamin deficiencies
d. Characterized by thin, wasted extremities and a prominent abdomen resulting from edema (ascites)
Marasmus is a syndrome of emotional and physical deprivation. It is not confined to geographic areas were food supplies are inadequate. Marasmus is a deficiency of both protein and calories. It is characterized by gradual wasting and atrophy of body tissues, especially of subcutaneous fat. The child appears very old, with flabby and wrinkled skin.
10. Although infants may be allergic to a variety of foods, the most common allergens are:
a. fruit and eggs.
b. fruit, vegetables, and wheat.
c. cow’s milk and green vegetables.
d. eggs, cow’s milk, and wheat.
Milk products, eggs, and wheat are three of the most common food allergens. Ingestion of these products can cause sensitization and, with subsequent exposure, an allergic reaction. Eggs are a common allergen, but fruit is not. Wheat is a common allergen, but fruit and vegetables are not. Cow’s milk is a common allergen, but green vegetables are not.
11. Cow’s milk allergy (CMA) is diagnosed in a 6-month-old infant. Which should the nurse recommend as a substitute formula?
b. Goat’s milk
Treatment of CMA is elimination of cow’s milk–based formula and all other dairy products. For infants fed cow’s milk formula, this primarily involves changing the formula to a casein hydrolysate milk formula (Pregestimil, Nutramigen, or Alimentum). Goat’s milk (raw) is not an acceptable substitute because it cross-reacts with cow’s milk protein, is deficient in folic acid, has a high sodium and protein content, and is unsuitable as the only source of calories. Cow’s milk protein is contained in both Enfamil and Similac.
12. A nurse is teaching parents about prevention and treatment of colic. Which should the nurse include in the teaching plan?
a. Avoid use of pacifiers.
b. Eliminate all second-hand smoke contact.
c. Lay infant flat after feeding.
d. Avoid swaddling the infant.
To prevent and treat colic, teach parents that if household members smoke, avoid smoking near infant; preferably confine smoking activity to outside of home. A pacifier can be introduced for added sucking. The infant should be swaddled tightly with a soft, stretchy blanket and placed in an upright seat after feedings.
13. A parent of an infant with colic tells the nurse, “All this baby does is scream at me; it is a constant worry.” The nurse’s best action is:
a. encourage parent to verbalize feelings.
b. encourage parent not to worry so much.
c. assess parent for other signs of inadequate parenting.
d. reassure parent that colic rarely lasts past age 9 months.
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 empathic, gentle, and reassuring attitude, in addition to suggestions about remedies, will help alleviate the parent’s anxieties. The nurse should reassure the parent that he or she is not doing anything wrong. Colic is multifactorial. 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.
14. Parent guidelines for relieving colic in an infant include:
a. avoiding touching abdomen.
b. avoiding using a pacifier.
c. changing infant’s position frequently.
d. placing infant where family cannot hear the crying.
Changing the infant’s position frequently may be beneficial. The parent can walk holding the child face down and with the child’s chest across the parent’s arm. The parent’s hand can support the child’s abdomen, applying gentle pressure. Gently massaging the abdomen is effective in some children. Pacifiers can be used for meeting additional sucking needs. The child should not be placed where monitoring cannot be done. The child can be placed in the crib and allowed to cry. Periodically, the child should be picked up and comforted.
15. Clinical manifestations of failure to thrive caused by behavioral problems resulting in inadequate intake of calories include:
a. avoidance of eye contact.
b. an associated malabsorption defect.
c. weight that falls below the 15th percentile.
d. normal achievement of developmental landmarks.
One of the clinical manifestations of nonorganic failure to thrive is the child’s avoidance of eye contact with the health professional. A malabsorption defect would result in a physiologic problem, not behavioral. Weight (but not height) below the 5th percentile is indicative of failure to thrive. Developmental delays, including social, motor, adaptive, and language, exist.
16. Which is an important nursing consideration when caring for an infant with failure to thrive?
a. Establish a structured routine and follow it consistently.
b. Maintain a nondistracting environment by not speaking to child during feeding.
c. Place child in an infant seat during feedings to prevent overstimulation.
d. Limit sensory stimulation and play activities to alleviate fatigue.
The infant with failure to thrive should have a structured routine that is followed consistently. Disruptions in other activities of daily living can have a great impact on feeding behaviors. Bathing, sleeping, dressing, playing, and feeding are structured. The nurse should talk to the child by giving directions about eating. This will help the child maintain focus. Young children should be held while being fed, and older children can sit at a feeding table. The child should be fed in the same manner at each meal. The child can engage in sensory and play activities at times other than mealtime.
17. An important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS) is to:
a. explain how SIDS could have been predicted and prevented.
b. interview parents in depth concerning the circumstances surrounding the child’s death.
c. discourage parents from making a last visit with the infant.
d. make a follow-up home visit to parents as soon as possible after the child’s death.
A competent, qualified professional should visit the family at home as soon as possible after the death and provide the family with printed information about SIDS. An explanation of how SIDS could have been predicted and prevented is inappropriate. SIDS cannot be prevented or predicted. Discussions about the cause will only increase parental guilt. The parents should be asked only factual questions to determine the cause of death. Parents should be allowed and encouraged to make a last visit with their child.
18. Which is an appropriate action when an infant becomes apneic?
a. Shake vigorously.
b. Roll head side to side.
c. Hold by feet upside down with head supported.
d. Gently stimulate trunk by patting or rubbing.
If the infant is apneic, the infant’s trunk should be gently stimulated by patting or rubbing. If the infant is prone, turn onto the back. The infant should not be shaken vigorously, the head rolled side to side, or held by the feet upside down with the head supported. These can cause injury.
19. To prevent plagiocephaly, the nurse should teach parents to:
a. place infant prone for 30 to 60 minutes per day.
b. buy a soft mattress.
c. allow infant to nap in the car safety seat.
d. have infant sleep with the parents.
Prevention of positional plagiocephaly may begin shortly after birth by implementing prone positioning or “tummy time” for approximately 30 to 60 minutes per day when the infant is awake. Soft mattresses or sleeping with parents (co-sleeping) are not recommended because they put the infant at a higher risk for a sudden infant death incident. To prevent plagiocephaly, prolonged placement in car safety seats should be avoided.
20. An infant has been pronounced dead from sudden infant death syndrome (SIDS) in the emergency department. Which is an appropriate question to ask the parents?
a. “Did you hear the infant cry out?”
b. “Why didn’t you check on the infant earlier?”
c. “What time did you find the infant?”
d. “Was the head buried in a blanket?”
During a SIDS incident, if the infant is not pronounced dead at the scene, he or she may be transported to the emergency department to be pronounced dead by a physician. While they are in the emergency department, the parents are asked only factual questions, such as when they found the infant, how he or she looked, and whom they called for help. The nurse avoids any remarks that may suggest responsibility, such as “Why didn’t you go in earlier?” “Didn’t you hear the infant cry out?” “Was the head buried in a blanket?”
21. An infant experienced an apparent life-threatening event (ALTE) and is being placed on home apnea monitoring. Parents have understood the instructions for use of a home apnea monitor when they state:
a. “We can adjust the monitor to eliminate false alarms.”
b. “We should sleep in the same bed as our monitored infant.”
c. “We will check the monitor several times a day to be sure the alarm is working.”
d. “We will place the monitor in the crib with our infant.”
The parents should check the monitor several times a day to be sure the alarm is working and that it can be heard from room to room. The parents should not adjust the monitor to eliminate false alarms. Adjustments could compromise the monitor’s effectiveness. The monitor should be placed on a firm surface away from the crib and drapes. The parents should not sleep in the same bed as the monitored infant.
22. 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.
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.
23. 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.
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.
1. After the introduction of the Back to Sleep campaign in 1992, an increased incidence has been noted of which of the following pediatric disorders? (Select all that apply.)
c. Failure to thrive
d. Apnea of infancy
ANS: B, E
Plagiocephaly is a misshapen head caused by the prolonged pressure on one side of the skull. If that side becomes misshapen, facial asymmetry may result. The sternocleidomastoid muscle may tighten on the affected side, causing torticollis. SIDS has decreased by more than 40% with the introduction of the Back to Sleep campaign. Apnea of infancy and failure to thrive are unrelated to the Back to Sleep campaign.
2. 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.)
b. Low Apgar scores
c. Male sex
d. Birth weight in the 50th or higher percentile
e. Recent viral illness
ANS: B, C, E
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.
3. An infant has been diagnosed with cow’s milk allergy. What are the clinical manifestations the nurse expects to assess? (Select all that apply.)
a. Pink mucous membranes
d. Abdominal pain
e. Moist skin
ANS: B, C, D
An infant with cow’s milk allergy will possibly have vomiting, rhinitis, and abdominal pain. The mucous membranes may be pale due to anemia from blood lost in the GI tract, and the skin will be itchy with the possibility of atopic dermatitis.
4. Which interventions should the nurse implement when caring for a family of a sudden infant death syndrome (SIDS) infant? (Select all that apply.)
a. Allow parents to say goodbye to their infant.
b. Once parents leave the hospital, no further follow-up is required.
c. Arrange for someone to take the parents home from the hospital.
d. Avoid requesting an autopsy of the deceased infant.
e. Conduct a debriefing session with the parents before they leave the hospital.
ANS: A, C, E
An important aspect of compassionate care for parents experiencing a SIDS incident is allowing them to say good-bye to their infant. These are the parents’ last moments with their infant, and they should be as quiet, meaningful, peaceful, and undisturbed as possible. Because the parents leave the hospital without their infant, it is helpful to accompany them to the car or arrange for someone else to take them home. A debriefing session may help health care workers who dealt with the family and deceased infant to cope with emotions that are often engendered when a SIDS victim is brought into the acute care facility. An autopsy may clear up possible misconceptions regarding the death. When the parents return home, a competent, qualified professional should visit them after the death as soon as possible.
1. An infant is having an anaphylactic reaction, and the nurse is preparing to administer epinephrine 0.001 mg/kg. The child weighs 22 pounds. What is the epinephrine dose the nurse should administer? (Record your answer using two decimal places.)
Convert the 22 pounds to kilograms by dividing 22 by 2.2 = 10. Multiply the 10 by 0.001 mg of epinephrine = 0.01 mg as the dose to be given.
Which strategy might be recommended to increase caloric intake in an infant with failure to thrive?
a. Use developmental stimulation by a specialist during feedings.
b. Avoid solids until after the bottle is well accepted.
c. Be persistent through 10 to 15 minutes of food refusal.
d. Vary the schedule for routine activities on a daily basis.
Calm perseverance is important. Parents often cannot persist through the child's refusals, but they should be encouraged to do so and supported.
Feeding should take place in a nonstimulating environment so that the focus is on feeding, enhancing the chances of increasing caloric intake.
Solids should be introduced slowly to decrease dependence on the bottle, beginning at 6 months of age.
The feeding schedule should be structured for the infant to have consistency and develop a routine for feeding.
A mother is bringing her 4-month-old infant into the clinic for a routine well-baby check. The mother is exclusively breastfeeding. There are no other liquids given to the infant. What vitamin does the nurse anticipate the provider will prescribe for this infant?
a. Vitamin B
b. Vitamin D
c. Vitamin C
d. Vitamin K
The American Academy of Pediatrics recommends that infants who are exclusively breastfed receive 200 IU of vitamin D daily by age 2 months to decrease vitamin D deficiency.
Vitamin B is not needed.
Vitamin C is not needed.
Vitamin K is not needed
A nurse is providing education to a community group in preparation for a mission trip to a third world country with limited access to protein-based food sources. The nurse is aware that children in this country are at increased risk for
Kwashiorkor is defined as primarily a deficiency of protein with an adequate supply of calories.
Rickets results from a lack of vitamin D, calcium, or phosphate. It leads to softening and weakening of the bones.
Marasmus results from general malnutrition of both calories and protein.
Pellagra is a vitamin-deficiency disease most commonly caused by a chronic lack of niacin (vitamin B3) in the diet.
A nurse is caring for a 2-month-old exclusively breastfed infant with an admitting diagnosis of colic. Based on the nurse’s knowledge of breastfed infants, what type of stool is expected?
a. Dark brown and small hard pebbles
b. Loose with green mucus streaks
c. Formed and with white mucus
d. Semiformed, seedy, yellow
Colic does not change the appearance, texture, or color of stools. The color, consistency, and texture of the stools would be normal for the type of feeding. In a breastfeeding infant, that would be semiformed, seedy, and yellow.
Dark brown, small hard pebbles are not a typical bowel movement of an exclusively breastfed infant.
Loose stool with green mucus streaks is not a typical bowel movement of an exclusively breastfed infant.
Formed stool with white mucus is not a typical bowel movement of an exclusively breastfed infant.
The nurse is providing education to parents of an infant diagnosed with colic. What would the nurse include in the discharge teaching?
a. The child will have to be watched for gastrointestinal issues in the future.
b. The symptoms of colic typically disappear by 3 months of age.
c. Providing juice at the start of the fussy period will help decrease the length of the crying episodes.
d. The feeding method needs to be changed to a hypoallergenic formula.
The symptoms of colic typically disappear by 3 months of age.
The child will not have to be watched for gastrointestinal issues in the future, because colic is not related to long-term gastrointestinal problems.
Providing juice at the start of the fussy period will help decrease the length of the crying episodes. There is no evidence that juice will decrease the length of crying in colicky babies.
Changing the feeding method to a hypoallergenic formula is not typically recommended for the infant with colic.
A 1-month-old infant is admitted to the hospital for failure to thrive (FTT) secondary to a cardiac condition. Based on the nurse’s knowledge of the different types of FTT, this type of FTT is categorized as
Organic FTT is the result of a physical cause, such as a cardiac condition, neurologic condition, renal failure, endocrine system disorder, or other possible chronic or acute disease process.
Nonorganic FTT is most often the result of psychosocial factors, such as inadequate nutritional information by the parent.
Idiopathic FTT is unexplained by the usual organic and environmental etiologies.
Generalized FTT is not a recognized term.
A 9-month-old infant is seen in the emergency department after developing urticaric rash with cough and wheezing. When collecting the history of events prior to 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?
b. Green beans
d. Peanut butter
Nuts of any type, including peanuts, 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 are not a highly allergenic food.
Green beans are not a highly allergenic food.
Spinach is not a highly allergenic food.
Infants most at risk for sudden infant death syndrome (SIDS) are those (Select all that apply)
a. Who sleep supine
b. Who sleep prone
c. Who were premature
d. With prenatal drug exposure
e. With a cousin that died of SIDS
Infants at increased risk for SIDS are low birth weight, have low Apgar scores, sleep prone, cosleep, were premature, and have a mother who smokes.
Infants at increased risk for SIDS are low birth weight, have low APGAR scores, sleep prone, cosleep, were premature, and have a mother who smokes.
Infants at increased risk for SIDS are low birth weight, have low APGAR scores, sleep prone, cosleep, were premature, and have a mother who smokes.
It is recommended that infants sleep supine to reduce the risk of SIDS.
A cousin dying of SIDS does not present an increased risk for the infant.
The nurse is providing education to a parent of a 10-month-old infant with the diagnosis of cow’s milk allergy. What will be included in the teaching? (Select all that apply.)
a. Reading of all food labels to avoid products with milk.
b. Use of milk to desensitize the child.
c. Introduction of soy-based products to replace milk.
d. Signs and symptoms associated with potential accidental ingestion of milk.
Reading of all food labels to avoid products with milk will be included in the teaching. This infant will not be desensitized to milk. Milk and milk-based products should be avoided with this child. Introduction of soy-based products to replace milk will be included in the teaching. Signs and symptoms associated with potential accidental ingestion of milk will be included in the teaching.