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Peds-Ch31-Old&New Books

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Terms in this set (27)

The nurse expects which D. Able to grasp object voluntarily

characteristic of fine motor This is characteristic of a 1-month-old infant. This is
skills in a 5-month-old infant? characteristic of an 11-month-old infant. This is
characteristic of a 15-month-old infant. This is
A. Strong grasp reflex appropriate for a 5-month-old infant
B. Neat pincer grasp
C. Able to build a tower of two
cubes
D. Able to grasp object
voluntarily

The nurse is assessing a 6- C. developmental/neurologic evaluation is needed.

month-old infant who smiles, A 6-month-old infant should have social interaction
coos, and has a strong head beyond smiling and cooing. The child requires
lag. The nurse should evaluation. The head lag should be almost gone by
recognize that: 4 months of age. This child requires evaluation. The
child requires evaluation before interventions can
A. this assessment is normal. be determined.
B. the child is probably
cognitively impaired.
C. developmental/neurologic
evaluation is needed.
D. the parent needs to work
with the infant to stop head
Peds-Ch31-Old&New
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The nurse educator instructs a A. trust.
nursing student that according The task of infancy is the development of trust.
to Erikson, infancy is Industry vs. inferiority is the developmental task of
concerned with acquiring a school-age children. Initiative vs. guilt is the
sense of: developmental task of preschoolers. Separation
occurs during the sensorimotor stage as described
A. trust. by Piaget.
B. industry.
C. initiative.
D. separation.

A parent of an 8-month-old B. this is a normal reaction for this age.

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:
These are developmentally appropriate. The infant
is experiencing stranger anxiety, which is expected
for this age child. These are developmentally
appropriate. No data have been shown to support
this.

A. the infant is most likely

spoiled.
B. this is a normal reaction for
this age.
C. this is an abnormal reaction
for this age.
D. grandparents are not
responsive to that infant.

Peds-Ch31-Old&New Books
At what age would the nurse C. 10 months
advise parents to expect their Consonants are added to infant vocalizations.
infant to be able to say "mama" Babbling resembles one-syllable sounds. At this age
and "dada" with meaning? infants say sounds with meaning. This is late for the
development of sounds with meaning.
A. 4 months
B. 6 months
C. 10 months
D. 14 months

The parents of a 9-month-old D. There is no need to restrain nonnutritive sucking

infant tell the nurse that they during infancy.
are worried about their baby's Evidence is inconclusive regarding whether a
thumb-sucking. What is the pacifier or thumb is better for satisfying sucking
nurse's BEST reply? needs. Thumb-sucking and the use of pacifier
should be stopped after 4 years of age. Thumb-
A. A pacifier should be sucking and the use of pacifier should be stopped
substituted for the thumb. after 4 years of age. Nonnutritive sucking reaches
B. Thumb-sucking should be its peak at about 18 to 20 months of age.
discouraged by age 12 months.
C. Thumb-sucking should be
discouraged when the teeth
begin to erupt.
D. There is no need to restrain
nonnutritive sucking during
infancy.

Peds-Ch31-Old&New Books
The MOST appropriate C. give child a frozen teething ring to relieve
recommendation for relief of inflammation.
teething pain is to instruct the Gums should not be rubbed with aspirin. It can be
parents to: dangerous if the child aspirates aspirin. Hydrogen
peroxide would not be effective. Cold reduces
A. rub gums with aspirin to inflammation and should be used for relief of
relieve inflammation. teething irritation. Cold, not warmth, reduces
B. apply hydrogen peroxide to inflammation
gums to relieve irritation.
C. give child a frozen teething
ring to relieve inflammation.
D. have child chew on a warm
teething ring to encourage
tooth eruption.

The mother of a 3-month-old A. fluids in addition to breast milk are not needed.
breastfed infant asks about The child will nurse according to needs. Additional
giving her baby water since it is fluids are not necessary for the breastfed baby.
summer and very warm. The Supplemental water should not be given. It may
nurse should recommend that: cause water intoxication. Supplemental water
should not be given. It may cause water
A. fluids in addition to breast intoxication. Clear juices do not provide sufficient
milk are not needed. caloric or nutrient intake and may interfere with
B. water should be given if the breastfeeding.
infant seems to nurse longer
than usual.
C. water once or twice a day
will make up for losses caused
by environmental temperature.
D. clear juices would be better
than water to promote
adequate fluid intake.

Peds-Ch31-Old&New Books
The parent of a 12-month-old D. "Feeding himself will help foster his growth and
infant says to the nurse, "He development. Perhaps we can discuss ways to make
pushes the teaspoon right out the messes more tolerable."
of my hand when I feed him. I The child is developmentally ready for self-feeding.
can't let him feed himself; he Ignoring the behavior and not allowing the child to
makes too much of a mess." self-feed is not fostering the child's development.
The nurse's BEST response is: The child is developmentally ready for self-feeding.
The parent should not force the use of the spoon
A. "It's important not to give in but should substitute finger foods. This response
to this kind of temper tantrum minimizes the parent's concerns about the mess
at this age. Simply ignore the created by self-feeding. At 12 months the child
behavior and the mess." should be self-feeding. Since children this age eat
B. "You need to try different primarily finger foods, it is useful to offer the parent
types of utensils, bowls, and suggestions for keeping the mess to a minimum.
plates. Some are specifically
designed for young children."
C. "It's important to let him
make a mess. Just try not to
worry about it so much."
D. "Feeding himself will help
foster his growth and
development. Perhaps we can
discuss ways to make the
messes more tolerable."

Peds-Ch31-Old&New Books
The parents of a 5-month-old
girl complain to the nurse that
they are exhausted because
she still wakes up as often as
every 1 to 2 hours during the
night. When she awakens, they
change her diaper, and her
mother nurses her back to
sleep. What should the nurse
suggest to help them deal with
this problem?
B. Beginning to put her to bed while still awake
The nurse needs to discuss the issue of co-sleeping
with parents. Having the infant in bed with them may
still interfere with their sleep. Parents need to
develop bedtime
time rituals that involve putting the
child in bed when awake. If the child is put in bed
awake, she will be able to return to sleep more
easily if she awakens at night. Providing formula at
night contributes to bottle-mouth caries.

A. Putting her in parents' bed

to cuddle
B. Beginning to put her to bed
while still awake
C. Letting her cry herself back
to sleep
D. Giving her a bottle of
formula instead of
breastfeeding her so often at
night

Peds-Ch31-Old&New Books
A 4-month-old infant is C. "When your baby learns to roll over, you must
brought to the clinic by his supervise him whenever he is on a surface from
parents for a well-baby which he might fall."
checkup. What should the This is appropriate guidance for a first-month
nurse include at this time appointment. This information should be included at
concerning injury prevention? the 9-month visit when the infant is beginning to
crawl and pull to a stand. Rolling over from
A. "Never shake baby powder abdomen to back occurs between 4 and 7 months.
directly on your infant because This is the appropriate anticipatory guidance for this
it can be aspirated into his age. This information should be included at the 9-
lungs." month visit when the infant is beginning to crawl
B. "Do not permit your child to and pull to a stand.
chew paint from window
ledges because he might
absorb too much lead."
C. "When your baby learns to
roll over, you must supervise
him whenever he is on a
surface from which he might
fall."
D. "Keep doors of appliances
closed at all time
times."

The nurse in the pediatric clinic C. Those using yogurt as primary source of milk
identifies which infants at risk Individuals who follow this diet include milk and its
for developing vitamin D- products in their diet. Breast milk has sufficient
deficient rickets? vitamin D if the mother is not deficient in this vitamin.
Yogurt may not be supplemented with vitamin D.
A. Lacto-ovo vegetarians Lack of sunlight contributes to vitamin D-deficient
B. Those who are breastfed rickets.
exclusively
C. Those using yogurt as
primary source of milk
D. Those exposed to daily
sunlight
Peds-Ch31-Old&New Books
A 3-month-old bottle-fed
infant is allergic to cow's milk.
The nurse's BEST option for a
substitute is:
A. goat's milk.
B. soy-based formula.
C. skim milk diluted with water.
D. casein hydrolysate milk
formula.
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:
A. advise the mother to follow
a milk-free diet for 3 to 5 days.
B. take a thorough, detailed
history of usual daily events.
C. administer simethicone
drops to provide relief from
gas pains.
D. explain that the parents
need to stay calm so the infant
will remain calm.
Peds-Ch31-Old&New Books
D. casein hydrolysate milk formula.
The milk protein in goat's milk cross-reacts with
cow's milk protein. This is avoided because of the
cross-reaction with soy. The cow's milk protein is
also found in skim milk. The milk protein is broken
down in these formulas.
B. take a thorough, detailed history of usual daily
events.
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.
Before suggesting formula changes or medications
to relieve symptoms, a detailed history is needed. It
is important that the nurse convey an empathetic
and compassionate attitude and reassure the
parents that they are not doing anything wrong.
Which strategy might be
recommended for an infant
with failure-to-thrive to
increase caloric intake?
A. Using developmental
stimulation by a specialist
during feedings
B. Avoiding solids until after the
bottle is well accepted
C. Being persistent through 10
to 15 minutes of food refusal
D. Varying schedule of routine
activities on a daily basis
Peds-Ch31-Old&New Books
C. Being persistent through 10 to 15 minutes of food
refusal
Feeding time
times should have a nonstimulating
environment so the focus is on the meal. Solids
should be introduced slowly to decrease
dependence on the bottle. Calm perseverance is
important. Parents often fail to persist through the
child's refusals. Daily schedule should be structured
to provide consistency for the child.
The nurse is interviewing the D. sudden infant death syndrome (SIDS).
parents of a 4-month-old male Although the child was found under the blanket, the
infant brought to the hospital bloody fluid is consistent with SIDS, not suffocation.
emergency department. The No other injuries are reported. No previous acute
infant is dead on arrival, and life-threatening events had been reported. The
no attempt at resuscitation is death is consistent with the characteristics of SIDS.
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:

A. suffocation.
B. child abuse.
C. infantile apnea.
D. sudden infant death
syndrome (SIDS).

Peds-Ch31-Old&New Books
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?
A. Cardiopulmonary resuscitation (CPR)
CPR is essential for parent and caregivers to know.
Most likely the child will not have venous access;
thus home IV therapy is not necessary. The monitor
is insulated and grounded. The parents should
arrange for other caregivers to help out. All need to
be taught how to use the monitoring equipment and
how to perform CPR.

A. Cardiopulmonary
resuscitation (CPR)
B. Administration of intravenous
(IV) fluids
C. Reassurance that the infant
cannot be electrocuted during
monitoring
D. Advice that the infant not be
left with other caretakers such
as baby-sitters

A mother is bringing her 4- B. Vitamin D

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?
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. Vitamin B
B. Vitamin D
C. Vitamin C
D. Vitamin K
Peds-Ch31-Old&New Books
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:
A. rickets.
B. marasmus.
C. kwashiorkor.
D. pellagra.
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
Peds-Ch31-Old&New Books
C. kwashiorkor.
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.
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.
A 9-month-old infant is seen in
the emergency department
after developing a 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?
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.

A. Potatoes
B. Green beans
C. Spinach
D. Peanut butter

Peds-Ch31-Old&New Books
The nurse should provide
further teaching about sudden
infant death syndrome (SIDS)
prevention when hearing the
mother of an 8-week-old make
which statement? (Select all
that apply.)
A. "I only smoke in the kitchen."
B. "I put my baby to sleep on
her back."
C. "I have my baby sleep with
me instead of alone in the
crib."
D. "I make sure my baby wears
a flannel sleeper and has two
blankets to keep warm in her
crib."
E. "I always leave my baby's
favorite stuffed bunny rabbit in
the crib to keep her from
crying at night."
Peds-Ch31-Old&New Books
A. "I only smoke in the kitchen."
C. "I have my baby sleep with me instead of alone in
the crib."
D. "I make sure my baby wears a flannel sleeper and
has two blankets to keep warm in her crib."
E. "I always leave my baby's favorite stuffed bunny
rabbit in the crib to keep her from crying at night."
Maternal smoking increases the risk of SIDS.
Smoking anywhere in the home with an infant
present is not recommended. The "Back to Sleep"
Campaign is given credit for reducing the rate of
SIDS in the United States. Co-sleeping increases the
risk of SIDS.
D. Overheating increases the risk of SIDS. Leaving a
stuffed animal in the crib is a suffocation risk but still
needs to be addressed as a safety hazard.

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.
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
Peds-Ch31-Old&New Books
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.
E. confirm that the newborn's mother has signed the
informed consent.
An immunization record is important for the nurse to
initiate and give to the mother so that a continuous
record of immunizations is maintained. Hepatitis B
vaccine is the primary prevention for the disease. If
the mother is positive for the hepatitis B virus, the
newborn will need to receive the hepatitis B
immunoglobulin (HBIG) in addition to the hepatitis B
vaccine. The dose of hepatitis B vaccine is 0.5 mL, to
be given with a 25-gauge, 5/8 inch needle,
intramuscularly (IM) in the newborn. Signed
informed consent must be obtained from the
mother before administration of the vaccine. The
only safe intramuscular injection site for the
newborn is the vastus lateralis muscle.
B. who sleep prone
C. who were premature
D. with prenatal drug exposure
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 receiving iron
supplements. What will be
included in the teaching?
(Select all that apply.)
A. Administer iron with meals.
B. Place iron toward the back
side of the mouth with a
dropper.
C. Mix iron with milk for greater
absorption.
D. Report black, tarry stools to
health care provider.
E. Apply barrier ointment if
needed to buttocks.
Peds-Ch31-Old&New Books
B. Place iron toward the back side of the mouth with
a dropper.
E. Apply barrier ointment if needed to buttocks.
Administration of Iron Supplements includes:
Ideally iron supplements should be administered
between meals for greater absorption.
Liquid iron supplements may stain the teeth,
therefore administer with a dropper. toward the
back of the mouth (side). In older children,
administer liquid iron. supplements through a straw
or rinse mouth thoroughly after ingestion.
Avoid administration of liquid iron supplements with
whole cow's milk or milk. products as these bind
free iron and prevent absorption.
Educate parents that iron supplements will turn
stools black or tarry green.
Iron supplements may cause transient constipation.
Caution parents not to switch to a low-iron
containing formula or whole milk, which are poor
sources of iron and may lead to iron deficiency
anemia (see Iron Deficiency Anemia, Chapter 43).
In older children, follow liquid iron supplement with
a citrus fruit or juice drink (no more than 3 to 4 oz).
Avoid administration of iron supplements with food
or drinks that bind iron and prevent absorption.

The primary goals in the
nutritional management of
children with failure to thrive
(FTT) are: (Select all that apply.)
A. allow for catch-up growth.
B. correct nutritional
deficiencies.
C. achieve ideal weight for
height.
D. restore optimum body
composition.
E. educate the parents or
primary caregivers on child's
nutritional requirements.
F. educate the parents or
primary caregivers that the
child will need tube feedings
first.
Peds-Ch31-Old&New Books
A. allow for catch-up growth.
B. correct nutritional deficiencies.
C. achieve ideal weight for height.
D. restore optimum body composition.
E. educate the parents or primary caregivers on
child's nutritional requirements.
The goal is to provide sufficient calories to support
"catch-up" growth, which is a rate of growth greater
than the expected rate for age. Correction of
nutritional deficiencies is another goal that may
require multivitamin supplements and dietary
supplements with high-calorie foods and drinks in
addition to treating any coexisting medical
problems.
Accurate assessment of the child's initial weight and
height are important, as well as the daily recording
of weight, food intake, and feeding behavior.
Correction of nutritional deficiencies is another goal
that may require multivitamin supplements and
dietary supplements with high-calorie foods and
drinks in addition to treating coexisting medical
problems to optimize body composition. A goal is
to provide education to the parents or primary
caregiver of the child's nutritional requirements
along with appropriate feeding methods.
What best describes colic? C. A paroxysmal abdominal pain or cramping
manifested by episodes of loud crying
A. Periods of abdominal pain This is the correct definition of colic.
that result in weight loss
B. Periods of abdominal pain
and crying that occur in infants
over age 6 months
C. A paroxysmal abdominal
pain or cramping manifested
by episodes of loud crying
D. Usually the result of poor or
inadequate mothering