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Chapter 15: Care of the Newborn and Infant

Terms in this set (85)

An infant is breastfed. When assessing the stools, which findings would be typical?
Less constipation than bottle-fed infants
The parents of a 6-month-old boy, born 8 weeks' prematurely, ask the visiting home nurse when they should consider starting the infant on solid foods. What would the nurse's best response be?
"I suggest you wait until he is 8 months old."

The infant should begin solid foods at the corrected age of 6 months. Feeding solids now would be a corrected age of 4 months, which is too early. Tongue thrust is a sign the infant is not ready, and whole milk should be started at 12 months corrected age, well after solid foods are introduced.
The nurse is examining the genitals of a healthy newborn girl. The nurse should observe which normal finding?
swollen labia minora

Explanation:
The newborn's labia minora is typically swollen from the effects of maternal estrogen. The minora will decrease in size and be hidden by the labia majora within the first weeks. Lesions on the external genitalia are indicative of sexually transmitted infection. Labial adhesions are not a normal finding for a healthy newborn. A swollen and red anal area would be an abnormal finding.
The parents of a newborn diagnosed with a chronic illness ask the nurse, "How will this effect our newborn's growth and development?" Which nursing response is most appropriate?
"It is common for newborn with chronic illnesses to grow and develop at a slower pace."
A breastfeeding mother asks the nurse about when she can begin feeding her 5-month-old infant some solids and vitamins. Which information provided by the nurse would most accurately address this mother's concerns?
The first food offered to an infant is iron-enriched rice cereal and can be started now. Additionally, the infant needs to receive vitamin D and iron.

Explanation:
By 4 to 6 months of age, breastfed infants need supplements of iron and vitamin D. Solids are introduced at the same age and parents should begin with iron-fortified rice cereal. The infant may also have diluted fruit juice in small portions.
The caregivers of an infant state that their child cries when her mother leaves for even a short amount of time. What might the nurse suggest as a way to console the infant and develop a sense of security when the child's primary caregiver is out of sight?
Play peek-a-boo with the child when happy.
The nurse is visiting a mother who has a 3-month-old infant. Which anticipatory guidance information should the nurse provide to the mother at this time?
The child should be able to turn over onto the back around age 4 months.
What action shows an example of Erik Erikson's developmental task for the infant?
The infant cries and the caregiver picks the child up.
The danger of fluid overload developing is a potential problem in the infant receiving an intravenous infusion. For which of the following would you observe?
increased pulse rate and increased blood pressure
A 3-month-old boy was diagnosed with failure to thrive. What action will be most helpful in assisting the nurse to determine if there is an inorganic cause?
Observing the mother-child interaction during feeding and hygiene activities.
The infant measures 21.5 in (54.6 cm) at birth. If the infant is following a normal pattern of growth, what would be an expected height for the infant at the age of 6 months?
27.5 in (70 cm)
The nurse is preparing to give a 4-month-old an oral medication. Which technique demonstrates the nurse's accurate knowledge of the infant's developmental level?
Position the infant upright, offer the infant a bottle of formula, remove the bottle and squirt the medication on the side of the tongue toward the cheek, then offer the infant the bottle again.
The nurse is caring for an infant who was injured in a severe automobile accident. The child experienced several fractures and is in significant pain. The child's mother questions if this will impact her child later in life. What information should be provided by the nurse?
Experiences with pain even in infancy can influence an individual's response to pain later.
A nurse is collecting weight on a 6-month-old infant. The weight was 14 lbs 3 oz. The mother states that the infant's birth weight was 8 lbs 8 oz. What is the nurse's assessment of this data?
The weight is too little for age.
Explanation:
By 6 months of age the infant should double its birth weight. The nurse may need to further assess the infant's health status and nutritional status.
The nurse is conducting a skin assessment of a newborn. The examination reveals a light pink macule on the back of the neck. The nurse understands that this is a normal variation and is most likely which type of birthmark?
salmon nevus
The nurse is examining a 6-month-old girl who was born 8 weeks early. Which finding is cause for concern?
Head size has increased 5 in (12 cm) since birth.
A new mother expresses concern to the nurse that her baby is crying and grunting when passing stool. What is the nurse's best response to this observation?
"This is normal behavior for infants unless the stool passed is hard and dry."
While assessing a 6-month-old, the nurse notes the posterior fontanel (fontanelle) is open. What action should the nurse take next?
Assess the anterior fontanel (fontanelle).
Which activity is most beneficial in the development of the newborn?
being sung to by his mother
Explanation:
Interaction between the newborn and his parents is the most beneficial activity. Later, toys and music may have a good influence but initially the parental interaction is best.
During a well-child visit for a 2-month-old infant, the nurse explains the need to perform a hearing screening on the child within the next few months. The child's mother reports she has not noticed any deficits and does not see the need for this being done. Which response by the nurse is indicated?
"Unfortunately hearing losses in infants are common and it is best to check hearing before your child is 6 months old to rule out problems."
The mother of a 1-month-old baby is scheduling the next well-child visit for her baby. Which statement by the mother indicates an understanding of the recommended appointment schedule?
"My baby will need to again be seen when he is 2 months old."
The nurse is examining an 8-month-old girl for appropriate development during a regular check-up. Which observation points to a developmental risk?
Uses only the left hand to grasp
Which of the following motor development milestones would you expect an infant to attain first?
A) Opens and closes hands
B) Uses a raking grasp
C) Picks up objects with pincer grasp
D) Feeds self with a spoon
A) Opens and closes hands
A nurse is working with OT to plan what developmentally-appropriate toys should be given to her 10-month-old patient. Which of the following toys would be most appropriate?
A) Unbreakable mirror
B) Mobile with highly contrasted pattern
C) A toy bar for the infant to bat at
D) Board books
D) Board books
Which of the following is not an impact of hospitalization for an infant?
A) Stranger anxiety when the infant is aged betwen 6-8 months of age
B) Displays physical behaviors as expressions of discomfort due to inability to verbalize
C) Can experience signs of advanced growth and development due to increased testing of skills
D) Can experience sleep deprivation due to strange noises, monitoring devices, and procedures
E) Can experience anxiety due to the unfamiliar environment and fear of the unknown
C) Can experience signs of advanced growth and development due to increased testing of skills

Newborns and infants can experience regression due to hospitalization, not advancement.
Separation anxiety manifests in which three behavioral responses?
Protest
Despair
Detachment
What is the protest behavioral response of separation anxiety?
Screaming, clinging to parents, verbal and physical aggression towards strangers
What is the despair behavioral response of separation anxiety?
Withdrawal from others, depression, decreased communication, developmental regression
What is the detachment response of separation anxiety?
Interacting with strangers
Forming new relationships
Happy appearance
Which of the following is not a common family response to their child being hospitalized?
A) Siblings being happy, since their sibling is not around at home
B) Fear and guilt regarding not bringing the child in for care earlier
C) Frustration due to the perceived inability to care for the child
D) Worry regarding finances if work is missed
E) Fear related to lack of knowledge regarding illness/treatments
A) Siblings being happy, since their sibling is not around at home

Siblings often experience loneliness, jealousy, guilt, fear or anger
Which of the following nursing actions is inappropriate when working with a family and their infant child?
A) Maintaining routine as much as possible
B) Providing developmentally appropriate activities
C) Explaining treatments, procedures and care to the child and caregivers
D) Rewarding good behavior by giving toys to the child
E) Encouraging family members to stay with the child during hospitalization
D) Rewarding good behavior by giving toys to the child

"Good behavior" is subjective, especially for infants. All infants have different temperaments, which makes for unequal comparisons of "good behavior". Also, children of this age group don't understand the difference between good and bad.
What is the proximodistal pattern of development?
Attainment of skills from truck out to extremities
When are well appointments conducted for infants and younger?
Newborn
1 month
2 months
4 months
6 months
9 months
12 months
T/F: Families are not considered clients when their infants are ill.
FALSE
T/F: Infants should be assessed while on the caregiver's lap.
TRUE
While assessing an infant up to 3 months of age, what process should you be assessing for?
Hip dysplasia
T/F: All infants need to have their blood pressure taken.
FALSE

Sick infants should have their BP taken, but it is not required in well infants.
Which fontanelle is larger?
Anterior
Which fontanelle closes first? When does it close?
Posterior
2-3 months
Until which age is strabismus common?
6 months
How do you inspect the pinna of the ear?
Pull back and down
An infant presents to the ER in distress, crying very loudly. Mom reports the child has not been breathing "normally". The RN notices the child is barrel-chested. What does this indicate?
A) COPD
B) Cystic fibrosis
C) A normal finding
D) A sign of infection
C) A normal finding

Infants are normally barrel-chested, with a 1:1 anteroposterior transverse diameter.
A nurse is assessing heart sounds in an infant and hears the S3 heart sound. What does this indicate?
A) Congenital heart defect
B) Transposition of the great arteries (TGA)
C) Heart failure
D) A normal finding
D) A normal finding

S3 may be audible in some infants. This should not be a cause for concern
Which of the following is not a primitive reflex?
A) Sucking
B) Protective
C) Babinski
D) Stepping
E) Palmar grasp
B) Protective

Protective reflexes develop after the disappearance of primitive reflexes. Not present until after 12 months of age
What is meconium?
A newborn's first stool
Thick and green
If an infant is breastfed, what will their stool look like?
Thinner consistency
Seedy and yellow
If an infant is formula-fed, what will their stool look like?
Pastier consistency
Darker in color
A father presents to a local clinic stating that his infant son has not pooped in 4 days and has been grunting. How should the nurse respond to this information?
A) "While grunting is not a sign of constipation itself, it is abnormal for your son to have not pooped in 4 days. Let's do an assessment to see what's going on."
B) "No need to worry. It's normaly for infants to have a stool every day or as infrequent as every 10 days. Let's do an assessment to be sure he's doing okay."
C) "Since your son is formula-fed, he is at greater risk for constipation. Why is he not breastfed?"
D) "Has the mother been the one changing him? Maybe she just hasn't told you he's gone."
A) "While grunting is not a sign of constipation itself, it is abnormal for your son to have not pooped in 4 days. Let's do an assessment to see what's going on."

The nurse is both educating dad that grunting is normal, while also showing concern for the lack of stooling. It is NOT normal for an infant to go that long without pooping. The normal range is one stool every other day to up to 10 stools daily. An assessment should be done to find a potential cause. Never ask "why" questions. Choice D is dismissive and insulting. Choice B is incorrect.
What is the FLACC scale?
Uses objective measurements to assess pain in infants and toddlers.
Face
Legs
Activity
Cry
Consolability
A nurse performs the FLACC scale on an infant and scores 9. What is this a sign of?
A) No pain
B) Mild pain
C) Moderate pain
D) Severe pain
D) Severe pain
A score of 9/10 on the FLACC scale indicates severe pain
What is NIPS? How is it scored?
Neonatal infants pain scale
Checks facial expression, cry, breathing pattern, arms, legs and state of arousal
Max score of 7
Score of 0 or 1 for all categories except cry, which can score between 0-2
How much to infants grow (height) per month between 0-12 months?
1.5-2.5 cm per month for first 6 months
1 cm per month for 6-12
How much to infants grow (weight) per month between 0-12 months?
Lose 10% body weight in the first week of life, but regained by end of second week.
Gain 20-30 g per day for the first 3 months.
Weight doubles by 4-6 months, and triples by 12 months.
An infant is at his 12-month well checkup. He currently weighs 21 lbs, and is on-track. How much did he weigh when he was born?
7 lbs

Remember: weight triples by 12 months. 21 lbs/3 = 7 lbs at birth
A child is born weighing 8.5 lbs. How much should she weight at 6 months?
17 lbs
Remember: Weight doubles by 6 months. 8.5x2=17 lbs
T/F: Head circumference growth is steady throughout the first year of life.
FALSE
Head circumference increases rapidly for the first 6 months, then slows until 12 months
Which developmental stage are infants in according to Erikson?
Trust vs mistrust
Which developmental stage are infants in according to Piaget?
Cognitive
Which developmental stage are infants in according to Freud?
Oral
When do infants begin to coo?
2 months
When do infants begin to babble?
6 months
When do infants begin to copy sounds?
9 months
When do infants begin to say a few words?
12 months
What is the vision of a newborn?
20/400
When do infants gain color vision?
7 months
What is an easy temperament?
Quickly establishes routines
Generally happy and adapts easily
What is a difficult temperament?
Requires high levels of activity
Fussiness and crying are common
What is a slow-to-warm-up temperatment?
Middle level of fussiness
Initial negative reactions, but adapts over time
Which of the following social determinants is not a risk to newborns and infants?
A) Tobacco exposure
B) Positive family relationships
C) Food insecurity
D) Housing insecurity
E) Parental substance abuse
B) Positive family relationships
This is a protective factor for newborns and infants
T/F: A newborn should sleep in bed with the parents to promote bonding.
FALSE
A newborn should sleep in their own bed until at least 6 months of age
T/F: A newborn can sleep on their belly or on their back.
FALSE
Newborns should always sleep on their back, since it reduces the risk of SIDS and suffocation
Which of the following immunizations is NOT one that an infant will get during their first 12 months of life?
A) DTaP
B) Hepatitis B
C) Pneumococcal conjugate vaccine
D) Varicella
E) Rotavirus
D) Varicella
When can an infant begin on solid foods?
6 months of age
Disappearance of tongue extrusion reflex and ability to sit in highchair with good head control
Which solid food is recommended to be the "beginner solid food"?
Iron-fortified cereal
How many days apart should a caregiver add new foods to the infant's diet? Why?
Every 3 days
Prevents allergies
When does the first tooth erupt?
4-7 months
Which of the following is NOT a sign of teething?
A) Fussiness or irritability
B) Increased salivation
C) Decreased oral intake
D) Low-grade fevers
E) Difficulty sleeping
C) Decreased oral intake
What is colic? When does it usually peak and resolve? What time of day is usually the worst?
Self-limiting condition of increased fussiness and inconsolable crying.
Peaks at 6 weeks
Resolves by 3-6 months
Often worse in evening
A first-time mother presents to the clinic with her 7-week old appearing exhausted. She states the child has been colic-y and she has not slept in days. She begins to cry and states that sometimes she feels like a horrible mother and that something is wrong with her. What is the nurse's best encouragement to the mother to handle the colic-y baby?
A) Encourage mom to take the child out on walks to calm the child down
B) Encourage mom to lay the infant in the crib when frustrated
C) Encourage mom to have dad leave work to care for the child when she hits her "breaking point"
D) Encourage mom to give the child Benadryl to but the child to sleep
E) Encourage mom to seek treatment for her self-esteem issues
B) Encourage mom to lay the infant in the crib when frustrated

A colic-y baby may not calm down due to a walk, and she herself might be too exhausted to go on a walk. Dad may not be able to leave work, or he may not be in the picture at all. That is not reliable. Giving Benadryl is not appropriate in this scenario. Mom's self-esteem issues are reasonable given that this is her first child.

Laying the infant in their crib when frustrated prevents potential harm to the child. It is normal for caregivers to become frustrated during this period.
What is a BRUE?
Brief resolves unexplained event
A father presents to the emergency rom with a 3-month-old child. Dad reports the child became blue and stopped breathing while on a car ride home from the babysitter's. By the time he noticed, pulled over, and got to the backseat, the child's color returned and she was breathing again. The child has a history of being 6 weeks premature. In the ED, the child is acting appropriately for her age. What does this presentation suggest? What is this child at risk for?
Suggests BRUE
At risk for another BRUE since she was premature and is age-corrected to be less than 2 months of age.
What is the best way to treat diaper dermatitis?
Leave diapers off and allow skin to dry
What is seborrhea?
"Cradle cap"
Scales and erythema on scalp
Not painful or itchy
Can remove scales with soft brush
Resolves by 12 months of age
A fever is defines as a temperature over ____
100.4
An antipyretic should only be administered to an infant if....
They are symptomatic and irritable
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