Chapter 010wong S Essentials of Pediatrics Test Bank

Hockenberry & Wilson: Wongs Essentials of Pediatric Nursing,
8th Edition
Pub Review
Chapter 10: Health Promotion of the Infant and Family
MULTIPLE CHOICE
1. Which of the following statements best describes the infants physical development?
a. Anterior fontanel closes by age 6 to 10 months.
b. Binocularity is well established by age 8 months.
c. Birth weight doubles by age 5 months and triples by age 1 year.
d. Maternal iron stores persist during the first 12 months of life.
ANS: C
Growth is very rapid during the first year of life. The birth weight has approximately
doubled by age 5 to 6 months and triples by age 1 year.
DIF: Cognitive Level: Analysis
REF: Page 323
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and
Development
2. The nurse is assessing a 6-month-old healthy infant who weighed 7 pounds at birth. The
nurse should expect the infant to now weigh approximately how many pounds?
a. 10
b. 15
c. 20
d. 25
ANS: B
Birth weight doubles at about age 5 to 6 months. At 6 months, a child who weighed 7
pounds at birth would weigh approximately 15 pounds.
REF: Page 323
Development
3. The nurse is doing a routine assessment on a 14-month-old infant and notes that the
anterior fontanel is closed. This should be interpreted as which of the following?
a. Normal finding
b. Questionable findingindicates infant should be rechecked in 1 month
c. Abnormal findingindicates need for immediate referral to practitioner
d. Abnormal findingindicates need for developmental assessment
ANS: A
This is a normal finding. The anterior fontanel closes between ages 12 and 18 months.
Copyright 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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REF: Page 323
Development
4. By what age does the posterior fontanel usually close?
a. 6 to 8 weeks
b. 10 to 12 weeks
c. 4 to 6 months
d. 8 to 10 months
ANS: A
The bones surrounding the posterior fontanel fuse and close by age 6 to 8 weeks.
DIF: Cognitive Level: Knowledge
REF: Page 323
Development
5. The parents of a 9-month-old infant tell the nurse that they have noticed foods such as
peas and corn are not completely digested and can be seen in their infants stools. The
nurses explanation of this is based on which of the following?
a. Child should not be given fibrous foods until digestive tract matures at age 4
years.
b. Child should not be given any solid foods until this digestive problem is resolved.
c. This is abnormal and requires further investigation.
d. This is normal because of the immaturity of digestive processes at this age.
ANS: D
The immaturity of the digestive tract is evident in the appearance of the stools. Solid
foods are passed incompletely broken down in the feces. An excess quantity of fiber
predisposes the child to large, bulky stools.
DIF: Cognitive Level: Application
REF: Page 324
TOP: Integrated Process: Teaching/Learning
Development
6. A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her
hands, but she will not voluntarily grasp it. The nurse should interpret this as:
a. normal development.
b. significant developmental lag.
c. slightly delayed development due to prematurity.
d. suggestive of a neurologic disorder such as cerebral palsy.
ANS: A
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This is indicative of normal development. Reflexive grasping occurs during the first 2 to
3 months and then gradually becomes voluntary.
REF: Page 325
Development
7. In terms of fine motor development, what should the infant of 7 months be able to do?
a. Transfer objects from one hand to the other and bang cubes on a table.
b. Use thumb and index finger in crude pincer grasp and release an object at will.
c. Hold a crayon between the fingers and make a mark on paper.
d. Release cubes into a cup and build a tower of two blocks.
ANS: A
By age 7 months, infants can transfer objects from one hand to the other, crossing the
midline, and bang objects on a hard surface.
REF: Page 325
Development
8. At what age can most infants sit steadily unsupported?
a. 4 months
b. 6 months
c. 8 months
d. 10 months
ANS: C
Sitting erect without support is a developmental milestone usually achieved by 8 months.
DIF: Cognitive Level: Comprehension REF: Page 326
Development
9. The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is
often prone (face down) while awake. The nurses response should be based on
knowledge that this is:
a. unacceptable because of the risk of sudden infant death syndrome (SIDS).
b. unacceptable because it does not encourage achievement of developmental
milestones.
c. acceptable to encourage fine motor development.
d. acceptable to encourage head control and turning over.
ANS: D
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These parents are implementing the guidelines to reduce the risk of SIDS. Infants should
sleep on their backs and then be placed on their abdomens when awake to enhance
development of milestones such as head control.
REF: Page 325
Development
10. By what age should the nurse expect an infant to be able to pull to a standing position?
a. 6 months
b. 8 months
c. 11 to 12 months
d. 14 to 15 months
ANS: C
Most infants can pull themselves to a standing position at age 9 months. Infants who are
not able to pull themselves to standing by age 11 to 12 months should be further
evaluated for developmental dysplasia of the hip.
Development
11. According to Piaget, the 6-month-old infant would be in what developmental stage?
a. Use of reflexes
b. Primary circular reactions
c. Secondary circular reactions
d. Coordination of secondary schemata
ANS: C
Infants are usually in the secondary circular reaction stage from age 4 to 8 months. This
stage is characterized by a continuation of the primary circular reaction for the response
that results. Shaking is performed to hear the noise of the rattle, not just for shaking.
MSC: Area of Client Needs: Health Promotion and Maintenance: Developmental
12. Which of the following behaviors indicates that an infant has developed object
permanence?
a. Recognizes familiar face, such as mother
b. Recognizes familiar object, such as bottle
c. Actively searches for a hidden object
d. Secures objects by pulling on a string
ANS: C
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During the first 6 months of life, infants believe that objects exist only as long as they can
see them. When infants search for an object that is out of sight, this signals the attainment
of object permanence, whereby an infant knows an object exists even when it is not
visible.
REF: Page 330
Development
13. At what age do most infants begin to fear strangers?
a. 2 months
b. 4 months
c. 6 months
d. 12 months
ANS: C
Between ages 6 and 8 months, fear of strangers and stranger anxiety become prominent
and are related to the infants ability to discriminate between familiar and unfamiliar
people.
TOP: Integrated Process: Nursing Process: Problem Identification
Development
14. The nurse is interviewing the father of 10-month-old Megan. She is playing on the floor
when she notices an electric outlet and reaches up to touch it. Her father says no firmly
and removes her from near the outlet. The nurse should use this opportunity to teach the
father that Megan:
a. is old enough to understand the word no.
b. is too young to understand the word no.
c. should already know that electric outlets are dangerous.
d. will learn safety issues better if she is spanked.
ANS: A
By age 10 months, children are able to associate meaning with words. The father is using
both verbal and physical cues to alert the child to dangerous situations.
REF: Page 341
Development
15. Sara, age 4 months, was born at 35 weeks of gestation. She seems to be developing
normally, but her parents are concerned because she is a more difficult baby than their
other child, who was term. The nurse should explain that:
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a. infants temperaments are part of their unique characteristics.

b. infants become less difficult if they are not kept on scheduled feedings and
structured routines.
c. Saras behavior is suggestive of failure to bond completely with her parents.
d. Saras difficult temperament is the result of painful experiences in the neonatal
period.
ANS: A
Infant temperament has a strong biologic component. Together with interactions with the
environment, primarily the family, the biologic component contributes to the infants
unique temperament.
Development
16. What information could be given to the parents of a 12-month-old child regarding
appropriate play activities for this age?
a. Give large push-pull toys for kinetic stimulation.
b. Place cradle gym across crib to facilitate fine motor skills.
c. Provide child with fingerpaints to enhance fine motor skills.
d. Provide stick horse to develop gross motor coordination.
ANS: A
The 12-month-old child is able to pull to standing and walk holding on or independently.
Appropriate toys for this age child include large pull toys for kinesthetic stimulation.
REF: Page 334
Development
17. The nurse is discussing development and play activities with the parent of a 2-month-old
boy. Recommendations should include giving him his first rattle at about what age?
a. 2 months
b. 4 months
c. 7 months
d. 9 months
ANS: B
It is recommended that a brightly colored toy or rattle be given to the child at age 4
months. Grasping has begun as a deliberate act, and the infant grasps, holds, and begins
shaking to hear a noise.
REF: Page 333
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Development
18. Which of the following is an appropriate play activity for a 7-month-old infant to
encourage visual stimulation?
a. Playing peek-a-boo
b. Playing pat-a-cake
c. Imitating animal sounds
d. Showing how to clap hands
ANS: A
Because object permanence is a new achievement, peek-a-boo is an excellent activity to
practice this new skill for visual stimulation.
REF: Page 334
Development
19. Which of the following would be the best play activity for a 6-month-old infant to
provide tactile stimulation?
a. Allow to splash in bath.
b. Give various colored blocks.
c. Play music box, tapes, or CDs.
d. Use infant swing or stroller.
ANS: A
The feel of the water while the infant is splashing will provide tactile stimulation.
REF: Page 334
TOP: Integrated Process: Nursing Process: Planning
Development
20. At what age should the nurse expect an infant to begin smiling in response to pleasurable
stimuli?
a. 1 month
b. 2 months
c. 3 months
d. 4 months
ANS: B
At age 2 months, the infant has a social, responsive smile.
DIF: Cognitive Level: Comprehension REF: Page 333 | Page 337
Development
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21. At about what age does an infant start to recognize familiar faces and objects, such as a
feeding bottle?
a. 1 month
b. 2 months
c. 3 months
d. 4 months
ANS: C
The child can recognize familiar objects at approximately age 3 months.
Development
22. What is normally the earliest age at which an infant begins teething with eruption of
lower central incisors?
a. 4 months
b. 6 months
c. 8 months
d. 12 months
ANS: B
Teething usually begins at age 6 months with the eruption of the lower central incisors.
Development
23. The nurse is guiding parents in selecting a daycare facility for their infant. Which of the
following is especially important to consider when making the selection?
a. Health practices of facility
b. Structured learning environment
c. Socioeconomic status of children
d. Cultural similarities of children
ANS: A
Health practices should be most important. With the need for diaper changes and
assistance with feeding, young children are at increased risk when hand washing and
other hygienic measures are not adhered to.
Development
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24. Austin, age 6 months, has six teeth. The nurse should recognize that this is which of the
following?
a. Normal tooth eruption
b. Delayed tooth eruption
c. Unusual and dangerous
d. Earlier-than-normal tooth eruption
ANS: D
This is earlier than expected. Most infants at age 6 months have two teeth.
Development
25. The nurse notices that a 10-month-old infant being seen in the clinic is wearing
expensive, inflexible, high-top shoes. The nurse should explain that:
a. soft and flexible shoes are generally better.
b. high-top shoes are necessary for support.
c. inflexible shoes are necessary to prevent in-toeing and out-toeing.
d. this type of shoe will encourage the infant to walk sooner.
ANS: A
The main purpose of the shoe is protection. Soft, well-constructed, athletic-type shoes are
best for infants and children.
REF: Page 343
Development
26. At what age is it safe to give infants whole milk instead of commercial infant formula?
a. 6 months
b. 9 months
c. 12 months
d. 18 months
ANS: C
The American Academy of Pediatrics does not recommend the use of cows milk for
children younger than 12 months.
TOP: Integrated Process: Nursing Process: Implementation
Development
27. A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant.
The nurse should recommend that the infant be given:
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a.
b.
c.
d.
10-10
skim milk.
whole cows milk.
commercial iron-fortified formula.
commercial formula without iron.
ANS: C
For children younger than 1 year, the American Academy of Pediatrics recommends the
use of breast milk. If breastfeeding has been discontinued, then iron-fortified commercial
formula should be used.
Development
28. What is the best age for solid food to be introduced into the infants diet?
a. 2 to 3 months
b. 4 to 6 months
c. When birth weight has tripled
d. When tooth eruption has started
ANS: B
Physiologically and developmentally, the 4- to 6-month-old is in a transition period. The
extrusion reflex has disappeared, and swallowing is a more coordinated process. In
addition, the gastrointestinal tract has matured sufficiently to handle more complex
nutrients and is less sensitive to potentially allergenic food. Infants of this age will try to
help during feeding.
TOP: Integrated Process: Nursing Process: Planning
Development
29. What information should the nurse give a mother regarding the introduction of solid
foods during infancy?
a. Solid foods should not be introduced until 8 to 10 months, when the extrusion
reflex begins to disappear.
b. Foods should be introduced one at a time, at intervals of 4 to 7 days.
c. Solid foods can be mixed in a bottle to make the transition easier for the infant.
d. Fruits and vegetables should be introduced into the diet first.
ANS: B
One food item is introduced at intervals of 4 to 7 days to allow the identification of food
allergies.
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Development
30. The parents of a 4-month-old infant tell the nurse that they are getting a microwave oven
and will be able to heat the babys formula faster. The nurse should recommend which of
the following?
a. Never heat a bottle in a microwave oven.
b. Heat only 10 ounces or more.
c. Always leave bottle top uncovered to allow heat to escape.
d. Shake bottle vigorously for at least 30 seconds after heating.
ANS: A
Bottles cannot be heated safely in microwave ovens even if safe guidelines are followed.
REF: Page 344
Development
31. Parents tell the nurse that their 1-year-old son often sleeps with them. They seem
unconcerned about this. The nurses response should be based on which of the following?
a. Children should not sleep with their parents.
b. Separation from parents should be completed by this age.
c. Daytime attention should be increased.
d. This is a common and accepted practice, especially in some cultural groups.
ANS: D
Co-sleeping, or sharing the family bed, in which the parents allow the children to sleep
with them, is a common and accepted practice in many cultures. Parents should evaluate
the options available and avoid conditions that place the infant at risk.
TOP: Integrated Process: Cultural Awareness
Development
32. The parent of 2-week-old Sarah asks the nurse if Sarah needs fluoride supplements,
because she is exclusively breast-fed. The nurses best response is which of the
following?
a. She needs to begin taking them now.
b. They are not needed if you drink fluoridated water.
c. She may need to begin taking them at age 6 months."
d. She can have infant cereal mixed with fluoridated water instead of
supplements.
ANS: C
Fluoride supplementation is recommended by the American Academy of Pediatrics
beginning at age 6 months if the child is not drinking adequate amounts of fluoridated
water.
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Development
33. Which of the following statements is true concerning susceptibility to pertussis?
a. Neonates will be immune the first few months.
b. If mother has had the disease, infant will receive passive immunity.
c. Children younger than 1 year seldom contract this disease.
d. Most children are highly susceptible from birth.
ANS: D
The acellular pertussis vaccine is recommended by the American Academy of Pediatrics
beginning at age 6 weeks. Infants are at greater risk for complications of pertussis. The
vaccine is not given after age 7 years, when the risks of the vaccine become greater than
those of pertussis.
MSC: Area of Client Needs: Health Promotion and Maintenance: Disease Prevention
34. A mother tells the nurse that she does not want her infant immunized because of the
discomfort associated with injections. The nurse should explain that:
a. this cannot be prevented.
b. infants do not feel pain as adults do.
c. this is not a good reason for refusing immunizations.
d. a topical anesthetic, EMLA, can be applied before injections are given.
ANS: D
Several topical anesthetic agents can be used to minimize the discomfort associated with
immunization injections. These include EMLA (eutectic mixture of local anesthetic) and
vapor coolant sprays.
REF: Page 360
MSC: Area of Client Needs: Health Promotion and Maintenance: Immunizations
35. The parents of a 12-month-old child ask the nurse if the child can eat hot dogs as do their
other children. The nurses reply should be based on which of the following?
a. Child is too young to digest hot dogs.
b. Child is too young to eat hot dogs safely.
c. Hot dogs must be sliced into sections to prevent aspiration.
d. Hot dogs must be cut into small, irregular pieces to prevent aspiration.
ANS: D
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Hot dogs are of a consistency, diameter, and round shape that may cause complete
obstruction of the childs airway. If given to young children, the hot dog should be cut
into small irregular pieces rather than served whole or in slices.
MSC: Area of Client Needs: Safe and Effective Care Environment: Safety and Infection
Control (Injury Prevention)
36. The clinic is lending a federally approved car seat to an infants family. The nurse should
explain that the safest place to put the car seat is:
a. front facing in back seat.
b. rear facing in back seat.
c. front facing in front seat with airbag on passenger side
d. rear facing in front seat if an air bag is on the passenger side.
ANS: B
The rear-facing car seat provides the best protection for an infants disproportionately
heavy head and weak neck. The middle of the back seat is the safest position for the
child.
MULTIPLE RESPONSE
1. Pacifiers can be extremely dangerous because of the frequency of use and the intensity of
the infants suck. In teaching the parents about appropriate pacifier selection, select all of
the characteristics the pacifier should have.
a. Easily grasped handle
b. One-piece construction
c. Ribbon or string to secure to clothing
d. Soft, pliable material
e. Sturdy, flexible material
ANS: A, B, E
A good pacifier should be easily grasped by the infant. One-piece construction is
necessary to avoid having the nipple and guard separate. The material should be sturdy
and flexible.
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2. In terms of gross motor development, what would the nurse expect a 5-month-old infant
to do? (Select all that apply.)
a. Roll from abdomen to back
b. Put feet in mouth when supine
c. Roll from back to abdomen
d. Sit erect without support
e. Move from prone to sitting position
f. Adjust posture to reach an object
ANS: A, B
Rolling from abdomen and to back and placing the feet in the mouth when supine are
developmentally appropriate for a 5-month-old infant.
REF: Page 325
Development

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DIF: Cognitive Level: Analysis

a. infants temperaments are part of their unique characteristics.

DIF: Cognitive Level: Comprehension REF: Page 350

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