Health Promotion Throughout the Life Span

Infant Edelman: Health Promotion Throughout the Life Span MULTIPLE CHOICE 1. An infant is lying in a crib watching and listening to a colorful mobile. Which of the following statements is correct concerning a mobile for an infant? a. Provides stimulation necessary for continued growth and development for the infant b. Provides too much stimulation for the infant, making it difficult for the infant to focus c. Serves as inadequate stimulation for the infant because it is an inanimate object d. Serves as a distractor for the infant, making it easier to fall asleep ANS: A The mobile is providing the stimulation necessary for continued growth and development because both auditory and visual stimuli are necessary to promote growth and development. Additionally, soft sounds and voices are soothing to infants. DIF: Cognitive Level: Analyze (Analysis) REF: p. 410 2. The nurse performs a home visit for a new mother and infant. The nurse observes that the infant lacks a regular feeding schedule, has diapers that are not changed promptly, and cries for long periods of time before being consoled. Which of the following problems is the infant most at risk for encountering in the future? a. Developing enuresis as a toddler b. Having difficulty forming relationships c. Becoming a picky eater d. Taking longer to toilet train ANS: B Erikson’s psychosocial developmental theory is concerned primarily with a series of tasks or crises that each individual must resolve before encountering the next one. The central task during infancy is the development of a sense of trust versus mistrust. This occurs when adults meet an infant’s basic needs for survival. Establishing this basic trust or mistrust determines the manner in which the infant approaches all future stages of growth. The infant may have difficulty forming relationships in the future because trust influences future relationships. By attending to the infant’s needs, parents are helping the infant develop trust in them. Not having his needs attended to hinders that developmental task. DIF: Cognitive Level: Analyze (Analysis) REF: p. 411 3. By what age is an infant’s retina fully developed? a. Birth b. 2 months c. 4 months d. 6 months ANS: C Rod cells in the retina of the eyes, which are responsible for light perception, are functional at birth; however, the retina (the organ of visual perception) is not fully developed until approximately 4 months of age. DIF: Cognitive Level: Remember (Knowledge) REF: p. 412 4. A nurse is completing a well-child assessment of a 6-month-old infant. Which of the following guidelines should be used when assessing the infant’s height and weight? a. CDC growth charts b. CDC body mass index (BMI) charts c. WHO growth standards d. Denver Developmental Screening height and weight standards ANS: C The CDC recommends that health care providers use the WHO growth standards to monitor growth for infants and children ages 0 to 2 years of age in the United States and use the CDC growth charts for children age 2 years and older in the United States. DIF: Cognitive Level: Apply (Application) REF: pp. 412-413 5. A delivery room nurse senses disappointment when a mother is told she just delivered a baby girl. Which of the following would be the most therapeutic response by the nurse? a. “Yes, you just delivered a healthy, beautiful baby girl.” b. “This is your first baby. You can always try again for a boy.” c. “Don’t worry, many parents often feel the same way you do.” d. “You are tired. I think you should get some rest.” ANS: A The gender of the infant, a major concern of many expectant parents, may well influence parental relationships and expectations. The infant’s gender can evoke disappointment; in some cases, a woman may feel disappointed in a girl because she knows that her husband wanted a boy. Today, the trend is to want one child of each gender. Because of the availability in America of better forms of contraception and economic factors such as the expense of raising children, most couples are having fewer children today when compared with the 1950s. The importance and stress of producing the “right-sex” infant is evident. Being the “wrong sex” can, combined with other factors, place an infant at risk for child abuse. The parents may find fault with and place blame on the infant for not meeting this expectation. The nurse should respond by saying, “Yes, you just delivered a healthy, beautiful baby girl.” This response provides information that will help increase the mother’s acceptance of having a girl rather than a boy. Acceptance and bonding are important in preventing child abuse. The fact that the mother appeared disappointed should be acknowledged with a positive comment. DIF: Cognitive Level: Analyze (Analysis) REF: p. 413 6. A nurse is working with a family of an infant to improve their health perception and health management pattern. Which of the following interventions would be most appropriate for the nurse to implement? a. Assess the home for safety hazards. b. Teach parents appropriate coping mechanisms. c. Demonstrate effective parenting skills. d. Encourage appropriate stimulation of the infant. ANS: C Health is largely a subjective judgment. With this understanding, the nurse uses every opportunity to convey confidence in the parents’ health perception–health management pattern and their ability to act to enhance the infant’s health. When parents learn and adopt behaviors to improve their own health, they are more likely to ensure that the health needs of their infant are met. Parental modeling increases the changes that good health practices will be retained throughout the child’s life. DIF: Cognitive Level: Apply (Application) REF: p. 414 7. The mother of an 8-month-old asks what the minimum recommended amount of fat intake is for her infant. Which of the following would be the minimum recommended fat intake? a. 18 g/day b. 25 g/day c. 30 g/day d. 48 g/day ANS: C Fats for infants should include 31 g/day for the first six months of life, and 30 g/day during the second six months of life that constitute about (40% to 50% of calories) are recommended for infants. This quantity is present in human milk and in all formulas prepared for infants. Breast milk and formulas provide approximately 50% of their calories as fat. Significantly lower intakes, such as in skim milk feedings, can result in an inadequate energy intake. DIF: Cognitive Level: Apply (Application) REF: p. 415 8. Which of the following statements concerning infant nutrition is correct? a. During hot and especially dry weather, infants should have supplemental water. b. 50% of an infant’s intake should come from protein to insure adequate growth. c. Breast milk and formulas contain 50% of their calories from fat. d. Skim milk started during infancy will help prevent later childhood obesity. ANS: C Supplemental water is not necessary, even in hot, dry climates. The sources of water are fluids (primarily milk) and food; most strained foods are 75% to 85% water. Most infant diets, without supplementation, meet the basic water requirement. Recommended protein requirements are 9/day during the first 6 months and 11g per day during the second 6 months. No more than 20% of an infant’s daily energy requirement should come from protein because they are not able to process and excrete the excess nitrogen from higher protein diets. Breast milk and formulas provide approximately 50% of their calories as fat. Significantly lower intakes, such as in skim milk feedings, can result in an inadequate energy intake. DIF: Cognitive Level: Remember (Knowledge) REF: p. 415 9. A nurse is completing a home visit of a new mother who is breastfeeding her infant. Which of the following instructions should the nurse provide during this visit? a. Consume 500 kcal/day above pre-pregnancy energy intake to avoid excessive weight loss. b. Drink 1 quart of fluids daily to produce sufficient quantity of breast milk. c. Be sure to wipe off all breast milk on the nipples between feedings to avoid infection d. All of the above statements are correct. ANS: B Community nurses who are caring for breastfeeding mothers should stress the following tips to increase the duration of this activity: drink 1 quart of fluids daily to produce sufficient quantity of breast milk; consume 300 to 400 kcal/day above pre-pregnancy energy intake to avoid excessive weight loss. Expose nipples to air after each feeding and allow some breast milk to dry on nipples for their lubricating and anti-infective properties. DIF: Cognitive Level: Remember (Knowledge) REF: p. 417 10. A mother asks the nurse when she should start feeding her infant solid foods. Which of the following is the most appropriate response by the nurse? a. “It is recommended that solid foods are introduced no earlier than 3 months of age.” b. “It is recommended that solid foods are introduced no earlier than 6 months of age.” c. “You should wait until your child is 9 months old to start solid foods.” d. “You should wait until your child is 1 year old to start solid foods.” ANS: B The AAP and WHO recommend that waiting until the child is 6 months of age to introduce solid food decreases the tendency to develop food allergies and reduce the risk of childhood obesity. The decision to start solid foods at 4 to 6 months of age is based more on neuromuscular and developmental readiness of the infant than on any hard scientific data, but research does validate the lowered risk of developing food allergies if solid foods are not introduced until 6 months of age. DIF: Cognitive Level: Apply (Application) REF: p. 418 11. A new mother has decided to breastfeed her infant after having bottle-fed her other two children. Which of the following information about having a breast-fed infant should the nurse discuss with the mother? a. Breast-fed infants have darker bowel movements than bottle-fed babies. b. Breast-fed infants have smellier bowel movements than bottle-fed babies. c. Breast-fed infants have more frequent bowel movements than bottle-fed babies. d. Breast-fed infants have harder bowel movements than bottle-fed babies. ANS: C A breast-fed infant’s stools have an orange-yellow color and a soft, even consistency, with a slightly sour but clean smell, dissimilar to stools passed later in life. A bottle-fed infant’s stools are harder, smellier, and resemble those of an infant eating solid food. The breast-fed infant has many daily stools during the first and second months of life. The bottle-fed infant has two to four stools per day during the first month. DIF: Cognitive Level: Apply (Application) REF: p. 419 12. During a home visit, the nurse finds a 9-month-old in a playpen with a couple of toys. Which of the following instructions would be most appropriate for the nurse to provide to the parent to encourage growth and development of the child? a. For safety, suggest removing all toys except soft stuffed animals from the playpen. b. Suggest keeping the infant in the playpen as much as possible to promote safe play. c. Encourage providing the infant with supervised time outside of the playpen. d. All of the above. ANS: C Anticipatory Guidance: Knowledge of developmental landmarks allows the nurse to guide parents in proper play and stimulation for infants. Handing a 15-month-old child a ball and placing the child in a fenced-in back yard to play is not enough. These activities must provide interpersonal contact, activity, and exercise. Activity and exercise through stimulation and play are extremely important for adequate and healthy development. Buying expensive toys is unnecessary; common household items, such as pots, pans, lids, and spoons, provide excellent objects for play purposes. Parental stimulation of the infant is an important developmental technique; the infant needs stimulation to learn about the world. The nurse should encourage the mother to provide the infant with supervised time outside of the playpen to allow the child to crawl and explore. Parental stimulation is important. These activities help promote growth and development. Additionally, by 9 months of age, most infants are crawling and need opportunity to exercise this developmental skill. DIF: Cognitive Level: Apply (Application) REF: p. 421 13. A new young mother asks the nurse what she should do to play with her 3-month-old infant. Which of the following suggestions should the nurse provide? a. Take the infant for a walk outside. b. Place several toys around the infant when lying on the floor. c. Rock the infant in a rocking chair. d. Search the Internet for toys highly recommended for infants. ANS: C Three-month-old infants cannot yet walk. Parental stimulation of the infant is an important developmental technique. The infant needs stimulation to learn about the world. This activity does not require expensive objects, but rather involves experiences in sight, sound, and touch that are free and can be provided by any parent. One example of a stimulating experience for infants is being rocked in a rocking chair. Infants who are 3 months old will hold toys, but not actively reach for them; thus surrounding the infant with toys would not be suggested. DIF: Cognitive Level: Apply (Application) REF: p. 421 14. The mother of a 4-month-old infant is concerned about the possibility of SIDS because her neighbor’s daughter passed away last year as a result of SIDS. The mother reports she is so nervous that she has taken up smoking again. The mother informs you that the 4-month-old sleeps supine and takes a pacifier to help her fall asleep. Which of the following statements would be the best response from the nurse? a. “You should place the infant in the bed with you until 6 months of age.” b. “You should never give the infant a pacifier while she is sleeping.” c. “You should try to stop smoking.” d. “You should place the infant on her stomach.” ANS: C Behavioral risk factors identified in epidemiological studies include prone and side sleeping positions, preterm birth and/or infant low birth weight, smoke exposure, soft bedding, bed sharing, not breastfeeding, and overheating. Considering using a pacifier during sleep once breastfeeding is established. In the interest of preventing SIDS, keep the infant away from smokers and places where people smoke; sleep with the infant in the same room where you sleep, but not the same bed (bed sharing is contraindicated) for the first 6 months. Pacifiers are not contraindicated and can appropriately be offered at nap time and bedtime. DIF: Cognitive Level: Apply (Application) REF: p. 422 15. A nurse is developing an educational program about SIDS for a new mothers’ support group in the community. Which of the following information would be included in this presentation? a. Parents are encouraged to place their infants in the supine sleeping position. b. SIDS is the leading cause of death among infants aged 6 months to 1 year old. c. SIDS is associated with infants who have had difficulty sleeping at night. d. Parents are encouraged to limit the amount of “tummy time” of their infant. ANS: A Through the Back to Sleep program, developed by the AAP, there have been a lower number of infant deaths from SIDS. This has encouraged the supine sleeping position. One of the consequences of the supine sleeping position is plagiocephaly (occipital flattening). The primary intervention to decrease the risk of plagiocephaly is “tummy time.” Parents should be instructed to allow supervised tummy time while the infant is awake and cautioned about the amount of time their infant spends in a car seat. SIDS is the leading cause of death among infants 28 to 365 days of age. By definition, the cause of SIDS is not known. DIF: Cognitive Level: Apply (Application) REF: p. 422, Box 17-8 16. A nurse is assessing the language development of a 6-month-old infant. Which of the following findings would the nurse anticipate? a. The infant forms two-syllable sounds. b. The infant coos and makes vowel sounds. c. The infant babbles. d. The infant says “ma-ma” and “bye-bye.” ANS: C Cooing sounds are heard at approximately 2 to 3 months, usually in response to an adult’s voice. By 6 months, babbling sounds are heard, and by 9 to 10 months, the infant forms two-syllable sounds. By 12 months, words such as “ma-ma,” “bye-bye,” and “da-da” are emerging. From 15 to 18 months, an expressive jargon with rhythmic intonations develops, but words are recognized only rarely. The infant uses jargon along with pointing to express wishes. DIF: Cognitive Level: Apply (Application) REF: p. 426 17. Which of the following infants is most at risk to experience child abuse? a. The father has experienced paternal engrossment. b. The infant responds to parental touch. c. The infant’s parents have low self-esteem. d. The infant has been adopted. ANS: C Because the parents’ self-esteem is associated closely with their infant’s interactions and accomplishments, when parents’ self-esteem is low, disappointment, anger, and a disturbance in the relationship with their infant can occur. In some instances this disturbed parent–infant relationship is short-lived and nothing harmful develops. When a disturbed parent–infant relationship continues, however, the infant is at risk for abuse and behavior problems. The process of paternal engrossment has been used to describe the behavior patterns of fathers when they interact with their infants. Responding to parental touch is a normal response and does not portend abuse. Similarly being adopted is not a risk factor for abuse. 18. A nurse is assessing a 4-month-old infant during a well-child visit. Which of the following findings will require the nurse to collect additional information? a. The infant’s shirt is wet from drooling. b. The infant has gained one pound since her 2-month well-child visit. c. The infant holds his or her head steady when in a sitting position. d. The infant grasps objects with two hands. ANS: B One of the passive manifestations of abuse includes poor nutrition, failure to thrive, and severe malnutrition. Weight gain of 1 pound in 2 months indicates a problem with the infant’s growth and requires further data collection by the nurse. The other assessment findings are normal growth and development for a 4-month-old infant. DIF: Cognitive Level: Analyze (Analysis) REF: p. 427 19. A nurse visits a 3-month-old infant of a single mother for a weight check. She finds two older children running around the home, the infant is crying, the mother yelling at the two children and a half-lit cigarette is in an ashtray. The mother tells the nurse the visit needs to be cut short today because she has to pick up her other children from the bus stop. Which of the following would be the most beneficial intervention this nurse can provide during this visit? a. Advise the mother that the nurse will wait in the home until mom returns from the bus stop. b. Advise the mother that if she does not reschedule the visit within 1 week, the nurse will notify child protective services. c. Weigh the infant and offer community resources to the mother. d. Offer to go pick up the other children at the bus stop. ANS: C Abusing parents are often socially isolated and have few people to whom they can turn during times of crisis; they also cannot support one another emotionally. The most beneficial intervention the nurse can provide is to keep the visit short, weigh the infant, and offer the mother the help of community services. Threatening the mother with a call to child protective services sets up an adversarial relationship, which is neither beneficial to the child nor the mother. If the nurse feels that the home situation rises to the level of notifying child protective services, she would do so without making threats or stipulations. Neither staying behind in the home nor picking the older children up at the bus stop represents professional nursing activity. Both have legal ramifications and would be inappropriate. DIF: Cognitive Level: Analyze (Analysis) REF: p. 427 20. Where do most accidents occur? a. In the home b. In the car c. At day care d. On the playground ANS: A Accidents occur in many situations: in the home, outside, on the playground, and in automobiles. However, most accidents occur in the home. DIF: Cognitive Level: Remember (Knowledge) REF: p. 430 21. Which of the following is an example of passive immunity? a. An attenuated (weakened) but live vaccine—measles, mumps, rubella (MMR) b. A toxin of the disease organism, which fosters immunity c. Diphtheria, tetanus, and acellular pertussis (DTaP) killed vaccine d. Protection from drinking breast milk ANS: D Vaccines, whether live and attenuated (MMR) or killed (DTaP), are all forms of active immunity. Vaccines stimulate the organism to produce its own immunity. The same would apply to a toxin injected with the intention of stimulating an immune response. Passive immunity is a form of temporary immunity which relies on antibodies formed by a different individual but which protect another individual. In the case of breast milk, the baby ingests the milk which contains immunity (immunoglobulins) formed by the mother and thus acquires temporary immunity. It is an example of passive immunity. DIF: Cognitive Level: Apply (Application) REF: p. 432 22. Which of the following is the most common poison ingested by infants? a. Houseplants b. Lead c. Cleaning agents d. Aspirin ANS: D The National Clearinghouse for Poison Control Centers lists plants as the third most commonly ingested poison, after aspirin and household cleaning agents. DIF: Cognitive Level: Remember (Knowledge) REF: p. 434 23. A new father is installing a car seat for an infant in the car. Which of the following information should be given to the father by the nurse? a. The infant should be in a rear-facing car seat in the front seat. b. The infant should be in a rear-facing car seat in the back seat. c. The infant should be in a front-facing car seat in the front seat. d. The infant should be in a front-facing car seat in the back seat. ANS: B The AAP recommends rear-facing car safety seats for most infants up to 2 years of age. The back seat is recommended because of the danger posed by air bags. DIF: Cognitive Level: Apply (Application) REF: p. 436 24. A 15-month-old infant has been brought into the office by his Spanish-speaking mother for symptoms of an upper respiratory infection. Which of the following should be the initial action taken by the nurse? a. Ask the mother if she would like an interpreter. b. Ask the mother what home remedies have been used. c. Ask the mother how long the child has had these symptoms. d. Ask the mother about any allergies the child may have. ANS: A The nurse should start by asking the mother if she would like an interpreter. Once the need for an interpreter has been definitively established, the nurse can then continue with the other questions. DIF: Cognitive Level: Analyze (Analysis) REF: p. 439 25. A nurse would like to be involved in promoting change in health care policies. Which of the following statements would be accurate as applied to this goal? a. Becoming a member of a health planning counsel or joining an advisory group to a legislator would be a good first start. b. Nurses must have a minimum of a master’s degree to directly advise legislators on a one-to-one basis regarding healthcare. c. Engaging in political lobbying activities is unprofessional and inappropriate to the nursing role. d. All of the above statements are correct. ANS: A The nurse can become a member of a health planning council, a concerned citizen’s group, or an advisory group to a local legislator or to a state health department grant task force. In this capacity, the nurse’s responsibility is to inform the other committee members. Because nurses have firsthand experience with many community needs, they are in a good position to speak out and inform others. While advanced education is valuable in developing expertise, there is no minimum required education to advise legislators either directly, i.e., on a one-to-one basis or indirectly, as a member of an advisory group. Lobbying is an appropriate activity for nurses and many lobbyists for health care issues are, in fact, nurses. DIF: Cognitive Level: Apply (Application) REF: p. 441 26. A mother asks a nurse what the best toy would be for her 2-month-old. Based on the growth and development of the infant, which of the following recommendations should be made by the nurse? a. Colorful mobile with music b. Rattle c. Stuffed teddy bear d. Play telephone ANS: A The most appropriate toy based on the child’s age and developmental level would be a colorful mobile with music. At this age, the infant can listen to sounds and follow objects. The mobile provides visual and auditory stimulation to continue to promote growth and development. The 2-month-old infant cannot yet grasp objects; hence neither a rattle nor a play telephone would be suitable, as yet. The same would apply for the stuffed teddy bear and worse yet, depending on the size of the bear, it could provide a suffocation hazard at this age. DIF: Cognitive Level: Analyze (Analysis) REF: p. 442, TBL 17-11 27. A 5-month-old boy was born at 6 pounds, 7 ounces. He is being seen in the office for a well-child visit. The nurse would expect him to weigh approximately a. 10 pounds, 14 ounces. b. 11 pounds, 7 ounces. c. 12 pounds, 14 ounces. d. 13 pounds, 7 ounces. ANS: C The child should weigh approximately 12 pounds, 14 ounces, because by 5 months of age, the child should weigh twice the birth weight. DIF: Cognitive Level: Apply (Application) REF: p. 409, TBL 17-1 28. A 9-month-old has mastered the pincer grasp. Which of the following tasks would the nurse anticipate that the infant can do by himself? a. Play with a rattle. b. Eat Cheerios off a hard surface. c. Hold a spoon to feed himself. d. Drink from a cup. ANS: B The pincer grasp is a fine motor skill that is necessary for picking items up off a surface. By this age, hand–mouth coordination has usually been met and therefore feeding the self with finger foods—such as the Cheerios—becomes possible. The other choices can be accomplished with a one-handed or two-handed grasp which is an earlier developmental skill. DIF: Cognitive Level: Apply (Application) REF: p. 410, TBL 17-1 29. A nurse makes a home visit to a 15-month-old following a hospitalization for a fall. Which finding would be concerning to the nurse? a. Radiator heating system in the home b. The child drinking from a cup c. The child experiencing a temper tantrum d. A decorative bowl filled with colorful marbles on the coffee table ANS: D Infants explore objects with their mouths, so anything they pick up should be too big to swallow; balloons, small objects, and foods are the most common causes of foreign-body airway obstruction in children. Parents should be advised that objects such as safety pins, peanuts, beads, coins, hot dogs, paper clips, nuts, corn, buttons, popcorn, chips, apple with peel, and parts of broken toys are frequently swallowed. Many objects can fit into this category and into the infant’s mouth. A decorative bowl filled with colorful marbles on the coffee table is concerning because by 15 months of age the infant is mobile and can eat finger foods. By 7 months of age, the infant fixates on small objects; therefore, a safe environment must be created for the infant. Small objects are the most common causes of foreign body aspiration. A bowl of colorful marbles, located on a coffee table, poses a risk for foreign body obstruction. The child can easily reach objects on a coffee table. DIF: Cognitive Level: Analyze (Analysis) REF: p. 429 30. Which of the following represents a developmental task(s) normally accomplished in infancy? a. Develops a feeling of affection for others b. Able to run c. Uses short sentences d. Choices “A” and “C” are correct ANS: A An infant who likes to be picked up is displaying affection for others. This task is usually accomplished by 6 months of age. The infant cannot yet run or use short sentences. These milestones occur in the toddler stage of development. DIF: Cognitive Level: Remember (Knowledge) REF: p. 411, TBL 17-3 31. An infant is going through the toys in his toy box. He looks at each one before dropping it to the floor and picking the next toy out of the box. Using a growth and development perspective, which of the following conclusions can the nurse draw by assessing this behavior? a. The infant is testing his limits. b. The infant is exploring his environment. c. The infant is expressing his emotions. d. The infant is developing fine motor skills. ANS: B In the first year, infants learn to focus their vision, reach out, explore, and seek out things around them. The infant is exploring his environment. By looking at each toy, he is developing the task of learning to understand and control his world through exploration. The behavior described would represent normal activity for a child of this age. DIF: Cognitive Level: Analyze (Analysis) REF: p. 408 32. The mother of a 16-month-old infant asks a nurse her opinion about holiday decorating. Which of the following recommendations should the nurse provide to the mother? a. Avoid hanging a wreath with holly and berries on the front door. b. Avoid hanging decorative pictures of a bearded Santa Claus on the window. c. Avoid placing poinsettia plants around the home. d. Avoid hanging stockings on the fireplace mantle. ANS: C Colorful, interesting-looking houseplants are often an irresistible attraction to a young infant or child. Infants and small children cannot keep their hands out of dirt-filled plant pots or resist the temptation of eating leaves from the plant. Houseplants are another source of poison if ingested. Household plants are frequently placed on the floor, where the leaves or flowers are easy to pull off and taste. Table 17-8 identifies several common household and garden plants that are poisonous. The mother should avoid placing poinsettia plants around the home because, if these attractive red leaves are swallowed, they could be fatal. By 16 months the infant can walk, and infants are more susceptible than adults to the effects of poisonous plants. Worse, the shiny green or brightly colored leaves of many plants are very attractive to a child who would be prone to explore them by putting the leaves in his mouth. Plants should be kept out of reach of infants. Berries on the wreath can also be fatal, but at 16 months, the child would not be able to reach the wreath; hence a wreath can safely be placed on the door. DIF: Cognitive Level: Analyze (Analysis) REF: pp. 433, 434, TBL 17-10 33. Which of the following statements is correct concerning weaning? a. Weaning should not be started until the infant can sit only slightly supported. b. Weaning can not be started until the extrusion reflex is fully developed. c. Once the child has learned to use as cup, he or she should no longer have a bottle d. or breast. AAP recommends weaning begin at 8 to 9 months and be completed by age 1 year. ANS: A The biological norm and desired method for weaning is to allow the infant to self-wean. Weaning should be started when the infant is ready. Developmentally, the infant can usually learn to use a cup by age 5 to 6 months; however, many children continue to nurse after they start using a cup. The infantile extrusion reflex needs to be absent. This reflex is present in very young infants and involves the tongue pushing out any material in the mouth not associated with sucking. The safety advantages of this are obvious, but weaning cannot be commenced until the infant has matured sufficiently for the reflex to be absent. In addition, weaning should not be started until the infant can sit only slightly supported and turn away his/her head to indicate food refusal. The AAP recommends breastfeeding for at least the first year of life. DIF: Cognitive Level: Remember (Knowledge) REF: p. 418 34. A 2-month-old infant is in for a well-baby visit. Which of the following immunizations should the nurse administer to the infant? a. DTaP-1 b. MMR c. Varicella d. Influenza ANS: A The Centers for Disease Control and Prevention (2007) recommends the following vaccines at 2 months of age: DTaP-1, Hib-1, PCV, Polio, RV. DIF: Cognitive Level: Apply (Application) REF: p. 433, TBL 17-9 MULTIPLE RESPONSE 1. Which of the following statements are correct concerning language development? ( Select all that apply .) a. Infants initially make vowel sounds using the front part of their mouth. b. Cooing sounds begin at 2 to 3 months. c. Babbling begins at approximately 9 to 12 months. d. By one year words such as “ma-ma” or “bye-bye” begin to emerge. ANS: A, B Language development, an important aspect of the infant’s cognitive and perceptual pattern, is affected by development of the intellect, maturation of the central nervous system, development of the organs of speech, and exposure to human verbalization. As in other areas of development, language acquisition follows a definite sequence. During the first 2 months, most of the infant’s sounds are vowels and are made primarily in the front part of the mouth. Crying is the major means of communication during this period. Cooing sounds are heard at approximately 2 to 3 months, usually in response to an adult’s voice. By 6 months, babbling sounds are heard, and by 9 to 10 months, the infant forms two-syllable sounds. By 12 months, words such as “ma-ma,” “bye-bye,” and “da-da” are emerging. From 15 to 18 months, an expressive jargon with rhythmic intonations develops, but words are recognized only rarely. Babbling begins by 6 months thus choice “C” is incorrect. Choices “A,” “B,” and “D,” are all correct. DIF: Cognitive Level: Remember (Knowledge) REF: p. 425 2. A nurse is completing an initial genetic counseling interview with a couple. Which of the following data would be collected during the interview? (Select all that apply.) a. Paternal age b. Maternal age c. Family history d. Religious affiliation ANS: B, C An important aspect of genetic counseling is identifying families at increased risk and referring them as necessary. Aspects that would be reviewed in the initial interview include maternal age, ethnic background, family history, reproductive history, and maternal disease. DIF: Cognitive Level: Apply (Application) REF: pp. 413, 414