NUR 106 - Module G2: Pediatric Growth & Development, Nursing Sciences EAQ, Theory & Communication | SBU Nursing Guide

NUR 106 - Module G2: Pediatric Growth & Development, Nursing Sciences EAQ, Theory & Communication | SBU Nursing Guide 1.Saddle Nose 2.Inner epicanthic folds 3.Transverse palmar crease Children with Down syndrome have a broad nose with a depressed bridge (saddle nose), as well as inner epicanthic folds, and oblique palpebral fissures; they also have speckling of the iris (Brushfield spots). Children with Down syndrome have a transverse palmar crease (simian crease) formed by fusion of the proximal and distal palmar creases. These children also have broad, short, stubby hands and feet. Children with Down syndrome have hypotonic, not hypertonic, musculature. - -A 12-year-old child with Down syndrome is admitted to the hospital for intravenous antibiotics for pneumonia. Which clinical findings associated with Down syndrome should the nurse expect when performing a physical assessment? Select all that apply. 1. Saddle nose 2. Thin fingers 3. Inner epicanthic folds 4. Hypertonic musculature 5. Transverse palmar crease 2. Obesity Obesity is a common nutritional problem of children with Down syndrome. It is thought to be related to excessive caloric intake and impaired growth. Rickets is a nutritional disorder related to vitamin D deficiency; it is usually not encountered in these children. Anemia is the most common nutritional problem in children with iron deficiency. Rumination is an eating disorder of infancy characterized by repeated regurgitation without a gastrointestinal illness. - -A nurse plans to discuss childhood nutrition with a group of parents whose children have Down syndrome in an attempt to minimize a common nutritional problem. What problem should be addressed? 1.Rickets 2.Obesity 3.Anemia 4.Rumination 3. One eye moves inward An inward moving eye (tropia) is one form of strabismus. A drooping eyelid is called ptosis; it may be congenital or caused by trauma. Cloudy eyes are associated with congenital cataracts. Blinking may be a tic. - -The mother of a 2-year-old child tells the nurse that she is concerned about her child's vision. What behavior when the child is tired leads the nurse to suspect strabismus? 1 One eyelid droops. 2Both eyes look cloudy. 3One eye moves inward. 4Both eyes blink excessively 1. Complete the entire course of antibiotic therapy Once antibiotics therapy is initiated, the antibiotics start to destroy specific bacterial infections that the health care provider is trying to treat. Antibiotic therapy takes a specific dose and number of days to completely eliminate the bacteria. If the caregivers start a dose and stop it before the course is complete, the remaining bacteria has a chance to grow again, become resistant to antibiotic treatment, and multiply. The nurse should not discourage use of herbal fever remedies; however the herbal treatment should be reviewed to see if it is contraindicated. Ampicillin should be taken 1 to 2 hours after meals. Antibiotic therapy should be completed as prescribed. View Topics - -A child is being treated with oral ampicillin (Omnipen) for otitis media. What should be included in the discharge instructions that the nurse provides to the parents of the client? 1. Complete the entire course of antibiotic therapy. 2. Herbal fever remedies are highly discouraged. 3.Administer the medication with meals. 4.Stop the antibiotic therapy when the child no longer has a fever. 2. Structural differences b/w Eustachian tubes of younger and older children. The eustachian tube in young children is shorter and wider, allowing a reflux of nasopharyngeal secretions. Immunological differences are not a factor in the development of otitis media. There is no difference in the function of the eustachian tube among age groups. The size of the middle ear does not play a role in the occurrence of otitis media in young children. - -The parents of an 18-month-old toddler are anxious to know why their child has experienced several episodes of acute otitis media. What should the nurse explain to the parents about why toddlers are prone to middle ear infections? 1.Immunological differences between adults and young children 2.Structural differences between eustachian tubes of younger and older children 3.Functional differences between eustachian tubes of younger and older children 4.Circumference differences between middle ear cavity size of adults and young children 1, 4 & 5 A cast is not flexible and can inhibit circulation. Cold toes, loss of sensation in toes, pain, and inability to move the toes should be reported immediately. A tingling sensation in the foot may indicate excessive pressure on the nerves and circulatory system in the casted extremity. A fiberglass cast dries within minutes; if it remains damp, it should be reported before 4 hours have elapsed. Increased urine output is not significant; it may be related to increased fluid intake. The expected pulse rate for a 9-year-old child ranges from 70 to 110 beats/min. - -A 9-year-old child has a fractured tibia, and a full leg cast is applied. Which assessment findings should the nurse immediately report to the health care provider? Select all that apply. 1. Inability to move the toes 2.Increased urine output 3.Pedal pulse of 90 beats/min 4.Tingling sensation in the foot 5.Fiberglass cast that is damp after 4 hours 1. The knees are more mobile. The exercises are done to preserve function by mobilizing restricted joints. Circulation is not affected by the arthritic process. Exercises are done to restore joint function; they do not necessarily relieve pain. Exercise does not affect the subcutaneous nodules in the joints. - -A nurse is helping a 7-year-old child with juvenile idiopathic arthritis (JIA) perform range-of-motion exercises. What outcome indicates that the exercises have been effective? 1.The knees are more mobile. 2.The pedal pulses become stronger. 3.Subcutaneous nodules at the joints recede. 4.The child states that the pain is diminished. 4. 7.20 and 460 mg/dL A pH of 7.20 and blood glucose level of 460 mg/dL are expected values in ketoacidosis; the pH of 7.20 indicates acidosis (metabolic) and the blood glucose level of 460 mg/dL is higher than the expected range of 90 to 110 mg/dL. Although the blood pH of 7.20 indicates acidosis, the blood glucose of 60 mg/dL is less than the expected range of 90 to 110 mg/dL, indicating hypoglycemia rather than hyperglycemia. Neither the pH of 7.50 nor the blood glucose value of 60 mg/dL is expected with ketoacidosis; with ketoacidosis, the pH is decreased and the blood glucose level is increased. Although the blood glucose is increased with ketoacidosis, the pH is decreased, not increased; a pH of 7.50 indicates alkalosis. - -A 9-year-old child who has had type 1 diabetes for several years is brought to the emergency department of a community hospital. The child is exhibiting deep, rapid respirations; flushed, dry cheeks; abdominal pain with nausea; and increased thirst. What blood pH and glucose level does the nurse expect the laboratory tests to reveal? 1.7.20 and 60 mg/dL 2.7.50 and 60 mg/dL 3.7.50 and 460 mg/dL 4.7.20 and 460 mg/dL 2, 3, 4 & 6 Weight loss is associated with hyperthyroidism because of the increase in the metabolic rate. Muscle weakness and wasting also occur. Tachycardia, palpitations, increased systolic blood pressure, and dysrhythmias occur with hyperthyroidism because of the increased metabolic rate. Restlessness and insomnia are also associated with hyperthyroidism because of the increased metabolic rate. Protrusion of the eyeballs occurs with hyperthyroidism because of peribulbar edema. Dry, coarse, scaly skin occurs with hypothyroidism, not hyperthyroidism, because of decreased glandular function. Smooth, warm, moist skin occurs with hyperthyroidism. Constipation is associated with hypothyroidism. Increased stools and diarrhea are associated with hyperthyroidism. - -What clinical indicators should a nurse expect when assessing a client with hyperthyroidism? Select all that apply. 1. Dry Skin 2. Weight loss 3.Tachycardia 4.Restlessness 5.Constipation 6.Exophthalmos 1.A low-phenylalanine diet is required Reducing dietary phenylalanine helps prevent brain damage. The PKU diet is planned to maintain the serum phenylalanine level at 2 to 8 mg/100 mL. Phenylalanine is essential for growth and development of the brain. Administering phenylalanine is contraindicated. There are no substitute for phenylalanine, which is one of the essential amino acids. - -What should the nurse teach parents about their newborn's diagnosis of phenylketonuria (PKU)? 1.A low-phenylalanine diet is required. 2.Phenylalanine is not necessary for growth. 3.Phenylalanine can be administered to correct the deficiency. 4.A substitute for phenylalanine is an increased amount of other amino acids. 1. Exercise is used in conjunction with a brace. An exercise program and a brace are the treatments of choice for mild structural scoliosis. Although compliance will affect the ultimate outcome of treatment, exercises alone are not helpful in this type of scoliosis. Exercises are to be encouraged, regardless of the type or extent of scoliosis. Exercises alone are used only with postural-related, not structural-related, scoliosis. - -A child with recently diagnosed idiopathic scoliosis has a mild structural curve. The child's mother asks whether the problem can be corrected with exercise. What should the nurse tell the mother concerning an exercise program? 1.Exercise is used in conjunction with a brace. 2.Exercise can be used if the child appears highly motivated. 3.Exercise might exaggerate the curvature if the curve is severe. 4.Exercise is needed to correct the curvature without the need for a brace. 2. Eyes Juvenile idiopathic arthritis can cause inflammation of the iris and ciliary body of the eyes, which may lead to blindness. The ears are not affected. The liver may become enlarged, but this does not occur as frequently as visual problems do. The brain is not affected. - -The nurse in the pediatric clinic is reviewing the health history of a 10-year-old girl with a diagnosis of juvenile idiopathic arthritis (JIA). Currently the child is experiencing recurrent pain and swelling of the joints, particularly her knees and ankles. What organ is commonly affected in children with this disorder? 1.Ears 2.Eyes 3.Liver 4.Brain 1, 4 & 5 Bedrest for children with nephrotic syndrome is generally no longer ordered. When there is gross edema, children usually prefer to remain in bed to conserve energy, but there are no ill effects of ambulating if they wish to do so. Nephrotic syndrome is a noninfectious disorder; however, these children are prone to infection, and if they contract an infection it is treated accordingly. Examples of symptomatic care are treating azotemia with a low-protein diet; encouraging bedrest if there is gross edema; restricting fluids if there is oliguria; and treating infection if it should occur. Foods that are high in sodium are restricted when there is gross edema; although restricting foods that are high in sodium does not lessen the edema, it seems to prevent it from worsening. A steroid is given to children with nephrotic syndrome because of its antiinflammatory properties. It is essential that the nurse monitor - -An 8-year-old child is admitted to the pediatric unit with nephrotic syndrome. What measures should the nurse expect to include in the plan of care for this child? Select all that apply 1.Providing symptomatic care 2.Maintaining bedrest 3.Administering antibiotics 4.Eliminating high-sodium foods 5.Monitoring response to steroids 1. Tense anterior fontanel A tense or bulging fontanel is indicative of increased intracranial pressure, which is caused by the fluid accumulation associated with hydrocephalus. Conjugate gaze does not occur until 3 to 4 months of age, once the eye muscles have matured. The head is the largest part of the body at this age; the head circumference should be about 1 inch larger than that of the chest. An infant cannot support the head before 1 to 1½ months of age. - -A nurse is assessing a 3-week-old infant who has been admitted to the pediatric unit with hydrocephalus. What finding denotes a complication requiring immediate attention? 1.Tense anterior fontanel 2.Uncoordinated eye/muscle movement 3.Larger head circumference than chest circumference 4.Inability to support the head while in the prone position 4. Strep throat in the past 2 weeks The smoky urine and the stated symptoms should lead the nurse to suspect glomerulonephritis, which usually occurs after a recent streptococcal infection. A rash on the hands and feet is associated with scarlet fever, not glomerulonephritis. Shoulder and knee pain is associated with rheumatic fever, not glomerulonephritis. Weight loss generally occurs in children who have type 1 diabetes, not those with glomerulonephritis - -A mother brings her 6-year-old child to the pediatric clinic, stating that the child has not been feeling well, is weak and lethargic, and has a poor appetite, headaches, and smoky-colored urine. What additional information should the nurse obtain that will aid diagnosis? 1.Rash on palms and feet 2.Shoulder and knee pain 3.Recent weight loss of 2 lb 4.Strep throat in the past 2 weeks 1. Limited abduction of the affected hip Abduction of the hip is limited because the head of the femur slips out of the acetabulum and is unable to rotate. Rotation of the affected hip is unaffected in an infant with DDH. The hip can be flexed on the affected side. Free abduction of the affected hip is impossible; the frog position may be used in the treatment of DDH. - -An infant who has been found to have developmental dysplasia of the hip (DDH) is being examined in the pediatric clinic. What clinical finding does the nurse expect to identify during the physical assessment? 1.Limited abduction of the affected hip 2.Downward and inward rotation of the affected hip 3.Inability to flex and extend the hip on the affected side 4.Free abduction of the affected hip when placed in the frog position 3. Placing the child in the side-lying position The side-lying position promotes a patent airway; the tongue can move away from the back of the pharynx and saliva can flow out of the mouth by gravity. Although monitoring of vital signs is important, a patent airway is the priority. Suctioning may be unnecessary; the child should not be left alone while equipment is obtained. The crib sides should have been padded as a part of seizure precautions before the seizure. If the seizure was unexpected and seizure precautions were not previously instituted, they should be instituted after the immediate respiratory and safety needs of the toddler have been met. - -A 2-year-old toddler is admitted to the pediatric unit with a diagnosis of bacterial meningitis. What is the most important safety measure for the nurse to institute immediately after the child has a seizure? 1.Monitoring the child's vital signs 2.Padding the side rails of the toddler's crib 3.Placing the child in the side-lying position 4.Bringing suction equipment to the bedside 4. Do not palpate the abdomen. Palpation increases the risk of tumor rupture and is contraindicated. There are no data to indicate that surgery is scheduled; therefore there is no reason to maintain nothing-by-mouth (NPO) status. There is no contraindication to intravenous medication. Recording of intake and output may or may not be instituted; it is not specific to children with Wilms tumor. - -A 4-year-old child is admitted to the pediatric unit with a diagnosis of Wilms tumor. Considering the unique needs of a child with this diagnosis, the nurse should place a sign on the child's bed that states: 1.Keep NPO. 2.No IV medications. 3.Record intake and output. 4.Do not palpate the abdomen. 1. Infertility Undescended testes (cryptorchidism) is the failure of the testes to move down the inguinal canal into the scrotum; this migration begins around the 25th to 30th week of gestation. Undescended testes are exposed to body heat that can destroy the sperm-producing ability of the testes, resulting in sterility. A hydrocele is an enlargement of the scrotum with fluid; it is not related to cryptorchidism. A varicocele is a dilation and tortuosity of the scrotal veins; it is not caused by undescended testicles. Inflammation of the epididymis may occur whether or not cryptorchidism is corrected. - -The parents of a 14-month-old boy with bilateral cryptorchidism ask the nurse in the pediatric clinic why it is important for him to have surgery before he is 2 years old. Before responding, the nurse takes into consideration the fact that uncorrected cryptorchidism can result in: 1.Infertility 2.Hydrocele 3.Varicocele 4.Epididymitis 1, 3 & 4 Therapeutic management is based on an accurate description of the seizure. Turning the child on one side or the other allows drainage of secretions that cannot be swallowed during the seizure. The first safety precaution is to prevent injury by raising the padded side rails. It is impossible to take vital signs during a seizure. Administering oxygen is useless because the child does not breathe during a seizure. - -A 4-year-old child is admitted to the pediatric neurological service with a seizure disorder. Shortly after admission, while in bed, the child has a generalized seizure. What nursing actions are most appropriate? Select all that apply. 1. Assessing the seizure 2.Taking the child's vital signs 3.Turning the child on the side 4.Pulling the padded side rails up 5.Initiating oxygen administration Correct4 The child believes there are more blocks when spread out on the floor than in the container. At ages 5 to 7, children learn that simply altering the arrangement of objects in space does not change certain properties of the objects. A 9-year-old child should able to resist perceptual cues that there are more blocks when on the floor than when in their container. During Piaget's stage of concrete operations, children develop an understanding of relationships between things and ideas. They become occupied with collections of objects, such as rocks, and derive enjoyment from classifying and ordering their environment. They may even begin to order friends and relationships (e.g., best friend, second-best friend). - -When assessing the cognitive development of a 9-year-old child, which characteristic indicates inadequate cognitive development? 1 The child collects different-colored rocks. 2 The child says that fall is better than spring. 3 The child considers a boy at school to be a better friend than a neighbor. 4 The child believes there are more blocks when spread out on the floor than in the container. 4 By focusing on simple anatomical diagrams According to Piaget, an 8-year-old child's level of development is in the stage of concrete operations; the child will benefit from simple, concrete examples. The preschooler and younger child, not the school-age child, require repetition. Therapeutic needle play is more appropriate if and when the child is to receive an injection. The child who is in the period of concrete operations cannot think in the abstract; the ability to do this develops during adolescence. - -An 8-year-old child is being prepared for surgery the next day. How should the nurse present preoperative instructions to this child? 1 By repeating instructions often 2 By providing time for needle play 3 By using several abstract examples 4 By focusing on simple anatomical diagrams 4 Sense-pleasure play Sense-pleasure play is a nonsocial stimulating experience in which the pleasurable experiences are derived from the environment, handling of raw materials, and body motion such as swinging, bouncing, and rocking. In skill play, infants persistently demonstrate and exercise their newly acquired abilities. The simple, imitative, dramatic play of toddlers, such as using a telephone, driving a car, or rocking a doll is called pretend play or dramatic play. In social-affective play, the infant takes pleasure in relationships with people. As adults talk, touch, nuzzle, and in various ways elicit responses from an infant, the infant soon learns to provoke parental emotions and responses. - -Which content type of play allows a child to experience pleasure by swinging? 1 Skill play 2 Pretend play 3 Social-affective play 4 Sense-pleasure play 2 "I will give my child hard candies for chewing." Hard candies should not be given to infants and toddlers because they can be easily aspirated, which will result in choking. Therefore, the nurse should suggest that the mother avoid giving hard candies to young children. The nurse should suggest that the mother use plastic eating and drinking utensils for young children because glass and ceramic utensils may break and lead to injury. Old furniture may contain lead paints, which are toxic. Therefore, children should not be allowed to chew on them. Some children, out of curiosity, may grab pot handles, which can cause burns. Therefore, the nurse should advise the mother to turn pot handles toward the back of the stove for the safety of young children. - -Which statement by a mother indicates the need for additional teaching about safety guidelines for infants and toddlers? 1 "I will use plastic eating and drinking utensils." 2 "I will give my child hard candies for chewing." 3 "I will not allow my child to chew on old furniture." 4 "I will turn pot handles toward the back of the stove." 1 Sits alone without support Infants between 6 and 8 months of age can sit alone without support. Infants can creep on their hands and knees at the age of 8 to 10 months. Infants who are 10 to 12 months of age can walk while holding onto furniture and can sit down from a standing position due to their well-developed motor skills. - -Which gross motor skill can be observed in a 7-month-old infant? 1 Sits alone without support 2 Creeps on hands and knees 3 Walks holding onto furniture 4 Sits down from a standing position 1 100 beats/min The normal pulse rate of a newborn ranges from 120 to 160 beats/min. Therefore, a pulse rate of 100 beats/min may indicate an abnormality. Pulse rates of 120 beats/min, 130 beats/min, and 140 beats/min are within normal range. - -Which reading of a newborn's pulse may indicate an abnormality in the function of the cardiovascular system? 1 100 beats/min 2 120 beats/min 3 130 beats/min 4 140 beats/min 1 "I will breastfeed my child." Breastfeeding is recommended for infant nutrition because breast milk contains essential nutrients of proteins, fats, carbohydrates, and immunoglobulins. Giving cow's milk to an infant may lead to internal bleeding, anemia, and an increased incidence of allergies. Fruit juices should be avoided because they do not provide sufficient calories during this period. Iron-fortified cereals should be given to infants after 6 months of age because infants younger than 6 months of age are not sufficiently mature to digest solid foods. - -Which statement by the mother of a 5-month-old infant indicates effective learning about proper nutrition for the infant's growth and development? 1 "I will breastfeed my child." 2 "I will give my child whole cow's milk." 3 "I will give my child adequate fruit juice." 4 "I will give my child iron-fortified cereals." 2 "I will position my baby on the back while sleeping." Sleeping on the stomach may cause upper airway obstruction and increase the risk of SIDS. Therefore, infants should be placed on their backs to decrease this risk. Sleeping in the same bed as the baby may increase the risk of SIDS. Covering the baby with warm blankets may cause overheating or suffocation and can increase the risk of SIDS. The use of soft bedding and pillows for an infant may lead to suffocation. Therefore, the nurse will teach the mother to use a firm mattress. - -The registered nurse is teaching the mother of an infant about the prevention of sudden infant death syndrome (SIDS). Which statement by the mother indicates effective learning? 1 "I will sleep in the bed with my baby." 2 "I will position my baby on the back while sleeping." 3 "I will use warm blankets and sheets to cover my baby." 4 "I will put my baby to sleep on soft bedding with pillows." 4 The adolescent has normal growth and development. Adolescents have a characteristic growth pattern. In male adolescents, the extremities grow first, followed by the trunk, which can make them appear awkward, with a short trunk and long limbs. Physical activity will not be beneficial because the long extremities reflect normal growth and development. The adolescent does not need hormone pills or further evaluation because these findings are normal for his age. - -The nurse finds that an adolescent male's trunk is short when compared to the legs. What should the nurse infer from these findings? 1 The adolescent needs further evaluation. 2 The adolescent needs a lot of physical activity. 3 The adolescent may need hormone pills for growth. 4 The adolescent has normal growth and development. 1 The child imitates the adults as they pray. A preschooler is in the intuitive-projective stage of Fowler's spiritual development, and would imitate the others as they pray and perform other religious activities. An infant is in the undifferential stage of Fowler's development and will not have any spiritual behavior. The school-age child is in mythical-literal stage of Fowler's spiritual development, and may accept the existence of a supreme power. An adolescent is in the synthetic-convention stage of Fowler's spiritual development, and may question religious practice and its benefits. - -After interacting with a preschooler, the nurse concludes that the child has normal development according to Fowler's spiritual development. Which behavior of the child supports the nurse's conclusion? 1 The child imitates the adults as they pray. 2 The child does not exhibit any spiritual behavior. 3 The child accepts the existence of a supreme power. 4 The child questions the religious practice and its benefits. Correct2 To prevent contractures A contracture deformity is the result of stiffness or constriction in the muscles. A contracture would adversely affect a child's development, depending upon location and severity. For example, if an infant developed a contracted Achilles tendon, the infant would not be able to physically develop the ability to walk. Administering pain medications helps decrease the pain. To promote the achievement of developmental milestones, the nurse encourages play exercises that involve joint movement and enhance fine and gross motor skill acquisition. The nurse places the child in the semi-upright position during feedings to facilitate the mobilization of food and fluids through the esophagus. - -A registered nurse advises parents to assist their child with stretching exercises. The child has impaired physical mobility due to neuromuscular impairment. What is the rationale for performing stretching exercises? 1 To minimize pain 2 To prevent contractures 3 To promote the achievement of developmental milestones 4 To facilitate the mobilization of foods and fluids through the esophagus Correct3 Identity vs. role confusion This child's statement indicates a struggle to establish a sense of identity, which is characteristic of the identity vs. role confusion stage. The intimacy vs. isolation stage is characterized by establishing intimate bonds of love and friendship. Looking back over one's life and accepting its meaning are observed in the ego integrity vs. despair stage of psychosocial development. The generativity vs. stagnation stage is seen in middle adulthood, where fulfilling life goals that involve family, career, and society plays an important role. - -A 13-year-old child states, "I don't know if I want to go to college or start working after high school." Which stage of psychosocial development is indicated by this child's uncertainty? 1 Intimacy vs. isolation 2 Ego integrity vs. despair 3 Identity vs. role confusion 4 Generativity vs. stagnation 1 First 12 weeks The critical period of organogenesis occurs during the first trimester, when fetal development is most likely to be adversely affected. The fetus is less vulnerable after the first trimester because organ development is complete. The fetus is less vulnerable to major anomalies during the second 16 weeks because all major organ systems already are formed. At the time of implantation cellular differentiation has not occurred; the genital bud appears in the seventh week. - -The parents of a toddler who has been admitted to the pediatric unit for surgery to correct hypospadias ask the nurse when this defect happened. The nurse responds that it usually occurs during fetal development, in the: 1 First 12 weeks 2 Third trimester 3 Second 16 weeks 4 Implantation phase 3 The condition usually subsides on its own in a few days. A difficult delivery performed with forceps may result in facial paralysis, which may manifest as asymmetrical movements of the face, an inability to close the eyelid, and drooping of the corner of the mouth. This condition is self-limiting and may subside in few days. Physiotherapy is not indicated for the treatment of this condition. The parents should be informed that this condition is not painful. - -A newborn who was delivered with the assistance of forceps sustains an injury that results in facial paralysis. What would the nurse state to the mother? 1 The baby will have this condition for life. 2 The newborn may need intensive physiotherapy. 3 The condition usually subsides on its own in a few days. 4 The newborn should not be allowed to cry because it can cause pain. 4 Associative play Children from 2 years of age are mostly involved in associative play, in which they play together, share toys, and communicate with other children. In parallel play, children play next to each other but have little interaction. In solitary play, the child plays alone, which is usually seen in infants. In onlooker play, a child watches others playing, but does not interact. - -In which type of play do children play together, share toys, and communicate with each other? 1 Parallel play 2 Solitary play 3 Onlooker play 4 Associative play 4 "Your daughter's behavior is expected in response to her slower growth." Growth slows during the toddler years and these children generally do not eat as much as they do during infancy; this is called physiologic anorexia, which is typical of this age group. Toddlers may try to manipulate as they assert their autonomy, but usually not through eating behaviors unless the parents express anxiety and concern over their food intake. Although toddlers have difficulty withstanding frustration and are prone to temper tantrums, these eating behaviors are within the norm for toddlers. Eating disorders usually do not occur in children this young; these behaviors are typical of healthy toddlers. - -A father expresses concern that his 2-year-old daughter has become a "finicky eater" and is eating less. How should the nurse respond? 1 "Your daughter has become manipulative." 2 "She's probably experiencing the stress of a typical 2-year-old." 3 "She may have an eating problem that requires a referral to a specialist." 4 "Your daughter's behavior is expected in response to her slower growth." 4 Rooting reflex When the infant's cheek is stroked, the infant will respond by turning toward the stimulated side, which is called the rooting reflex. The red reflex is elicited by placing the infant in a dark room. In an alert state, many infants open their eyes in a supported sitting position. The sucking reflex is elicited by placing a nipple or gloved finger in the infant's mouth. The startle reflex can be elicited by making a loud noise near the infant. - -While assessing a newborn, the nurse strokes the newborn's cheek and observes for a response. What reflex does the newborn produce in response to the nurse's stimulation? 1 Red reflex 2 Startle reflex 3 Sucking reflex 4 Rooting reflex 1 The mother gives low-fat milk to the infant in a bottle. Cholesterol is required for proper neurological development in infants. Therefore, low-fat milk should not be given to infants and toddlers. Finger foods, such as teething crackers, should be introduced at the age of 6 months, as it helps provide complete nutrition to the infant. The nurse should encourage the mother to give whole cereals instead of iron supplements to the child. Chopped table food can be given to the child at the age of 9 months. - -The nurse is evaluating the dietary plan of a 6-month-old infant. Which action by the infant's mother needs correction? 1 The mother gives low-fat milk to the infant in a bottle. 2 The mother gives teething crackers to the infant for pain relief. 3 The mother refrains from giving iron supplements to the infant. 4 The mother refrains from giving chopped table food to the infant. 4 "The fat has diminished, and the fat distribution pattern has changed." As the preschooler develops into a school-age child, the fat in the body diminishes and the distribution pattern of the fat changes, making the child appear slim. Looking slimmer during school age is a normal part of growth and development. It does not need further investigation and does not indicate that the child has not been eating well. The child may become obese if the parent includes more carbohydrates in the child's diet. - -An anxious parent of a 6-year-old child expresses that the child looks slimmer than a year ago, although the nurse finds the child's height and weight to be age-appropriate. What is the nurse's response to the parent? 1 "The child's condition may need further investigation." 2 "It seems like the child has not been eating well lately." 3 "You need to include more carbohydrates in the child's diet." 4 "The fat has diminished, and the fat distribution pattern has changed." 4 Waking up the child at night to use the bathroom Wetting the bed at night, called nocturnal enuresis, may be managed by waking up the child at night to use the bathroom, relieving the bladder. The child should wear regular sleepwear, and parents should avoid use of diapers or pull-ups. Constipation may contribute to enuresis, so dietary fiber should be increased. Fruit juices and beverages are high in water content, and therefore result in an urge to urinate. - -The nurse teaches a parent about managing nocturnal enuresis for a 7-year-old child. Which action by the parent would be helpful in managing the child? 1 Making the child wear a diaper 2 Limiting fiber in the child's diet 3 Giving the child cranberry juice in the evening 4 Waking up the child at night to use the bathroom 1 The neonate is crying. Sutures are the layers of connective tissue formed between the bones of the cranium. They facilitate the molding of the cranium during vaginal delivery. Conditions like crying and coughing may cause a temporary bulging in the sutures, which may cause stiffness and tension on palpation. Sneezing and an irregular breathing pattern may not directly influence the stiffness of the sutures. The fusion of skull bones is not generally observed in newborns except in some rare conditions. - -What could be a cause of a stiff, tense appearance of the sutures in a newborn? 1 The neonate is crying. 2 The neonate is sneezing. 3 The skull bones of the neonate are fused. 4 The neonate has irregular breathing pattern. Correct A Adding water to dilute the expressed milk Correct B Storing expressed milk at room temperature Correct E Adding honey to expressed milk to improve taste - -A new mother who is unable to breastfeed her newborn expresses breast milk to feed the baby. Which actions of the mother should be corrected by the nurse? Select all that apply. A Adding water to dilute the expressed milk B Storing expressed milk at room temperature C Expressing milk by hand or with breast pump D Storing expressed milk in the refrigerator for 5 days E Adding honey to expressed milk to improve taste 2 Spinal cord injury The spinal cord controls the movements of the legs. Therefore, failure to move the legs indicates a spinal cord lesion or injury. Rickets is suspected if physiologic craniotabes is present in an infant. Caput succedaneum refers to swelling of the infant's head that is sustained during its passage through the birth canal. Neonatal abstinence syndrome is suspected if the infant has sustained rhythmic tremors, twitches, and myoclonic jerks. - -While caring for a newborn in a neonatal intensive care unit, the nurse notices that the neonate is not moving his legs simultaneously. Which condition might the nurse suspect to be the reason for this? 1 Rickets 2 Spinal cord injury 3 Caput succedaneum 4 Neonatal abstinence syndrome 4 After 12 months The Babinski reflex disappears after 1 year or 12 months. The Perez reflex disappears by 6 months. The extrusion reflex and the Moro reflex may disappear by 4 months. The rooting reflex may disappear by 3 months. - -When does the Babinski reflex disappear? 1 By 6 months 2 By 4 months 3 By 3 months 4 After 12 months 1 IgG Significant amounts of maternal IgG antibodies are passed on to a newborn and confer immunity against antigens. IgA is not present at birth but is found in saliva and tears by 2 to 5 weeks of age. The production of IgD is gradual, and increases progressively during childhood. Significant amounts of IgM are produced at birth, and adult levels are reached by 9 months of age. - -Which immunoglobulins (Ig) are transferred from a mother to a fetus? 1 IgG 2 IgA 3 IgD 4 IgM 1 Dysplasia Dysplasias result from abnormal organizations of cells into a particular tissue. Disruptions result from the breakdown of normal tissue. Extrinsic mechanical forces on previously normal tissue cause deformations. A malformation results when developmental processes lead to an abnormally formed body part or organ. - -Which condition results from an abnormal organization of cells into a particular tissue type? 1 Dysplasia 2 Disruption 3 Deformation 4 Malformation 3 Failure to thrive Incorrect formula preparation can lead to inadequate calorie intake and malnutrition, which causes failure to thrive in the infants. Colic in infants may be due to overfeeding, improper feeding techniques, and swallowing excessive air, but not incorrect formula preparation. Positional plagiocephaly and sudden infant death syndrome (SIDS) are avoided by repositioning the infant's sleeping positions, not through formula preparations. - -Upon interacting with the parent of an infant, the nurse observes that the parent is using an incorrect formula preparation method. Which risk does this pose to the infant? 1 Colic 2 Plagiocephaly 3 Failure to thrive 4 Sudden infant death syndrome 1 Ataxic Ataxic cerebral palsy is caused by damage to the cerebellum, which is essential for the coordination of muscle movements and balance. Therefore, a wide-based gait is observed in patients with ataxic cerebral palsy. Spastic cerebral palsy causes hypertonicity with poor control of posture, balance, and coordinated motion. Dyskinetic cerebral palsy is characterized by athetoid and dystonic movements. Mixed cerebral palsy is a combination of spastic and dyskinetic cerebral palsy, and symptoms of both conditions are present. - -Which type of cerebral palsy may cause a wide-based gait in children? 1 Ataxic 2 Spastic 3 Dyskinetic 4 Mixed type 1 Initiative vs. guilt Children between 3 and 6 years of age like to pretend and try out new things. Conflicts may often occur between the child's desire to explore and the limits placed on his or her behavior, which may lead to frustration and guilt. Therefore, the initiative vs. guilt stage is seen in 3- to 5-year-old children. The trust vs. mistrust stage is observed in infancy (birth to 18 months). The industry vs. inferiority stage is seen in children between 6 and 12 years of age. The autonomy vs. shame and doubt stage is seen in children between 18 months and 3 years of age. - -Which stage of psychosocial development is observed in a 5-year-old child according to Erikson's theory? 1 Initiative vs. guilt 2 Trust vs. mistrust 3 Industry vs. inferiority 4 Autonomy vs. shame and doubt 1 Closed eyes A newborn in deep sleep will have closed eyes, regular breathing, and no eye movements. A newborn in light sleep would have irregular breathing, rapid eye movements, and may smile. - -Which behavior is observed in a newborn in deep sleep? 1 Closed eyes 2 Irregular breathing 3 Occasional smiling 4 Rapid eye movements 3 Social competencies Social competencies help young people make positive choices and build relationships. Positive values are a strong sense of values that are needed to direct the choices of young people. Positive identity provides a sense of own power, purpose, worth, and promise in young people. Young people need to develop a commitment to education and lifelong learning. - -Which internal asset helps young people make positive choices and build relationships? 1 Positive values 2 Positive identity 3 Social competencies 4 Commitment to learning 2 Including cereals in the child's diet A child with encopresis may pass feces voluntarily or involuntarily at inappropriate settings. Encopresis is usually associated with constipation. Therefore, cereals should be included in the diet to prevent constipation. Limiting fluids may increase the risk of dehydration and constipation. Increasing the fluid intake may help prevent constipation and encopresis. Milk and milk-based products may increase the risk of encopresis and should be avoided. Delaying defecation may result in constipation, and should not be encouraged. - -Which intervention, if followed by the parent, may help manage encopresis in a 9-year-old child? 1 Limiting fluids in the child's diet 2 Including cereals in the child's diet 3 Giving milk and milk-based products 4 Encouraging the child to delay defecation when the urge is felt 4 The child is motivated by a selfish desire to obtain rewards and benefits. According to Kohlberg's moral judgment theory, every child has a gradual development of moral consciousness based on cognitive development. During the naive instrumental orientation stage, the child's behavior is motivated by a selfish desire to obtain rewards and benefits. During the law and order orientation stage, the child tries to follow rules and laws. During the social contract orientation stage, the child tries to develop good social relationships. During the punishment and obedience orientation stage, the child obeys rules without question due to fear of punishment. - -According to Kohlberg's moral judgment theory, which characteristic behavior would the nurse find in the child who is in the naive instrumental orientation stage? 1 The child tries to follow laws and respects order. 2 The child tries to develop good social relationships. 3 The child follows the rules due to fear of punishment. 4 The child is motivated by a selfish desire to obtain rewards and benefits. 4 Middle childhood Logical thinking is a characteristic of middle childhood, which is 6 to 12 years of age. The use of symbols and egocentric behavior is seen in preschoolers. Adolescence is characterized by abstract thinking. Early childhood is characterized by a preoperational period during which thinking using symbols and egocentric behavior are observed. - -According to Piaget, which developmental stage is characterized by logical thinking? 1 Preschool 2 Adolescence 3 Early childhood 4 Middle childhood 1 1 month The grasp reflex is strong in 1-month-old infants. Fading of the grasp reflex is observed at 2 months of age. The absence of a grasp reflex is observed in a 3-month-old infant. A 4-month-old infant grasps objects with both hands. However, a grasp reflex is absent in this infant. - -At which age does an infant have a strong grasp reflex? 1 1 month 2 2 months 3 3 months 4 4 months 1 Sensorimotor During the sensorimotor period, the child understands that objects continue to exist even when they cannot be seen, heard, or touched. This is called object permanence. During the preoperational phase, children learn to think with the use of symbols and mental images. Egocentricity is observed in the formal operations period. Children are able to perform mental operations during the concrete operations period. - -n which phase does a child develop the sense of object permanence according to Jean Piaget? 1 Sensorimotor 2 Preoperational 3 Formal operations 4 Concrete operations 3 Giving grades and gifts for satisfactory performances During the psychosocial development of school-age children, reinforcement in the form of grades, material rewards, additional privileges, and recognition provides encouragement and stimulation. A sense of accomplishment also involves the ability to cooperate, to compete with others, and to cope effectively with people, so separating children will not promote their mental health. When the reward structure is based on evidence of mastery, children who are incapable of developing these skills are also at risk for feelings of inadequacy and inferiority. Comparison with one another can also cause some children to develop negative feelings towards themselves, and result in a sense of inferiority. - -The school health nurse is teaching a group of teachers about promoting the mental health of school-age children. Which action made by the teachers promotes a sense of industry among the children? 1 Separating children during tasks 2 Basing a reward structure on evidence of mastery 3 Giving grades and gifts for satisfactory performances 4 Comparing the performances of children with one another 4 Concrete operations During the stage of concrete operations, the child's thought becomes more logical and coherent. The child in this stage is able to classify, sort, order, and organize facts about the world to use in problem-solving. Therefore, the child placing the pebbles in order of smallest to largest indicates that the child is in the stage of concrete operations. In the sensorimotor stage, the child develops a sense of cause and effect as they direct behavior towards objects. In the preoperational stage, thinking is concrete and tangible. The child lacks the ability to make deductions or generalizations. In formal operations, thought is characterized by adaptability and flexibility. Abstract thinking and problem-solving skills are observed in this stage. - -While playing, a child takes a few pebbles and places them in order from smallest to largest. Which stage of cognitive development does the child's behavior demonstrate? 1 Sensorimotor 2 Preoperational 3 Formal operations 4 Concrete operations 1 Freud's theory Psychosexual development through the five developmental stages is explained by Freud's theory. Piaget's theory explains cognitive and moral development from infancy to adolescence. Erikson's theory explains psychosocial development. Kohlberg's theory demonstrates the development of moral reasoning. - -Which theory explains psychosexual development through infancy to adolescence? 1 Freud's theory 2 Piaget's theory 3 Erikson's theory 4 Kohlberg's theory 3 Poisonings Household plants may be a source of accidental poisonings because a curious infant may put the leaves in the mouth. Therefore, plants should be kept out of the child's reach to avoid poisonings and ingestions. Stairs, diaper changing table, and infant walkers are the risk factors for falls in the infant. Asphyxia can be prevented by keeping the small objects out of reach of an infant and avoid giving hard candies to the infants and toddlers. Allergic reactions can be prevented by preventing exposure to the allergens. - -After teaching from the nurse about common infant injuries, the parent says, "I will not allow my child to go near the plants in our house." Which risk to the infant can be prevented by this action? 1 Falls 2 Asphyxia 3 Poisonings 4 Allergic reactions 3 Intensity of reaction The energy level of the child's reaction is called intensity of reaction. Sensory threshold is the amount of stimulation, such as sounds or light, required to evoke a response in the child. Approach-withdrawal is the nature of initial responses to a new stimulus. Approach responses are positive expressions, and withdrawal responses are negative expressions. The length of time a child pursues a given activity is called attention span. - -Which attribute of temperament is related to the energy level of the child's reaction? 1 Attention span 2 Sensory threshold 3 Intensity of reaction 4 Approach-withdrawal 4 Generativity versus stagnation In the generativity versus stagnation stage, the adult focuses on supporting future generations. Middle-aged adults achieve success in this stage by contributing to future generations through parenthood, teaching, and community involvement. The ego integrity versus despair stage is seen in older adults. During this stage, some older adults live their lives with a sense of satisfaction and others see themselves as failures marked by despair and regret. The intimacy versus isolation stage is seen in young adults, in which they develop a sense of identity and a capacity to love and care for others. In the identity versus role confusion stage, an individual will have a marked preoccupation with his or her appearance and body image. - -A middle-aged adult contributes to future generations through parenthood, teaching, and community involvement. To which stage of Erikson's theory does this relate? 1 Ego integrity versus despair 2 Intimacy versus isolation 3 Identity versus role confusion 4 Generativity versus stagnation A Obeying the rules B Respecting authority C Maintaining social order At the conventional stage, individuals are concerned with conformity and loyalty. Obeying the rules, doing one's duty, showing respect for authority, and maintaining the social order are the behaviors demonstrated during the conventional stage. Changing law in terms of societal needs is observed at the postconventional level. In the preconventional level, individuals are culturally oriented to the labels of good or bad and right or wrong. These labels of good and bad are then integrated into their concept of physical or pleasurable consequences of their actions. - -Which behaviors are observed in individuals at a conventional level of moral development? Select all that apply. A Obeying the rules B Respecting authority C Maintaining social order D Changing law in terms of societal needs E Orienting culturally to the labels of good or bad 2 Down syndrome An infant's inability to control the head in an upright position when pulled to a sitting position indicates head lag. The nurse suspects Down syndrome in this neonate because infants with Down syndrome typically experience delays in certain areas of development, including head lag. Hydrocephalus is suspected if the infant has a head circumference more than 4 cm larger than the chest circumference, or if physiologic craniotabes is found in the infant. The presence of physiologic craniotabes in an infant may indicate congenital syphilis. An underlying thromboembolic condition may be suspected if the infant has hypertension. - -During the assessment of a newborn, the nurse pulls the infant from a lying to a sitting position and observes that the infant is unable to control the head in an upright position. Which problem does the nurse suspect? 1 Hydrocephalus 2 Down syndrome 3 Congenital syphilis 4 Thromboembolic condition 3 Secondary circular reactions The third stage of Piaget's sensorimotor phase involves secondary circular reactions, in which the child intentionally repeats an action in order to trigger a response. The first stage of sensorimotor phase comprises of reflexes, in which the infant will exhibit involuntary responses to stimuli, such as sucking, rooting, grasping, and crying. Replacement of reflexive behavior with voluntary acts is seen in primary circular reactions, which is the second stage of sensorimotor phase. The fourth stage is coordination of secondary schemas, in which the child starts showing intentional actions and uses previous behavioral achievements, primarily as the foundation for new intellectual skills. - -The parent of a child says, "My child is repeatedly banging the table to make loud sounds." Which sensorimotor stage of cognitive development best explains this behavior of the child? 1 Reflexes 2 Primary circular reactions 3 Secondary circular reactions 4 Coordination of secondary schemas 3 Blood glucose levels Skin piercing can cause bleeding, dermatitis, and metal allergy. A patient with diabetes mellitus has an increased risk of skin infection due to high blood glucose levels. Therefore, the nurse should monitor the adolescent's blood glucose levels to ensure safety. A change in thyroxin levels does not indicate that the client has a risk of bleeding, so the nurse does not assess thyroid levels. The nurse assesses hemoglobin levels when the patient has risk of anemia. The nurse will assess serum potassium levels if the adolescent has risk of dehydration, but not before skin piercing. - -During a routine checkup, the nurse learns that an adolescent patient is planning to get a navel piercing. What should the nurse assess in the adolescent to ensure safety? 1 Thyroxin levels 2 Hemoglobin levels 3 Blood glucose levels 4 Serum potassium levels A Reduced gag reflex B Loss of head control Cranial nerve deficits are evidenced by diminished or reduced gag reflex or loss of head control. Accumulated secretions are seen due to laryngospasm and tetany of the respiratory muscles. Breathlessness in vocalizations is observed in Guillain-Barré syndrome due to intercostal and phrenic nerve involvement. Paroxysmal muscle contractions are observed in patients with tetanus due to extreme sensitivity to external stimuli. - -The nurse who is caring for a child with botulism anticipates that the child's growth and development may be hampered due to cranial nerve deficits. Which signs presented by the child support the nurse's conclusion? Select all that apply. A Reduced gag reflex B Loss of head control C Accumulated secretions D Breathlessness in vocalizations E Paroxysmal muscle contractions 3 "I should protect my child's crib mattress with a plastic covering." 5 "I should ensure that my child's car seat is rear-facing in a seat with an airbag." Covering a crib mattress with plastic should be avoided, as it can expose the child to toxins. The nurse should instruct the mother to refrain from placing the infant in a seat with an air bag, as it can cause suffocation and trauma. The nurse should inform the mother to use cool mist vaporizers, as they prevent burns. The mother should provide a one-piece pacifier to the infant, as it prevents accidental swallowing of any small objects and aspiration. Placing the infant in a crib with a firm mattress and loose blankets helps to prevent suffocation. - -After collecting data on a 2-month-old infant, the nurse reinforces proper safety measures to the infant's mother to reduce the risk of injury in the infant. Which statements made by the infant's mother need correction? Select all that apply. 1 "I should use cool mist vaporizers if my baby has a cold." 2 "I should provide a one-piece pacifier to soothe my baby." 3 "I should protect my child's crib mattress with a plastic covering." 4 "I should place a firm mattress and loose blankets in my baby's bed." 5 "I should ensure that my child's car seat is rear-facing in a seat with an airbag." Correct 1 "My child will be able to take a few steps on tiptoe." Correct 4 "My child will be able to pick up objects without falling." Correct 5 "My child will be able to kick a ball without losing balance." The child starts taking a few steps on tiptoe at the age of 30 months, not 18 months. The child will be able to pick up objects without falling and kick a ball forward at the age of 24 months, not 18 months. The gross motor skills of an 18-month-old child are well developed, so the child can pull or push toys. The child should also be able to climb stairs with one hand held. - -The nurse is explaining which developmental milestones a child's parents should expect to see at the age of 18 months. Which statements made by the parents indicate the need for further instruction? Select all that apply. 1 "My child will be able to take a few steps on tiptoe." 2 "My child will be able to pull and push toys." 3 "My child will be able to climb stairs with assistance." 4 "My child will be able to pick up objects without falling." 5 "My child will be able to kick a ball without losing balance." Age of child in months minus 6 = Number of deciduous teeth. Therefore, the number of deciduous teeth is 10 - 6 = 4. - -How many deciduous teeth would be present in a 10-month-old infant? Record your answer as a whole number. ________ 3 "I should motivate my child to perform well in exams by comparing her to her siblings." 5 "I should teach my child to make decisions and understand consequences as an adult would." The nurse should suggest that the parents avoid comparing the adolescent to his or her siblings in order to prevent the development of an inferiority complex. The nurse should encourage parents to allow adolescent children to make their own choices and learn from them, even when those choices are not the choices an adult would make. The nurse should suggest that the parents respect their child and apologize to their child if they make a mistake. The nurse should suggest that the parents assist their child in selecting appropriate career goals and preparing for adult roles. The nurse should suggest that the parents make clear house rules and instruct the child to adhere to them, as it helps prevent the development of high-risk behavior - -The nurse is reinforcing best parenting practices to the parents of a 13-year-old child. Which statements made by the parent need correction? Select all that apply. 1 "I should apologize to my child when I am wrong." 2 "I should assist my child in selecting appropriate career goals." 3 "I should motivate my child to perform well in exams by comparing her to her siblings." 4 "I should strictly instruct my child to adhere to the house rules even though it hurts her." 5 "I should teach my child to make decisions and understand consequences as an adult would." 2 Transductive reasoning Transductive reasoning is observed in the preoperational stage, in which the individual thinks that because two events occur together, they cause each other. Inductive reasoning occurs in the stage of concrete operations. Sense of cause and effect is observed in the sensorimotor stage of cognitive development. Deductive and abstract reasoning is the characteristic of formal operations. - -Which is observed in the preoperational stage of Piaget's cognitive development? 1 Inductive reasoning 2 Transductive reasoning 3 Sense of cause and effect 4 Deductive and abstract reasoning 1 "My child can throw a ball." A child who is 8 to 12 months old is capable of throwing objects. Therefore, this statement made by the parent indicates that the 9-month-old infant has achieved the developmental milestone appropriate for the age. An infant who is 4 to 7 months old is capable of crawling backwards and can locate small objects. These actions can be observed in an infant who is 9 months old, but it does not indicate major developmental accomplishments as per its age. Showing jerky movements upon hearing loud noise indicates that the child is showing startle reflex, which is an involuntary reflex seen from the birth to 4 months of age. - -Which statement by the parent of a 9-month-old supports the nurse's conclusion that the infant displays developmental accomplishments appropriate for this age? 1 "My child can throw a ball." 2 "My child can crawl backwards." 3 "My child can locate small objects." 4 "My child shows jerky movements upon hearing loud sounds." C The crawling reflex disappears. D The posterior fontanel is closed. The crawling reflex disappears and the posterior fontanel is closed by 2 months of age. The doll's eye reflex disappears at 1 month of age. The primitive reflexes fade during the third month. The rooting reflex disappears at 4 months of age. - -Which physical findings can be observed in a 2-month-old infant? Select all that apply. A The doll's eye reflex is fading. B The rooting reflex disappears. C The crawling reflex disappears. D The posterior fontanel is closed. E The primitive reflexes are fading. Correct A Fatigue Correct C Urinary frequency Correct E Braxton Hicks contractions Due to the enhanced growth of the fetus and uterus in the third trimester, physiologic changes including fatigue, urinary frequency, and Braxton Hicks contractions are observed in pregnant women. Women in the first trimester may experience morning sickness, breast enlargement and tenderness, and fatigue. - -Which physiologic changes are observed in pregnant women during the third trimester? Select all that apply. A Fatigue B Morning sickness C Urinary frequency D Breast enlargement E Braxton Hicks contractions 4 Grasping objects voluntarily The 5-month-old infant's neurological development has reached the stage at which objects can be grasped voluntarily; this is considered a developmental milestone. The pincer grasp appears between 9 and 12 months of age. Sitting alone without support is usually accomplished at 6 to 8 months of age. The infant begins to crawl at 8 to 10 months of age. - -What behavior does the nurse expect a healthy 5-month-old infant to exhibit? 1 Using the pincer grasp 2 Sitting without support 3 Crawling across the floor 4 Grasping objects voluntarily 1 Encouraging the parents to stroke their infant Because the infant cannot be held, tactile stimulation helps meet the infant's needs and fosters bonding with the parents. An infant with an unrepaired myelomeningocele cannot be held in the arms. Referrals will be more appropriate at a later time. Although special feeding techniques are important in the postoperative period, they may not improve the parent-infant relationship. - -An infant with a myelomeningocele is scheduled for surgery to close the defect. Which nursing action best facilitates the parent-child relationship in the preoperative period? 1 Encouraging the parents to stroke their infant 2 Allowing the parents to hold their infant in their arms 3 Referring the parents to the Spina Bifida Association of America 4 Teaching the parents to use special techniques when feeding the infant 4 Cognitive impairment Congenital hypothyroidism is the result of insufficient secretion by the thyroid gland