Nokea
The nurse is interviewing the parents of a 4-month-old boy brought to the hospital emergency department. The infant is dead, and no attempt at resuscitation is made. The parents state that the baby was found in his crib with a blanket over his head, lying face down in bloody fluid from his nose and mouth. The nurse might initially suspect his death was caused by what?
- A. Suffocation
- B. Child abuse
- C. Infantile apnea
- D. Sudden infant death syndrome (SIDS)
Correct Answer: D
Rationale: The description of how the child was found in the crib is suggestive of SIDS. The nurse is careful to tell the parents that a diagnosis cannot be confirmed until an autopsy is performed.
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A new parent asks the nurse, How can diaper rash be prevented? What should the nurse recommend?
- A. Wash the infant with soap before applying a thin layer of oil.
- B. Clean the infant with soap and water every time diaper is changed.
- C. Wipe stool from the skin using water and a mild cleanser.
- D. When changing the diaper, wipe the buttocks with oil and powder the creases.
Correct Answer: C
Rationale: Change the diaper as soon as it becomes soiled. Gently wipe stool from the skin with water and mild soap. The skin should be thoroughly dried after washing. Applying oil does not create an effective barrier. Over washing the skin should be avoided, especially with perfumed soaps or commercial wipes, which may be irritating. Baby powder should not be used because of the danger of aspiration.
Which term refers to the relative lactase deficiency observed in preterm infants of less than 34 weeks of gestation?
- A. Congenital lactase deficiency
- B. Primary lactase deficiency
- C. Secondary lactase deficiency
- D. Developmental lactase deficiency
Correct Answer: D
Rationale: Developmental lactase deficiency refers to the relative lactase deficiency observed in preterm infants of less than 34 weeks of gestation. Congenital lactase deficiency occurs soon after birth after the newborn has consumed lactose-containing milk. Primary lactase deficiency, sometimes referred to as late-onset lactase deficiency, is the most common type of lactose intolerance and is manifested usually after 4 or 5 years of age. Secondary lactase deficiency may occur secondary to damage of the intestinal lumen, which decreases or destroys the enzyme lactase.
Rickets is caused by a deficiency in what?
- A. Vitamin A
- B. Vitamin C
- C. Folic acid and iron
- D. Vitamin D and calcium
Correct Answer: D
Rationale: Fat-soluble vitamin D and calcium are necessary in adequate amounts to prevent rickets. No correlation exists between rickets and folic acid, iron, or vitamins A and C.
Which one of the following strategies might be recommended for an infant with failure to thrive (FTT) to increase caloric intake?
- A. Vary the schedule for routine activities on a daily basis.
- B. Be persistent through 10 to 15 minutes of food refusal.
- C. Avoid solids until after the bottle is well accepted.
- D. Use developmental stimulation by a specialist during feedings.
Correct Answer: B
Rationale: Calm perseverance through 10 to 15 minutes of food refusal will eventually diminish negative behavior. Children with FTT need a structured routine to help establish rhythmicity in their activities of daily living. Many children with FTT are fed exclusively from a bottle. Solids should be fed first. Stimulation is reduced during mealtimes to maintain the focus on eating.
What is most descriptive of atopic dermatitis (AD) (eczema) in an infant?
- A. Easily cured
- B. Worse in humid climates
- C. Associated with hereditary allergies
- D. Related to upper respiratory tract infections
Correct Answer: C
Rationale: AD is a type of pruritic eczema that usually begins during infancy and is associated with allergy with a hereditary tendency. Approximately 50% of children with AD develop asthma. AD can be controlled but not cured. Manifestations of the disease are worse when environmental humidity is lower. AD is not associated with respiratory tract infections.