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What may be a clinical manifestation of failure to thrive (FTT) in a 13-month-old include?
- A. Irregularity in activities of daily living
- B. Preferring solid food to milk or formula
- C. Weight that is at or below the 10th percentile
- D. Appropriate achievement of developmental landmarks
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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An infant, age 6 months, has six teeth. The nurse should recognize that this is what?
- A. Normal tooth eruption
- B. Delayed tooth eruption
- C. Unusual and dangerous
- D. Earlier than expected tooth eruption
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The nurse is performing an assessment on a 10-week-old infant. The nurse understands that the developmental characteristic of hearing at this age is which?
- A. The infant responds to his own name.
- B. The infant localizes sounds by turning his head directly to the sound.
- C. The infant turns his head to the side when sound is made at the level of the ear.
- D. The infant locates sound by turning his head to the side and then looking up or down.
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The mother of a 3-month-old breastfed infant asks about giving her baby water because it is summer and very warm. What should the nurse tell her?
- A. Fluids in addition to breast milk are not needed.
- B. Water should be given if the infant seems to nurse longer than usual.
- C. Clear juices are better than water to promote adequate fluid intake.
- D. Water once or twice a day will make up for losses resulting from environmental temperature.
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The nurse is caring for an infant who was born 24 hr ago to a mother who received no prenatal care. The infant is a poor feeder but sucks avidly on his hands. Clinical manifestations also include hyperactive reflexes, tremors, sneezing, and a high-pitched shrill cry. What does the nurse consider as a possible diagnosis for this infant?
- A. Seizure disorder
- B. Narcotic withdrawal
- C. Placental insufficiency
- D. Meconium aspiration syndrome
Correct Answer: B
Rationale: In this case, the infant's symptoms are consistent with narcotic withdrawal. Infants exposed to drugs in utero may display withdrawal symptoms starting around 12 to 24 hours post-birth. The presentation often includes hyperactive reflexes, tremors, sneezing, high-pitched shrill cry, poor feeding, and sucking avidly on hands. Signs such as loose stools, tachycardia, fever, projectile vomiting, sneezing, and generalized sweating are common. These symptoms are not indicative of a seizure disorder. Placental insufficiency typically leads to a small-for-gestational-age child, which is not mentioned in the scenario. Meconium aspiration syndrome primarily presents with respiratory distress, not the symptoms described in this case.
Which medication should the nurse expect to administer to a child with an acute sickle cell pain crisis?
- A. Meperidine (Demerol)
- B. Morphine
- C. Acetaminophen (Tylenol)
- D. Ibuprofen (Motrin)
Correct Answer: B
Rationale: In the management of acute sickle cell pain crisis in children, morphine is the preferred medication due to its effectiveness in providing pain relief. Meperidine (Demerol) is less commonly used in this scenario because of its potential for neurotoxicity with repeated doses. Acetaminophen (Tylenol) and Ibuprofen (Motrin) are not typically sufficient for managing the severe pain associated with sickle cell crises and are not the first-line treatment options.