CH. 11 INFANTS

1. You're assessing a 10-month-old infant. You note on examination the anterior fontanelle is open. The nurse will:

• Document this as an abnormal finding because this fontanelle should close at 2 months.

• Document this as a normal finding because this fontanelle closes at about 18 months.

• Document this as a normal finding because this fontanelle closes at about 12 months.

• Document this as an abnormal finding because this fontanelle should close at 6 months.

Answer explanation

This is a normal finding in a 10-month-old infant. The anterior fontanelle closes around 18 months.

An infant weighed 8 lbs. at birth. How many lbs. should the infant weigh at 6 months?

• 24 lbs.

• 10 lbs.

• 16 lbs.

• 32 lbs.

Answer explanation

The birth weight should DOUBLE at 6 months and triple at 1 year. Therefore, if the infant weighed 8 lbs. at birth, he or she should weigh 16 lbs. at 6 months.

An infant was 21 inches at birth. How many inches should the infant be at 6 months?

• 30-36 inches

• 24-27 inches

• 23-25 inches

• 22-24 inches

Answer explanation

At 6 months the infant should grow about 1/2 to 1 inch every month. Therefore, if the infant was 21 inches at birth, he or she should be around 24-27 inches at 6 months.

During an assessment of a 10-month-old infant, you note on the infant’s gum line two teeth that have erupted. These are the only teeth present in the infant’s mouth. These teeth are known as the?

• Lower central incisors

• Upper central incisors

• Lateral incisors

• Canine

Answer explanation

The lower central incisors are the first teeth that erupt in an infant’s mouth and this tends to occur by 10 months of age.

You’re assessing a 2-month-old infant. Which finding below is a normal milestone that should be reached by this infant at this age?

• The infant can sit up with support.

• The infant holds a rattle.

• The infant smiles at its parent.

• The infant is afraid of strangers.

Answer explanation

An infant at this age should be smiling. All the other options are too advanced for this infant at this age.

At what age would you educate the parents of an infant to stop swaddling the infant because the infant will be able to roll over onto its tummy?

• 2 months

• 4 months

• 6 months

• 10 months

Answer explanation

An infant should not be swaddled once they can roll over, which is about 4 months.

At 8-9 months of age, what milestone should an infant be able to successfully perform?

• Begin walking

• Say several words like mama or dada

• Sit without support.

• Follow basic commands

Answer explanation

The answer is C. The infant at 8-9 months should be able to sit without support. The other options are milestones for a 10-12 month old.

A 6.5-month-old is hospitalized. What nursing intervention will you include in their plan of care?

• Separate the infant and parent during procedures

• Maintain the infant’s daily rituals and routines.

• Allow the infant to examine equipment before usage.

• Maintain the same nursing staff during each shift.

Answer explanation

The answer is D. At this age, stranger anxiety begins to develop. Therefore (if possible), the same nursing staff should be used for providing care. Option A would increase anxiety in the infant and options C and B are for older children.

You note a 10-month-old is using the pincer grasp. Which option below best describes this milestone?

• The infant is able to grasp large objects with the palm and forefingers.

• The infant is able to grasp small objects with the index finger and thumb.

• The infant is able to grasp small and large objects with the middle finger and thumb.

• The infant is able to grasp large objects with the palm and thumb.

Answer explanation

The answer is B. The infant is able to grasp small objects with the index finger and thumb.

You’re developing a plan of care for an infant and you include activities for play. The play activities include hiding a toy and letting the infant look for it along with playing peek-a-boo. Which infant below would best benefit from this type of play?

• 6-month-old

• 2-month-old

• 9-month-old

• 4-month-old

Answer explanation

The answer is C: 9-month-old. Infants at this age understand object permanence. This is when an object can be hidden, and the infant understands it still exists. This happens around 8-9 months.