Question 1

The nurse is conducting an assessment for an infant during a well-baby check-up. When does the nurse expect the anterior fontanel to close?

Accepted Answer

The anterior fontanel, or soft spot on a baby's skull, typically closes between the ages of 12 to 18 months as the skull bones gradually fuse together.

Question 2

The nurse is preparing to conduct a physical assessment during a 12-month well-baby visit. In which position should a fearful infant be placed during this assessment?

Accepted Answer

Placing a fearful infant on the parent's or caregiver's lap during a physical assessment can help to soothe and comfort the child, making the examination process less stressful for the infant. This approach leverages the close and trusting relationship between the child and the caregiver to create a more secure environment for the assessment.

Question 3

The nurse is assessing a newborn who exhibits a poor rooting reflex. Which does the nurse anticipate the newborn will have difficulty with based on this assessment finding?

Accepted Answer

The rooting reflex is crucial for a newborn's ability to find and latch onto the breast or bottle for feeding. If this reflex is poor, the newborn will likely have difficulty with feeding.

Question 4

The nurse is assessing an infant whose length was 19 inches at birth. Which is his expected height at 6 months of age?

Accepted Answer

Infants typically grow about 1 inch per month for the first 6 months. Therefore, if the infant was 19 inches at birth, at 6 months, the infant would be expected to be about 25 inches long (19 inches + 6 inches = 25 inches).

Question 5

Which procedure should be performed first during the physical exam of the newborn?

Accepted Answer

Auscultation of the heart and lungs should be performed first during the physical exam of a newborn to assess for any immediate life-threatening conditions such as respiratory distress or congenital heart defects. This allows for prompt identification and management of any critical issues.

Question 6

A 2-week-old newborn is accompanied by the mother for the first visit to the clinic. The breastfeeding mother asks, "What should my baby's bowel movements look like?" Which response by the nurse is the most appropriate?

Accepted Answer

Breastfed babies typically have several soft, mustard-colored stools each day. This is considered normal and indicates healthy digestion and adequate milk intake.

Question 7

The nurse is conducting a 2 week well-baby visit for a newborn. Which immunizations are recommended for this newborn?

Accepted Answer

At a 2-week well-baby visit, the only recommended immunization is the Hepatitis B vaccine if it was not given at birth. The other vaccines listed are typically started at 2 months of age, not 2 weeks.

Question 8

Which medical term is used to describe the white cheeselike substance that covers the skin of newborns at birth?

Accepted Answer

Vernix caseosa is the correct term for the white, cheesy substance that covers the skin of newborns at birth. It serves as a protective layer.

Question 9

A 4-month-old infant presents with vomiting over the last 12 hours. Which is a good assessment of hydration status?

Accepted Answer

All of the options listed are valid methods to assess hydration status in infants. Skin turgor reflects the elasticity of the skin, which decreases with dehydration. Sunken fontanels can indicate dehydration, and the number of wet diapers provides a direct measure of fluid output compared to intake.

Question 10

The nurse is assessing an 11-month-old infant during a well-baby check-up. Which neurologic reflexes does the nurse expect the infant to demonstrate during the visit?

Accepted Answer

The answer of The nurse is assessing an 11-month-old infant...

Question 11

The nurse is assessing an infant whose birth weight was 7 lb 8 oz. Which is the expected weight at 1 year?

Accepted Answer

Typically, infants triple their birth weight by their first birthday. Since the infant's birth weight was 7 lb 8 oz, tripling this would be approximately 22 lb 8 oz, making option B (23 lb) the closest and expected weight at 1 year.

Question 12

The nurse is providing care to several newborn patients during well-baby visits. Which set of vital signs is the most abnormal?

Accepted Answer

A temperature of 39°C is considered a fever and is abnormal for a newborn. The heart rate and respirations are also on the higher end of normal, indicating potential distress or infection.

Question 13

Which action by the nurse is most appropriate when performing the Barlow-Ortolani maneuver to assess for congenital hip dislocation on a 2-week-old newborn?

Accepted Answer

The Barlow-Ortolani maneuver is a clinical test used to assess for congenital hip dislocation in newborns. The correct technique involves placing the first two fingers over the greater trochanter and the thumb over the inner thighs. This positioning allows the examiner to feel for the movement of the head of the femur, indicating potential dislocation or instability in the hip joint.

Question 14

The nurse is assessing a newborn who exhibits continued extrusion of the tongue. Which diagnosis does the nurse anticipate based on this data?

Accepted Answer

Continued extrusion of the tongue is a common characteristic of Down syndrome, a genetic disorder caused by the presence of all or part of a third copy of chromosome 21. This feature is not typically associated with Tetralogy of Fallot, Diabetes insipidus, or Diabetes mellitus.

Question 15

Which is a key gross motor change that occurs during the first year of life?

Accepted Answer

Beginning to walk is a significant gross motor milestone typically achieved in the first year of life, marking a major development in a child's mobility.

Question 16

Which technique will the nurse use when eliciting the Moro reflex during a newborn assessment?

Accepted Answer

The Moro reflex, also known as the startle reflex, is elicited by jarring the bassinette or allowing the newborn's head to drop back slightly in a controlled environment. This action simulates a falling sensation, causing the newborn to quickly extend and then flex their arms and legs in a protective response.

Question 17

The nurse is conducting a newborn assessment. The lack of which reflex is often associated with spinal cord problems?

Accepted Answer

The trunk incurvation reflex, also known as the Galant reflex, involves stroking along one side of the spine while the newborn is in a prone position, causing the pelvis to tilt towards the stimulated side. Its absence can indicate spinal cord issues.

Question 18

Which term is used to describe the condition in which the foreskin of an uncircumcised penis remains tight and cannot be retracted?

Accepted Answer

Phimosis is the condition where the foreskin of an uncircumcised penis is too tight to be pulled back over the head of the penis.

Question 19

Most states have mandatory phenylketonuria (PKU) screening several days after birth to rule out phenylalanine amino acids in blood that can cause which disorder?

Accepted Answer

Phenylketonuria (PKU) is a genetic disorder that results in the body's inability to break down the amino acid phenylalanine. High levels of phenylalanine can lead to intellectual disability if not treated, which is why newborns are screened for PKU to start dietary management if necessary.

Question 20

A newborn's health history reveals an Apgar score of 4 to 7. Which condition is inferred with this score?

Accepted Answer

An Apgar score of 4 to 7 indicates a guarded condition, suggesting the newborn may require medical intervention but is not in a critical state.

Quiz 15: Assessing the Newborn and Infant