Module 1 Exam
1. 1.ID: 22104063291
A nurse is providing information to a group of pregnant clients and their partners about
the psychosocial
... [Show More] development of an infant. Using Erikson's theory of psychosocial
development, what should the nurse tell the group about the infants?
A. Rely on the fact that their needs will be met Correct
B. Tolerate a great deal of frustration and discomfort to develop a
healthy personality
C. Ignore needs for short periods to develop a healthy personality
D. Experience frustration to allow an infant to cry for a while before
meeting his or her needs
Rationale: According to Erikson’s theory of psychosocial development, infants struggle
to establish a sense of basic trust rather than a sense of basic mistrust in their world,
their caregivers, and themselves. If provided with consistent satisfying experiences that
are delivered in a timely manner, infants come to rely on the fact that their needs are
met and that, in turn, they will be able to tolerate some degree of frustration and
discomfort until those needs are met. This sense of confidence is an early form of trust
and provides the foundation for a healthy personality. Therefore the other options are
incorrect.
Test-Taking Strategy: Eliminate the option that contains the closed-ended
word "must." Eliminate the options that are comparable or alike and indicate that
experiencing frustration is necessary.
Review: Erikson’s theory of psychosocial development as it relates to the infant.
Level of Cognitive Ability: Applying
Client Needs: Health Promotion and Maintenance
Integrated Process: Teaching and Learning
Content Area: Developmental Stages
Giddens Concepts: Development, Reproduction
HESI Concepts: Developmental, Sexuality/Reproduction
Awarded 99.0 points out of 99.0 possible points.
2. 2.ID: 22104063288
A nurse is weighing a breastfed 6-month-old infant who has been brought to the
pediatrician's office for a scheduled visit. The infant's weight at birth was 6 lb 8 oz (2.9
kg). The nurse notes that the infant now weighs 13 lb (5.9 kg). Which action should the
nurse take?
A. Tell the mother that the infant's weight is increasing as
expected Correct
B. Tell the mother to decrease the daily number of feedings because
the weight gain is excessive
C. Tell the mother that semisolid foods should not be introduced until
the infant's weight stabilizesD. Tell the mother that the infant should be switched from breast milk
to formula because the weight gain is inadequate
Rationale: Infants usually double their birth weight by 6 months and triple it by 1 year
of age. If the infant is 6 lb 8 oz (2.9 kg), at birth, a weight of 13 lb (5.9 kg) at 6 months
of age is to be expected. Semisolid foods are usually introduced between 4 and 6
months of age.
Test-Taking Strategy: Focus on the subject in the question, the current weight of the
infant. Recalling that infants double their weight by 6 months of age will direct you to
the correct option.
Review: The growth rate of an infant.
Level of Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Implementation
Content Area: Developmental Stages
Giddens Concepts: Development, Nutrition
HESI Concepts: Developmental, Nutrition
Awarded 99.0 points out of 99.0 possible points.
3. 3.ID: 22104063285
A nurse performing a physical assessment of a 12-month-old infant notes that the
infant's head circumference is the same as the chest circumference. Based on this
finding, what should the nurse do?
A. Suspect the presence of hydrocephalus
B. Suggest to the pediatrician that a skull x-ray be performed
C. Tell the mother that the infant is growing faster than expected
D. Document these measurements in the infant's health-care
record Correct
Rationale: The head circumference growth rate during the first year is approximately
0.4 inch (1 cm) per month. By 10 to 12 months of age, the infant’s head and chest
circumferences are equal. Therefore, suspecting the presence of hydrocephalus, telling
the mother that the infant is growing faster than expected, and suggesting that a skull
x-ray be performed are incorrect.
Test-Taking Strategy: Eliminate the options that are comparable or alike and
indicate that the infant has a physiological problem.
Review: The expected growth rate of an infant.
Level of Cognitive Ability: Applying
Client Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process/Implementation
Content Area: Developmental Stages
Giddens Concepts: Clinical Judgment, Development
HESI Concepts: Clinical Decision-Making/Clinical Judgment, Developmental
Awarded 99.0 points out of 99.0 possible points.
4. 4.ID: 22104063282A new mother asks the nurse, "I was told that my infant received my antibodies during
pregnancy. Does that mean that my infant is protected against infections?" Which
statement should the nurse make in response to the mother?
A. "Yes, your infant is protected from all infections."
B. "If you breastfeed, your infant is protected from infection."
C. "The transfer of your antibodies protects your infant until the infant
is 12 months old."
D. "The immune system of an infant is immature, and the infant is at
risk for infection." Correct
Rationale: Transplacental transfer of maternal antibodies supplements the infant’s
weak response to infection until approximately 3 to 4 months of age. Although the
infant begins to produce immunoglobulin (Ig) soon after birth, by 1 year of age the
infant has only approximately 60% of the adult IgG level, 75% of the adult IgM level,
and 20% of the adult IgA level. Breast milk transmits additional IgA protection. The
activity of T-lymphocytes also increases after birth. Even though the immune system
matures during infancy, maximal protection against infection is not achieved until early
childhood. This immaturity places the infant at risk for infection.
Test-Taking Strategy: Eliminate the option containing the closed-ended word "all."
Recalling that breastfeeding alone does not protect the infant from infection will assist
you in eliminating the option that suggests breastfeeding protects the infant. From the
remaining options, use the strategy of selecting the umbrella option to answer
correctly.
Review: The physiological concepts related to the maturity of body systems in an
infant.
Level of Cognitive Ability: Applying
Client Needs: Safe and Effective Care Environment
Integrated Process: Nursing Process/Implementation
Content Area: Developmental Stages
Giddens Concepts: Development, Immunity
HESI Concepts: Developmental, Immunity
Awarded 99.0 points out of 99.0 possible points.
5. 5.ID: 22104063279
A nurse is assessing the language development of a 9-month-old infant. Which
developmental milestones does the nurse expect to note in an infant of this
age? Select all that apply.
A. The infant babbles.
B. The infant says "Mama." Correct
C. The infant smiles and coos.
D. The infant babbles single consonants.
E. Words begin to have meaning for the infant. Correct
F. The infant strings vowels and consonants together. Correct
Rationale: An 8- to 9-month-old infant can string vowels and consonants together. The
first words, such as "Mama," "Daddy," "bye-bye," and "baby," begin to have meaning. A1- to 3-month-old infant produces cooing sounds. Babbling is common in a 3- to 4-
month-old. Single-consonant babbling occurs between 6 and 8 months of age.
Test-Taking Strategy: Focus on the subject, the age of the infant. Recalling the
language development that occurs during infancy will direct you to the correct option.
Remember that an 8- to 9-month-old infant can string vowels and consonants together.
Review: The developmental milestones related to language development in an
infant.
Level of Cognitive Ability: Applying
Client Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process/Assessment
Content Area: Developmental Stages
Giddens Concepts: Communication, Development
HESI Concepts: Communication, Developmental
Awarded 33.0 points out of 99.0 possible points.
6. 6.ID: 22104063276
The mother of a 9-month-old infant calls the nurse at the pediatrician's office, tells the
nurse that her infant is teething, and asks what can be done to relieve the infant's
discomfort. What should the nurse instruct the mother to do?
A. Schedule an appointment with a dentist for a dental evaluation
B. Rub the infant's gums with baby aspirin that has been dissolved in
water
C. Obtain an over-the-counter (OTC) topical medication for gum-pain
relief
D. Give the infant cool liquids or a Popsicle and hard foods such as dry
toast Correct
Rationale: Although sometimes asymptomatic, teething is often signaled by behaviors
such as nighttime awakening, daytime restlessness, increase in nonnutritive sucking,
excess drooling, and temporary loss of appetite. Some degree of discomfort is normal. It
is unnecessary to obtain a dental evaluation, but a health-care professional should
further investigate any incidence of increased temperature, irritability, ear-tugging, or
diarrhea. The nurse may suggest that the mother provide cool liquids and hard foods
such as dry toast, Popsicles, or a frozen bagel for chewing to relieve discomfort. Hard,
cold teethers and ice wrapped in cloth may also provide comfort for inflamed gums. OTC
medications for gum relief should only be used as directed by the healthcare provider.
Home remedies such as rubbing the gums with aspirin should be discouraged, but
acetaminophen (Tylenol), administered as directed for the child’s age, can relieve
discomfort.
Test-Taking Strategy: Focus on the subject, teething and relieving the infant’s
discomfort. First recall that it is unnecessary to consult with a dentist. Next, eliminate
the options that are comparable or alike and involve administering medication to the
infant.
Review: The measures that will relieve the discomfort of teething.
Level of Cognitive Ability: ApplyingClient Needs: Physiological Integrity
Integrated Process: Nursing Process/Implementation
Content Area: Developmental Stages
Giddens Concepts: Comfort, Development
HESI Concepts: Comfort—Pain, Developmental
Awarded 99.0 points out of 99.0 possible points.
7. 7.ID: 22104063273
A nurse is teaching the mother of an 11-month-old infant how to clean the infant's
teeth. What should the nurse tell the mother to do?
A. Use water and a cotton swab and rub the teeth Correct
B. Use diluted fluoride and rub the teeth with a soft washcloth
C. Use a small amount of toothpaste and a soft-bristle toothbrush
D. Dip the infant's pacifier in maple syrup so that the infant will suck
Rationale: Because the primary teeth are used for chewing until the permanent teeth
erupt and because decay of the primary teeth often results in decay of the permanent
teeth, dental care must be started in infancy. The mother can use cotton swabs or a soft
washcloth to clean the teeth. Appropriate amounts of fluoride are necessary for the
development of healthy teeth, but infants usually receive fluoride when formula and
cereal are mixed with fluoridated water or through fluoride supplementation. Toothpaste
is not recommended because infants tend to swallow it, possibly ingesting excessive
amounts of fluoride. Dipping the infant’s pacifier in maple syrup is unacceptable
because of the risk of tooth decay.
Test-Taking Strategy: Focus on the subject, cleaning the teeth. Recalling the risk
associated with tooth decay will help eliminate the option that identifies the use of
maple syrup. To select from the remaining options, noting that the client in the question
is an infant will direct you to the correct option.
Review: The procedure for cleaning teeth in an infant.
Level of Cognitive Ability: Applying
Client Needs: Health Promotion and Maintenance
Integrated Process: Teaching and Learning
Content Area: Developmental Stages
Giddens Concepts: Client Education, Development
HESI Concepts: Developmental, Teaching and Learning/Client Education
Awarded 99.0 points out of 99.0 possible points.
8. 8.ID: 22104063270
A nurse provides information about feeding to the mother of a 6-month-old infant.
Which statement by the mother indicates an understanding of the information?
A. "I can mix the food in my infant's bottle if he won't eat the food."
B. "Fluoride supplementation is not necessary until permanent teeth
come in."
C. "Egg white should not be given to my infant because of the risk for
an allergy." CorrectD. "Meats are really important for iron, and I should start feeding
meats to my infant right away."
Rationale: Egg white, even in small quantities, is not given to the infant until the end
of the first year of life because it is a common food allergen. Fluoride supplementation
may be needed beginning at of 6 months, depending on the infant’s intake of
fluoridated tap water. Foods are never mixed with formula in the bottle. It may be
difficult for the infant to consume the formula, and it will also be difficult to determine
the infant’s intake of the formula. Solid foods may be introduced into the diet when the
infant is 5 to 6 months old. Rice cereal may be introduced first because of its low
allergenic potential; or, depending on the pediatrician’s preference, fruits and
vegetables may be introduced first.
Test-Taking Strategy: Note the strategic words “indicates an understanding of the
information.” Read each option carefully and think about the principles associated with
feeding and nutrition. Recalling that allergy is a concern will direct you to the correct
option.
Review: The principles related to nutrition in an infant.
Level of Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Evaluation
Content Area: Nutrition
Giddens Concepts: Development, Nutrition
HESI Concepts: Developmental, Nutrition
Awarded 99.0 points out of 99.0 possible points.
9. 9.ID: 22104063237
A nurse provides instructions to a mother of a newborn infant who weighs 7 lb 2 oz (3.2
kg) about car safety. What should the nurse tell the mother?
A. To secure the infant in the middle of the back seat in a rear-facing
infant safety seat Correct
B. To place the infant in a booster seat in the front seat of the car with
the shoulder and lap belts secured around the infant
C. That it is acceptable to place the infant in the front seat in a rearfacing infant safety seat as long as the car has passenger-side air bags
D. That because of the infant's weight it is acceptable to hold the
infant as long as the mother and infant are sitting in the middle of the back
seat of the car
Rationale: Infants should not be restrained in the front seats of cars. If a passengerside air bag is deployed, the air bag may severely jolt an infant safety seat, harming the
infant. Infants weighing less than 20 lb (9.1 kg) and those younger than 1 year should
always be in the middle of the back seat in a rear-facing car safety seat. An infant must
be placed in an infant safety seat and is never to be held by another person when riding
in a car.
Test-Taking Strategy: Eliminate the options that are comparable or alike and
recommend placing the infant in the front seat. To select from the remaining options,keep safety in mind and remember that the infant should never be held and should be
placed in an infant safety seat.
Review: car safety principles for an infant.
Level of Cognitive Ability: Applying
Client Needs: Safe and Effective Care Environment
Integrated Process: Teaching and Learning
Content Area: Safety
Giddens Concepts: Development, Safety
HESI Concepts: Developmental, Safety
Awarded 99.0 points out of 99.0 possible points.
10. 10.ID: 22104063234
A nurse provides instructions to a mother about crib safety for her infant. Which
statement by the mother indicates a need for further instructions?
A. "I need to keep large toys out of the crib."
B. "The drop side needs to be impossible for my infant to release."
C. "Wood surfaces on the crib need to be free of splinters and cracks."
D. "The distance between the slats needs to be no more than 4 inches
(10 cm) wide to prevent entrapment of my infant's head or body [Show Less]