HA Chapter 26

B. Measure head and chest circumference and length, then plot current weight, length, and head and chest circumferences on standardized growth charts.

A caregiver brings their 6-month-old infant to the clinic for a routine evaluation. At birth, the term newborn weighed 3.5 kg (7 lb 12 oz) and was 51 cm (20 in.) long. The infant now weighs 4.6 kg (10 lb 2 oz). Which assessments are most important for you to do next?

A. Obtain a thorough obstetrical and neonatal history and say, “I’m very worried that the baby hasn’t gained more weight. What are you feeding the baby?”

B. Measure head and chest circumference and length, then plot current weight, length, and head and chest circumferences on standardized growth charts.

C. Review the immunization history, administer the Denver II assessment, and ask if the caregiver has noticed any unusual patterns or behaviors.

D. Screen for domestic violence and focus on the neurological, cardiac, and abdominal portions of the physical examination.

C. Plot the weight and length on a standardized growth chart for a 7-week-old infant and compare with birth measurements and measurements on previous visits.

You are evaluating the growth pattern of a 5-month-old infant born at 27 weeks gestation. Which of the following actions will yield the most accurate assessment of growth for this infant?

A. Calculate how many kilocalories per day the infant is consuming, evaluate bowel movement pattern, plot measurements, and compare with the last two visits.

B. Determine whether the infant has gained at least 2.2 kg (5 lb) since birth, because infants should gain 500 g to 1 kg (1 to 2 lb) per month in the first 6 months.

C. Plot the weight and length on a standardized growth chart for a 7-week-old infant and compare with birth measurements and measurements on previous visits.

D. Plot the weight and length on a standardized growth chart for a 12-week-old infant and compare with birth measurements and measurements on previous visits.

A. Stiff neck with an arched back

The nurse is assessing a 2-month-old infant brought to the emergency department by their caregiver because the baby wasn’t eating well and “just looks sick.” Which of the following assessment findings is most worrisome?

A. Stiff neck with an arched back

B. Circumoral cyanosis noted when crying

C. PMI not palpable, anterior fontanelle bulges slightly when crying

D. Temperature 36.4°C (97.5°F), heart rate (HR) 160 beats/min, respiratory rate (RR) 38 breaths/min

B. A 6-week-old infant whose caregiver reports, “He’s vomited several times and he won’t take his bottle.” Temperature 36°C (96.8°F), HR 70 beats/min, RR 20 breaths/min. His lips are white. He is limp.

You are triaging infants who have presented to the emergency department on a Friday night. Which infant should you take in for treatment first?

A. A 2-week-old infant whose caregiver reports, “She just won’t stop crying. I’m so worried.” The cry is medium pitch; temperature 37°C (99°F), HR 160 beats/min, RR 50 breaths/min; abdomen moves with each breath.

B. A 6-week-old infant whose caregiver reports, “He’s vomited several times and he won’t take his bottle.” Temperature 36°C (96.8°F), HR 70 beats/min, RR 20 breaths/min. His lips are white. He is limp.

C. A 5-month-old infant with a stuffy nose who has been unusually fussy and has had three loose stools in the past 8 hours. Temperature 37.6°C (99.8°F), HR 140 beats/min, RR 45 breaths/min while crying.

D. An 8-month-old infant whose caregiver reports he choked on a bean at dinner. The bean came out after five back pats. He turns blue around his mouth when he cries. Temperature 37°C (98.6°F), HR 130 beats/min, RR 30 breaths/min.

B. A 4-week-old African American girl whose liver margins are barely palpable along the right costal margin; her kidneys are easily palpable; her ears look “funny.”

You evaluate all the following infants one morning in the clinic. Which should you refer for further assessment?

A. A 6-week-old boy whose caregivers recently immigrated from Thailand; his head lags when pulled up by his arms; he has several dark spots that look like bruises on his lower back and buttocks.

B. A 4-week-old African American girl whose liver margins are barely palpable along the right costal margin; her kidneys are easily palpable; her ears look “funny.”

C. A 4-month-old White boy with loud breath sounds throughout the lung fields; auscultation of the heart reveals a split S2.

D. A 9-month-old Latina who is fussy; her tympanic membrane is pearly gray and moves during pneumatic otoscopy.

D. Baby is sleeping supine in the crib, no pillow, one blanket, bottle lying beside baby, and a tiny dribble of milk at the corner of the mouth.

You are teaching a parenting class, and the caregivers are sharing baby pictures. Which picture indicates that the caregiver may need additional education?

A. Baby is playing peek-a-boo in the car seat, which is installed in the middle part of the rear seat.

B. Caregiver is brushing baby’s two front teeth while baby is splashing in the bathtub.

C. Baby (10 months old) is in the high chair self-feeding a banana cut into small pieces.

D. Baby is sleeping supine in the crib, no pillow, one blanket, bottle lying beside baby, and a tiny dribble of milk at the corner of the mouth.

C. “Has anything changed lately, such as shampoos, soaps, or laundry detergent?”

An infant has a new onset of rash but otherwise seems well. Which interview question is best when trying to pinpoint a possible cause?

A. “Was there a prolonged NICU stay?”

B. “What treatments have you given for the rash?”

C. “Has anything changed lately, such as shampoos, soaps, or laundry detergent?”

D. “How many diapers is the baby wetting per day, and what is the stool pattern?”

D. Encouraging caregivers to make an appointment with the pediatrician before the baby is born

Which of the following activities best facilitates anticipatory guidance?

A. Becoming very proficient in interviewing and performing the physical examination

B. Doing as much of the examination as possible with the infant in the caregiver’s lap

C. Recognizing and reporting signs of physical abuse and neglect

D. Encouraging caregivers to make an appointment with the pediatrician before the baby is born

D. When baby cries, caregiver says, “Shut up already.” Baby has a foul odor and looks dirty.

Which of the following infants has the most signs that point to possible abuse?

A. History of a long NICU stay for extreme prematurity; does not respond to loud clapping

B. Positive Ortolani and Barlow maneuver results; one leg looks shorter than the other

C. Small baby with large areas of denuded skin on the face and torso

D. When baby cries, caregiver says, “Shut up already.” Baby has a foul odor and looks dirty.

C. Has significant head lag, one ear is small and malformed, nipples are unusually close together

Which of the following 6-month-old infants has the most markers for a possible genetic disorder?

A. Has large ears, is in the 95th percentile for weight and height, babbles

B. Has large scaly plaques on face and torso, red reflex is absent in one eye, posterior fontanelle has closed

C. Has significant head lag, one ear is small and malformed, nipples are unusually close together

D. Sits up alone, cranial sutures are palpable, back of the head is flat