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Chapter 11: Health Problems of Infants
Chapter 11: Health Problems of Infants
MULTIPLE CHOICE
1. Recent studies indicate that a deficiency of which vitamin correlates with increased
morbidity and mortality in children with measles?
a. A
b. C
c. Niacin
d. Folic acid
ANS: A
Vitamin A deficiency is correlated with increased morbidity and mortality in children with
measles. This vitamin deficiency also is associated with complications from diarrhea, and
infections are often increased in infants and children with vitamin A deficiency. No correlation
exists between vitamins C, niacin, or folic acid and measles.
2. Which vitamin is recommended for all women of childbearing age to reduce the risk of
neural tube defects such as spina bifida?
a. A
b. C
c. Niacin
d. Folic acid
ANS: D
The vitamin supplement that is recommended for all women of childbearing age is a daily
dose of 0.4 mg of folic acid. Folic acid taken before conception and during pregnancy can
reduce the risk of neural tube defects by 70%. No correlation exists between vitamins A, C,
or folic acid and neural tube defects.
3. A nurse is assessing a child with kwashiorkor disease. Which assessment findings should
the nurse expect?
a. Thin wasted extremities with a prominent abdomen
b. Constipation
c. Elevated hemoglobin
d. High levels of protein
ANS: A
The child with kwashiorkor has thin, wasted extremities and a prominent abdomen from
edema (ascites). Diarrhea (persistent diarrhea malnutrition syndrome) not constipation
commonly occurs from a lowered resistance to infection and further complicates the
electrolyte imbalance. Anemia and protein deficiency is a common finding in malnourished
children with kwashiorkor.
4. A nurse is preparing to accompany a medical mission’s team to a third world country.
Marasmus is seen frequently in children 6 months to 2 years in this country. Which
symptoms should the nurse expect for this condition?
a. Loose, wrinkled skin
b. Edematous skin
c. Depigmentation of the skin
d. Dermatoses
ANS: A
Marasmus is characterized by gradual wasting and atrophy of body tissues, especially of
subcutaneous fat. The child appears to be very old, with loose and wrinkled skin, unlike the
child with kwashiorkor, who appears more rounded from the edema. Fat metabolism is less
impaired than in kwashiorkor; thus, deficiency of fat-soluble vitamins is usually minimal or
absent. In general, the clinical manifestations of marasmus are similar to those seen in
kwashiorkor with the following exceptions: With marasmus, there is no edema from
hypoalbuminemia or sodium retention, which contributes to a severely emaciated
appearance; no dermatoses caused by vitamin deficiencies; little or no depigmentation of
hair or skin; moderately normal fat metabolism and lipid absorption; and a smaller head size
and slower recovery after treatment.
5. Rickets is caused by a deficiency in:
a. vitamin A.
b. vitamin C.
c. vitamin D and calcium.
d. folic acid and iron.
ANS: C
Fat-soluble vitamin D and calcium are necessary in adequate amounts to prevent the
development of rickets. No correlation exists between vitamins A, C, folic acid, or iron and
rickets.
6. A nurse is preparing to administer an oral iron supplement to a hospitalized infant. Which
should not be given simultaneously with the iron supplement?
a. Milk
b. Multivitamin
c. Fruit juice
d. Meat, fish, poultry
ANS: A
Many foods interfere with iron absorption and should be avoided when the iron is consumed.
These foods include phosphates found in milk, phytates found in cereals, and oxalates found
in many vegetables. Multivitamins may contain iron; no contraindication exists to taking the
,two together. Vitamin C–containing juices enhance the absorption of iron. Meat, fish, and
poultry do not have an effect on absorption.
7. Parents report that they have been giving a multivitamin to their 1-year-old infant. The
nurse counsels the parents that which vitamin can cause a toxic reaction at a low dose?
a. Niacin
b. B6
c. D
d. C
ANS: C
Hypervitaminosis of vitamin D presents the greatest problem because this fat-soluble vitamin
is stored in the body. Vitamin D is the most likely of all vitamins to cause toxic reactions in
relatively small overdoses. The water-soluble vitamins, primarily niacin, B6, and C, can also
cause toxicity but not at the low dose that occurs with vitamin D.
PTS: 1 DIF: Cognitive Level: Understand REF: 355
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity
8. The nurse is helping parents achieve a more nutritionally adequate vegetarian diet for their
child. Which is most likely lacking in their particular diet?
a. Fat
b. Protein
c. Vitamins C and A
d. Complete protein
ANS: D
The vegetarian diet can be extremely healthy, meeting the overall nutrition objectives for
Healthy People. Parents should be taught about food preparation to ensure that complete
proteins are available for growth. When parents use a strict vegetarian diet, likelihood exists
of inadequate protein for growth and calories for energy. Fat and vitamins C and A are readily
available from vegetable sources. Plant proteins are available. Foods must be combined to
provide complete proteins for growth.
PTS: 1 DIF: Cognitive Level: Understand REF: 356
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity
9. Which describes marasmus?
a. Deficiency of protein with an adequate supply of calories
b. Not confined to geographic areas where food supplies are inadequate
c. Syndrome that results solely from vitamin deficiencies
d. Characterized by thin, wasted extremities and a prominent abdomen resulting from edema
(ascites)
ANS: B
Marasmus is a syndrome of emotional and physical deprivation. It is not confined to
geographic areas were food supplies are inadequate. Marasmus is a deficiency of both
protein and calories. It is characterized by gradual wasting and atrophy of body tissues,
especially of subcutaneous fat. The child appears very old, with flabby and wrinkled skin.
10. Although infants may be allergic to a variety of foods, the most common allergens are:
a. fruit and eggs.
b. fruit, vegetables, and wheat.
c. cow’s milk and green vegetables.
d. eggs, cow’s milk, and wheat.
ANS: D
Milk products, eggs, and wheat are three of the most common food allergens. Ingestion of
these products can cause sensitization and, with subsequent exposure, an allergic reaction.
Eggs are a common allergen, but fruit is not. Wheat is a common allergen, but fruit and
vegetables are not. Cow’s milk is a common allergen, but green vegetables are not.
11. Cow’s milk allergy (CMA) is diagnosed in a 6-month-old infant. Which should the nurse
recommend as a substitute formula?
a. Nutramigen
b. Goat’s milk
c. Similac
d. Enfamil
ANS: A
Treatment of CMA is elimination of cow’s milk–based formula and all other dairy products.
For infants fed cow’s milk formula, this primarily involves changing the formula to a casein
hydrolysate milk formula (Pregestimil, Nutramigen, or Alimentum). Goat’s milk (raw) is not an
acceptable substitute because it cross-reacts with cow’s milk protein, is deficient in folic acid,
has a high sodium and protein content, and is unsuitable as the only source of calories.
Cow’s milk protein is contained in both Enfamil and Similac.
PTS: 1 DIF: Cognitive Level: Apply REF: 360-361
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity
12. A nurse is teaching parents about prevention and treatment of colic. Which should the
nurse include in the teaching plan?
a. Avoid use of pacifiers.
b. Eliminate all second-hand smoke contact.
c. Lay infant flat after feeding.
d. Avoid swaddling the infant.
ANS: B
To prevent and treat colic, teach parents that if household members smoke, avoid smoking
near infant; preferably confine smoking activity to outside of home. A pacifier can be
introduced for added sucking. The infant should be swaddled tightly with a soft, stretchy
blanket and placed in an upright seat after feedings.
PTS: 1 DIF: Cognitive Level: Apply REF: 367
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity
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