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Chapter 08: Andrew Hocktochee: Failure to Thrive
1. The nurse is conducting a well-child check on a 6-month-old infant when the parent states, "I
am so glad we can switch to whole milk now. The cost of infant formula is really high." What
is the nurse's best response?
A. "You are right about that; this switch should save your family a lot of money."
B. "Do not forget to offer iron supplements to your infant with each bottle."
C. "The current recommendation is for infants to remain on breast milk or formula
until 12 months of age."
D. "In addition to the whole milk, you can begin offering solid foods such as fruits
and vegetables 2 to 3 times a day."
ANS: C
Rationale: The American Academy of Pediatrics recommends that breast milk or infant
formula serve as the primary source of nutrition for infants until 12 months of age. Most
infant formulas are iron fortified to aid in the hemoglobin synthesis process. Infants who
consume whole milk are at risk for iron deficiency anemia. Solid foods may be introduced
between 4 and 6 months of age; however, they should not replace breast milk or formula as
the primary source of nutrition in the infant's diet.
PTS: 1
REF: p. 91
OBJ: 2
NAT: Client Needs: Physiological Integrity: Basic Care and Comfort
TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
BLM: Cognitive Level: Apply
2.
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The nurse is reviewing a client's growth statistics prior to conducting a 6-month well-child
check-up. Based on the measurements documented in the client's chart above, which finding
should the nurse anticipate during the infant's exam?
A. Length: 40 in (101.6 cm)
B. Weight: 14 lb 12 oz (9.7 kg)
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C. Head circumference: 28 in (72 cm)
D. Chest circumference: 26 in (66 cm)
ANS: B
Rationale: Infants generally double their birth weight by 6 months of age and triple their birth
weight by 1 year of age. Length increases on average 10 in (25.5 cm) during the first year of
life. Head and chest circumferences will not double during childhood.
PTS: 1
REF: p. 91
OBJ: 1
NAT: Client Needs: Physiological Integrity: Basic Care and Comfort
TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
BLM: Cognitive Level: Apply
3. A nurse is assessing physical growth of a 6-month-old child during a well-child check-up.
Which data should the nurse be most concerned about?
A. Head circumference in the 19th percentile
B. Length in the 27th percentile
C. Weight in the 4th percentile
D. Body mass index (BMI) in the 8th percentile
ANS: C
Rationale: Length, weight, and head circumference are routine body measurements collected
during well-child visits. Measurements that fall between the 5th and 95th percentiles on growth
charts are considered healthy. Body mass index is not typically calculated for infants.
PTS: 1
REF: p. 91-92
OBJ: 1
NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
BLM: Cognitive Level: Analyze
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4. A community health nurse is conducting a seminar offered to parents of young infants. During
the teaching session, a parents asks, "When is the appropriate time to introduce solid food into
the infant's diet?" What is the nurse's best response?
A. "You should offer solid foods around 2 to 3 months of age."
B. "Infants may begin eating pureed foods at age 4 to 6 months."
C. "Infants are ready to eat solid foods once they have triple their birth weight."
D. "Pureed foods may be offered upon eruption of the first tooth."
ANS: B
Rationale: Current recommendations are to begin offering solid foods such as fruits and
vegetables to infants between 4 and 6 months of age. Cues that indicate readiness for solid
foods include ability to sit in a high chair and birth weight has been doubled. Eruption of teeth
is not an indicator of readiness for solid foods.
PTS: 1
REF: p. 94
OBJ: 2
NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
BLM: Cognitive Level: Remember
5. A home health nurse is completing a follow-up visit with a 6-month-old infant diagnosed with
failure to thrive. During the visit, the infant's grandparent asks the nurse for recommendations
of age-appropriate toys to promote development. Which toy(s) should the nurse suggest?
Select all that apply.
A. Teething toys
B. Soft board books
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C. Large piece puzzles
D. Noise-making toys
E. Small toy race car
ANS: A, B, D
Rationale: Teeth may begin to erupt around 6 to 8 months and teething toys may ease
discomfort. Soft board books will stimulate an infant's curiosity and prevent the risk of
ingestion if the infant chews on the book. Noise-making toys will attract the attention of
infants at this stage. They will attempt to reach for noisy objects, which may also promote
gross motor skill development. Large piece puzzles are appropriate for older infants and
toddlers. Small toy race cars are not appropriate for infants because they may be made of
metal and have small parts that pose a choking hazard.
PTS: 1
REF: p. 93
OBJ: 2
NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
BLM: Cognitive Level: Apply
6. The nurse is providing anticipatory guidance to a new mother during an infant checkup. Place
in order the sequence of cephalocaudal development that the mother can expect during the
first year of the infant's life. Begin with the first development expected, sequencing to the
final development expected. Use all options.
A. Rolls from back to front
B. Rolls from front to back
C.Sits unsupported
D. Lifts head while prone
E. Pulls self into standing position
ANS:
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Answer: D, B, A, C, E
Rationale: Infants develop gross motor skills in a cephalocaudal sequence. Lifting the head
occurs during tummy time. Infants develop the ability to roll from front to back followed by
back to front. Unsupported sitting occurs once the infant has trunk control. The infant will pull
itself to the standing position prior to cruising along furniture and walking.
PTS: 1
REF: p. 90
OBJ: 1
NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
BLM: Cognitive Level: Understand
7. A community health nurse is conducting a home visit with the family of a 6-month-old child
diagnosed with developmental delay. Which statement by the parent indicates the need for
further teaching?
A. "My infant is drinking iron-fortified formula thickened with rice cereal."
B. "My infant loves to play marbles with an older sibling."
C. "The car seat is in the back seat facing backward."
D. "My infant has an appointment for immunizations next week."
ANS: B
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Rationale: Infants should consume iron-fortified formula to prevent the development of
iron-deficiency anemia and to promote neurological development. Small objects are not
appropriate for infants and small children because they pose a choking hazard. Infant car seats
should be secured in the back seat facing backward until the child weighs 20 lb (9 kg) and is
at least 2 years old. Several routine immunizations are administered at the 6-month checkup.
PTS: 1
REF: p. 94
OBJ: 2
NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control
TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
BLM: Cognitive Level: Analyze
8. A nurse is providing care to a pregnant adolescent client who lives on a reservation in the
Navajo Nation. During a prenatal visit, the client states, "I think it is important to incorporate
tribal medicine into my plan of care." What is the nurse's best response?
A. "Your tribe elders will emphasize the importance of practicing traditional
medicine."
B. "Perhaps you can discuss herbal remedies provided by the tribe's Medicine Man
with your healthcare provider."
C. "Your father should come to the next visit, because he will guide you regarding
childrearing and feeding practices."
D. "It will be important for you to maintain a balance between yin and yang during
this pregnancy to continue leading a healthy life."
ANS: B
Rationale: Members of the Navajo tribe are often resistant to Western medicine and prefer to
incorporate tribe traditions such as a Medicine Man and herbal remedies into their health
regimens. In the Navajo culture, daughters must listen to their mothers regarding child rearing
and feeding practices. Tribe members believe that balance among components is necessary to
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maintain a healthy life; however, these elements are not yin and yang.
PTS: 1
REF: p. 89
OBJ: 7
NAT: Client Needs: Psychosocial Integrity
TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
BLM: Cognitive Level: Apply
9. The mother of a 6-month-old child calls the clinic triage nurse and states, "I'm worried that
my baby is falling behind. He just doesn't do the same things other babies his age are doing."
Which of the following behaviors reported by the mother should the nurse recognize as a sign
of developmental delay?
A. Head lags when pulled to sitting position
B. Sits leaning forward on both hands
C. Able to roll from back to front
D. Grasps food with whole hand
ANS: A
Rationale: Infants develop gross motor skills in a cephalocaudal sequence. Head control is
established by 4 months of age and would indicate a developmental delay if observed in a
6-month-old child. Supported sitting occurs around 8 months of age once the infant has
established trunk control. The 6-month-old child should be able to roll from back to front and
grasp large objects with the whole hand.
PTS: 1
REF: p. 94
OBJ: 1
NAT: Client Needs: Health Promotion and Maintenance
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TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
BLM: Cognitive Level: Apply
10.
A clinic nurse is providing education regarding increasing caloric intake to the parent of a
6-month-old infant diagnosed with failure to thrive. Based on the measurements in the client's
chart above and knowledge that infants should consume 98 kcal/kg/day, how many
kilocalories should the nurse
TErecommend
STBANKSthat
ELLthe
ERparent
.COMprovide to the infant per day? Record
your answer using one decimal place.
ANS:
712.5
Rationale: Using the client's weight in kg, multiply weight by recommended kilocalories.
2.727 kg  98 kcal/kg/day = 712.5 kcal/day
PTS: 1
REF: p. 97
OBJ: 6
NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
BLM: Cognitive Level: Apply
11. The nurse is caring for a 6-month-old infant who is in foster care and diagnosed with organic
failure to thrive. Which statement by the foster parent indicates a need for additional teaching?
A. "We may need to thicken the formula with rice cereal to decrease reflux."
B. "Offering enough calories would have prevented this problem."
C. "The inability to absorb nutrients has prevented the infant from gaining weight."
D. "Switching to a hypoallergenic formula may help with achieving the target
weight."
ANS: B
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Rationale: Organic failure to thrive has an underlying etiology, such as the inability to absorb
or use nutrients, and could not have been prevented by offering increased calories. Severe
gastrointestinal reflux disorder (GERD) may result in excessive vomiting and lead to poor
weight gain in infancy. GERD may be managed by thickening feedings to decrease the risk of
emesis and help with retention of formula and calories. If the infant had failure to thrive as the
result of a milk allergy, switching to a hypoallergenic formula may help with weight gain.
PTS: 1
REF: p. 94
OBJ: 4
NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
BLM: Cognitive Level: Apply
12. A clinic nurse is planning to administer immunizations to a 6-month-old infant according to
the recommended schedule. Which instruction(s) should the nurse include in the client
teaching with the infant's parent? Select all that apply.
A. "Call the provider for a fever of 103° F (39.4° C)."
B. "Redness at the injection site may result."
C. "Call 911 if your child has a seizure."
D. "Increased sleeping may occur for up to 24 hours."
E. "Your infant may cry for hours at a time."
ANS: A, B, C, D
Rationale: Educating clients and families regarding risks and benefits of immunization is an
important nursing role. Part of this education should include common and life-threatening side
effects. Guardians of minors must provide consent prior to vaccine administration. Common
side effects include low grade fever, redness at the injection site, and increased irritability.
Increased irritability may occur but not for hours at a time. Seizures are a serious side effect
and emergency treatment should be initiated.
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PTS: 1
REF: p. 95
OBJ: 2
NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
BLM: Cognitive Level: Apply
13. A clinic nurse is developing a plan of care with the parent of a formula-fed infant diagnosed
with nonorganic failure to thrive. The parent states, "I do not understand how my infant has
been diagnosed with failure to thrive." What is the nurse's best response?
A. "Your infant's body has been unable to absorb the nutrients from the foods the
infant has been eating."
B. "Illnesses leading to malabsorption can lead to nonorganic failure to thrive."
C. "Your infants reflux has caused the infant to lose weight, which led to the
diagnosis."
D. "When formula is mixed inappropriately it may lead to nonorganic failure to
thrive."
ANS: D
Rationale: Infants diagnosed with nonorganic failure to thrive do not have an underlying
medical problem, such as reflux or malabsorption, causing poor weight gain. Common causes
of nonorganic failure to thrive include missed hunger cues, poor parent–infant attachment,
inappropriately mixed formulas, complex social issues and lack of weaning.
PTS: 1
REF: p. 94
OBJ: 4
NAT: Client Needs: Health Promotion and Maintenance
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TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
BLM: Cognitive Level: Apply
14. The nurse is conducting a well-child check-up on a 6-month-old infant who has not been seen
by a health care provider since birth. Which assessment finding(s) should alert the nurse to
possible failure to thrive? Select all that apply.
A. Weight below the 5th percentile
B. Increased irritability
C. Poor sleeping pattern
D. Able to roll back and forth
E. Supports full weight on legs when held upright
ANS: A, B, C
Rationale: Weight below the 5th percentile indicates poor weight gain, caused by inadequate
consumption or use of calories. Sufficient caloric intake is necessary during infancy to aid in
physical growth and psychological, cognitive, social, emotional, language and motor
development. Infants may exhibit increased irritability and sleeplessness because of unsatiated
hunger. Rolling back to front and supporting weight on legs when held upright are expected
gross motor milestones for 6-month-old infants.
PTS: 1
REF: p. 90
OBJ: 5
NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
BLM: Cognitive Level: Apply
15. A nursing student is designing a poster to be presented at a community health fair for
soon-to-be parents. The student should include which developmental milestone(s) is
appropriate for 6-month-old children? Select all that apply.
A. Enjoys looking at mirrors
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B. Likes to play with others
C. Babbles by stringing vowels together
D. Sits unsupported
E. Explores with hands and mouth
ANS: A, B, C, E
Rationale: Six-month-old infants enjoy looking in mirrors, smiling and playing with others.
They often begin babbling the letters "b" and "d," stringing vowels together and mimicking
the noises their parents make. They explore the environment with their hand and mouth, so
babyproofing and close monitoring are important. Unsupported sitting occurs around 8
months of age.
PTS: 1
REF: p. 93
OBJ: 1
NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
BLM: Cognitive Level: Understand
16. The community health nurse is conducting a home visit with the family of a developmentally
delayed preschooler who is a member of the Navajo Nation. During the visit, the nurse should
discuss balance among which component that is necessary for traditional American Indians to
maintain a healthy life? Select all that apply.
A. Mother Earth
B. Tribal community
C. Daily exercise
D. Surrounding environment
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E. One's self
ANS: A, B, D, E
Rationale: Members of the Navajo tribe believe that balance among the components of
Mother Earth, tribal community, surrounding environment, and one's self is necessary to
maintain a healthy life. They are likely to incorporate daily prayers along with herbal
remedies to stay balanced.
PTS: 1
REF: p. 83
OBJ: 7
NAT: Client Needs: Psychosocial Integrity
TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
BLM: Cognitive Level: Apply
17. A nurse is developing a nutrition plan with the parent of an exclusively breastfed 6-month-old
infant diagnosed with failure to thrive. When the nurse suggests supplementing with infant
formula, the parent states, "Traditional Navajo health practices are very important to my
family. I am worried my infant will be out of balance if I stop breastfeeding." What is the
nurse's best response?
A. "Your infant needs more calories and supplementing with formula is the only way
to do that right now."
B. "Have you considered herbal supplements such as fenugreek to help increase your
milk supply?"
C. "Because your infant is only 6 months old, it is unlikely that he is at risk for
becoming out of balance."
D. "Would it be possible for you to obtain breastmilk from other women in your tribe
to offer to your infant?"
ANS: B
ESTBA
NKS
ELbe
LEresistant
R.COMto Western medicine and seek help
Rationale: Members of theTNavajo
tribe
may
from the tribe's Medicine Man who may offer herbal remedies and teas for their ailments.
Traditional beliefs also include maintaining balance among four components for tribe
members to lead a healthy life. While the infant needs more calories to catch up to target
weight, the nurse's response that formula is the only way is nontherapeutic. Obtaining
breastmilk from other tribe members is not the best option at this time as donor milk should be
screened for safety.
PTS: 1
REF: p. 94
OBJ: 7
NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
BLM: Cognitive Level: Apply
18. A parent brings the infant to a community health clinic for the first time since giving birth on
the Navajo Reservation 6 months ago. What is a priority topic for discussion during this
visit?
A. Infant food preferences
B. Enrollment in a daycare program
C. Catch-up schedule for immunizations
D. Dental referral
ANS: C
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Rationale: Initiating an immunization catch-up schedule is the priority for this interaction.
Because the infant has not been seen by a health care provider since birth, it is anticipated that
several recommended vaccines have not been administered. The infant may be at a high risk
for preventable diseases which makes vaccination a high priority. Infant food preferences,
daycare programs and dental topics should be discussed but are not the highest priority at this
time.
PTS: 1
REF: p. 95
OBJ: 2
NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
BLM: Cognitive Level: Apply
19. At a community center, the nurse is teaching about child developmental milestones for
6-month-old infants. Which statement by a participant is most concerning?
A. "Babies this age like to play with others and are generally happy."
B. "We expect that our 6-month-old infants will have head lag."
C. "It may get noisy in the room for 6-month-old infants; they are learning to babble."
D. "Close monitoring is necessary as these babies explore with their hands and
mouths."
ANS: B
Rationale: Head control should be established by 4 months of age and would be a red flag for
developmental delay if noted in a 6-month-old infant. Infants at this age are typically happy,
enjoy watching and playing with others, and are starting to babble.
PTS: 1
REF: p. 93
OBJ: 3
NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
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BLM: Cognitive Level: Analyze
20. A nurse has completed discharge teaching with the parent of a child diagnosed with failure to
thrive. Which statement by the parent indicates an understanding of the teaching?
A. "I will need to mix formula a different way, so it has more calories per ounce."
B. "Daycare should offer my infant one jar of baby food twice a day."
C. "Switching to soy formula should help my infant gain weight."
D. "My infant will catch up to friends in size once my infant starts elementary
school."
ANS: A
Rationale: Infants diagnosed with failure to thrive require increased caloric intake. To meet
these demands, caregivers are instructed to mix infant formula to a concentration of 24
kcal/ounce versus the standard preparation of 20 kcal/ounce. Human milk fortifier can be
added to breastmilk to increase the caloric concentration. Solid foods should be introduced
between 4 and 6 months of age but will not offer enough calories for the infant to catch up to
the target weight. Changing formulas does not address the principle problem of ineffective
weight gain as the caloric concentration remains the same. Stating that the infant will catch up
to friends does not address the current problem and may not be accurate.
PTS: 1
REF: p. 97
OBJ: 8
NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 8: Andrew Hocktochee: Failure to Thrive
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BLM: Cognitive Level: Apply