The parent of a 10-month-old is being interviewed by the nurse preceding an examination by the pediatric nurse practitioner and states, “My baby loves all kinds of food, and he always drinks his milk from a sippy cup, except in the evening when he wants a bottle.” Which of the following follow-up questions is most important for the nurse to ask?

“Have you decided when you will wean your child from the bottle entirely?”

“Is your child drinking cow’s milk from the sippy cup and bottle?”

“Which fruits and vegetables have you fed your child so far?”

“Have you fed your child any foods that he can feed himself, like cereal or peas?”

Answer and Explanation

The Correct Answer is B

Introducing cow’s milk before 12 months can lead to iron-deficiency anemia, as cow’s milk is low in iron, can irritate the gastrointestinal lining, and may interfere with iron absorption. Early introduction also displaces nutrient-dense breast milk or formula, increasing the risk of nutrient deficiencies during a critical growth phase.

Rationale for correct answer:

B. This question directly addresses the most immediate nutritional risk. At 10 months, infants should not yet be consuming cow’s milk as a primary milk source. The nurse must clarify what type of milk the infant is drinking to ensure it is breast milk or iron-fortified formula and prevent nutrient imbalances, especially iron deficiency.

Rationale for incorrect answers:

A. While bottle weaning is important to prevent dental caries and promote independence, it is not as urgent as assessing for the risk of early cow’s milk introduction.

C. While asking about fruits and vegetables the child has been fed is relevant to dietary variety, this does not address the primary safety concern about inappropriate milk intake and its impact on iron status.

D. Self-feeding supports motor development and autonomy, but again, this is secondary to the need to verify the type of milk consumed.

Take home points

Cow’s milk should not be introduced before 12 months due to the risk of iron-deficiency anemia and poor nutrient content for infants.
Iron-fortified formula or breast milk should remain the primary milk source until the first birthday.
Nurses must assess feeding practices carefully to ensure safe transitions in infant nutrition.
Prompt, respectful caregiver education is key to preventing avoidable nutritional risks in the first year of life.

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Correct Answer is D

Explanation

Nutrient deficiencyrefers to inadequate intake or absorption of essential nutrients critical for healthy growth, immunity, and development.Infants rely heavily on breast milk or formula in the first months, and appropriate timing of solid food introduction helps meet evolving nutritional needs such as iron and zinc, and developmental milestones.

Rationale for correct answer:

D.The tongue extrusion reflex, which causes infants to push food out of their mouths with their tongue, typically fades between 4 to 6 months of age. Its disappearance signals readiness for spoon-feeding and oral motor coordination necessary for handling solids. This is why complementary feedingusually starts around 6 months, alongside continued breast/formula feeding.

Rationale for incorrect answers:

A.Solid foods should never be fed via a bottleas this increases the risk of choking and does not support oral motor development. At 3 months, the infant’s GI tract and neuromuscular maturity are not yet sufficient for solids.

B.Waiting until 12 monthsdelays key nutrientslike iron and zinc and misses a critical developmental window for introducing textures and preventing feeding difficulties.

C.Infants are not expected to handle a spoon themselves at 6 months.Rather, they begin to accept food from a spoon held by a caregiver when they demonstrate readiness signs such as disappearance of tongue thrust, good head control, and interest in food.

Take home points

Solid foods are typically introduced around 6 months when the tongue thrust reflex disappears.
Feeding solids with a spoon, not a bottle, is essential for safety and development.
Early introduction (before 4 months) or late introduction (after 6–7 months) may pose nutritional and developmental risks.
Nurses should guide parents using evidence-based recommendations and assess developmental readiness, not just age.

A. “Have you decided when you will wean your child from the bottle entirely?” B. “Is your child drinking cow’s milk from the sippy cup and bottle?” C. “Which fruits and vegetables have you fed your child so far?” D. “Have you fed your child any foods that he can feed himself, like cereal or peas?”

Correct Answer is B

Explanation

Introducing cow’s milk before 12 monthscan lead to iron-deficiency anemia, as cow’s milk is low in iron, can irritate the gastrointestinal lining, and may interfere with iron absorption. Early introduction also displaces nutrient-dense breast milk or formula, increasing the risk of nutrient deficiencies during a critical growth phase.

Rationale for correct answer:

B.This question directly addresses the most immediate nutritional risk. At 10 months, infants should not yet be consuming cow’s milkas a primary milk source. The nurse must clarify what type of milk the infant is drinking to ensure it is breast milk or iron-fortified formulaand prevent nutrient imbalances, especially iron deficiency.

Rationale for incorrect answers:

A.While bottle weaning is important to prevent dental cariesand promote independence, it is not as urgent as assessing for the risk of early cow’s milk introduction.

C.While asking about fruits and vegetables the child has been fedis relevant to dietary variety, this does not address the primary safety concern about inappropriate milk intake and its impact on iron status.

D.Self-feedingsupports motor development and autonomy, but again, this is secondary to the need to verify the type of milk consumed.

Take home points

Cow’s milk should not be introduced before 12 months due to the risk of iron-deficiency anemia and poor nutrient content for infants.
Iron-fortified formula or breast milk should remain the primary milk source until the first birthday.
Nurses must assess feeding practices carefully to ensure safe transitions in infant nutrition.
Prompt, respectful caregiver education is key to preventing avoidable nutritional risks in the first year of life.

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Naxlex Comprehensive Predictor Exams

The mother of a 3-month-old boy asks the nurse about starting solid foods. What is the most appropriate response by the nurse?

Correct Answer is D

Explanation

Correct Answer is B

Explanation

A mother brings her 5-month-old to the clinic for a well-child appointment. A nurse is doing an assessment when the mother asks when she can give her baby solid foods. What response is most appropriate?

The nurse is providing anticipatory guidance to the mother of a 6-month-old infant. What is the best instruction by the nurse in relation to the infant’s oral health?

A 9-month-old infant’s mother is questioning why cow’s milk is not recommended in the first year of life as it is much cheaper than formula. What rationale does the nurse include in her response?

A 6-month-old child received the following play things as a gift from a relative. The nurse should advise the parents that which of the items is potentially dangerous for the child to play with?