Chapter 25

1. The nurse explains that implantation is the embedding of the fertilized ovum the uterine mucosa this implantation
is called FUNDUS OF THE UTERUS
2. When the patient is diagnosed with a tubal pregnancy, the nurse is aware that in this pregnancy the patient will
probably REQUIRE SURGERY TO REMOVE THE ZYGOTE
3. The nurse uses a diagram to show the development of the embryonic stage of pregnancy that usually lasts about 8
WEEKS
4. The nurse is anxious about the patient who is in her first trimester and has been exposed to German measles,
because this disease is capable of CAUSING BIRTH DEFECTS.
5. The nurse explains that the placenta function as an endocrine gland secreting estrogen and progesterone as well as
HCG HUMAN CHORIONIC GONADOTROPIN
6. The nurse lecturing to a class of prenatal women explains the fetus is protected from bacterial invasions by the
PLACENTAL BARRIER
7. The nurse explains that the maternity cycle is divided into three periods. The intrapartal period begins covers
ONSET OF LABOR TO DELIVERY OF THE PLACENTA.
8. A woman who has just discovered she is pregnant states the first day of her last menstrual period was July 10. The
nurse tells her that her expected date of birth (EDB) will be APRIL 17
9. A pregnant woman on her first visit to the physician office presents all the information listed below. The nurse
assesses as a positive sign of pregnancy the indicator of POSITIVE ULTRASONIC TRACINGS
10. When the patient complains of frequency of urination, the nurse explains that frequency of urination early in
pregnancy occurs due to INCREASED CIRCULATING VOLUME
11. The pregnant woman asks about sexual activity during her pregnancy. The nurse states that sexual activity should
be CEASED IN THE CASE OF VAGINAL BLEEDING
12. A woman tells the nurse that this is her third pregnancy. She has had twin girls at full term and one miscarriage.
The nurse records this information as G3 T1 A1 L2
13. A primigravida eager to be able to feel the baby move inside her asks the nurse when she can expect to feel the
movement. The nurse replies that first faint movement may be felt during gestational week 10 WEEKS
14. The pregnant woman arrives for a visit to the physician. The nurse applies an amplified stethoscope to the
abdomen and can hear the fetal heart tone. The nurse assesses the fetus is at the fetal development week of
16 WEEKS.
15. The nurse assures an anxious primigravida that during fetal development from week 34 +, maternal antibodies are
transferred to the baby. These provide immunity for the baby for 6 MONTHS
16. Early in the first trimester, the woman may complain of morning sickness. The nurse suggests that this may be
relieved by EATING DRY CRACKERS BEFORE GETTING UP
17. The nurse explains that the increase in circulating volume will cause DECREASED HEMOGLOBIN
18. A woman entering 22 weeks of pregnancy complains to the nurse that feels she has become unsightly because of
chloasma. The nurse recommends that to reduce the chloasma the patient should AVOID EXPOSURE TO THE SUN
19. During the last weeks of pregnancy, urinary frequency may return due to the enlarged uterus compressing the
bladder against the pelvic bones. The nurse makes the suggestion that to reduce this the patient should SLEEP ON
HER SIDE
20. A pregnant teenager presents all the complaints listed below. The nurse assess that the complaint that’s a danger
sign is VISUAL DISTURBANCES
21. During the last trimester of pregnancy, the nurse recommends that the woman wear low-heeled shoes. This is an
effort to prevent or relieve LOWER BACK PAIN
22. At a prenatal visit, the woman who is 32 weeks pregnant states that the movement of the baby and the shortness of
breath are causing her to have difficulty sleeping. The nurse suggests she DRINK A GLASS OF WARM MILK
BEFORE BEDTIME
23. The newly diagnosed primigravida who is 6weeks pregnant says “I don’t feel like I have a real baby inside me”.
the nurse reassures her that at 6 weeks the embryo has a functioning HEART
24. A newly confirmed pregnant patient asks the nurse what the dangers of smoking are to her baby. The nurse tells
her that smoking can cause the fetus to have LOW BIRTH WEIGHT
 25. The father asks how soon the sex of the baby can be confirmed. The nurse answers that the genitalia are well-
defined at 9 WEEKS
26. The physician decides to send the mother for a test to determine the fetal lung capacity. This fetal well-being test
is called AMNIOCENTESIS
27. When the young primigravida asks about how to adjust her diet for her pregnancy. The nurse outlines that the diet
should be modified to include increases in LEAFY GREEN VEGETABLES AND FRUIT
28. The nurse stresses that a sign of a complication of pregnancy that must be reported to the physician at the first
occurrence is VAGINAL BLEEDING
29. The nurse uses a diagram to show how the arteries in the umbilical cord carry DEOXYGENTATED BLOOD
BACK TO THE PLACENTA
30. To assess an accurate fundal height, the nurse should instruct the patient to EMPTY HER BLADDER
Chapter 26
1. A woman who is about 2 weeks before her due date tells the nurse that the baby has dropped and she is
having urinary frequency again. The nurse assesses this as LIGHTENING
2. Braxton-Hicks contractions that may begin in the first trimester and become increasingly stronger during
the pregnancy differ from labor contractions that they DO NOT DILATE THE CERVIX
3. The nurse helps to differentiate false from true labor in that with true labor CONTRATIONS GET
STRONGER WITH AMBULATION
4. The pelvis is divided into two parts, the false and true pelvis. The nurse explains that the size of the true
pelvis is most important because THE FETAL HEAD MUST PASS THROUGH THIS PART
5. The nurse reassures the patient that the method used to determine the size of the true pelvis for over
20yrs with no detrimental effects to the fetus is ULTRASONOGRAPHY
6. The nurse plans to use a picture to show the area of the uterus that provides the force during a
contraction which is the UPPER PORTION OF THE UTERUS
7. The nurse points out the largest diameter of the fetal skull is the BIPARIETAL
8. The nurse prepares a group of primigravidas that during delivery, pressure on the fetal skull may
produce changes in the shape of the skull which is called MOLDING
9. The relationship of fetal body parts to one another during labor is called fetal attitude. The nurse explains
why the ideal attitude for the fetal body is FLEXION
10. Assessing the mother for fetal position, the nurse uses Leopold’s maneuvers and finds a soft rounded
prominence in the fundus, a hard round prominence at the symphysis pubis, and nodulation on the left side
of the uterus. The fetal position is RIGHT OCCIPUT ANTERIOR (ROA) VERTEX
11. During the second stage of labor, the nurse should monitor the fetal heart rate every 5 MINUTES
12. The nurse clarifies that the type of monitor that will assess the intensity of the contractions is an
INTERNAL MONITOR
13. The nurse observing the fetal heart monitor recognizes the FHR decreases to 120bpm at the beginning
of a contraction and returns to baseline 155bpm at the end of the contraction. This indicates EARLY
DECELERATION DUE TO HEAD COMPRESSION
14. The first time mother has been told by the nurse that the first stage of labor is the longest. An
appropriate nursing intervention for comfort during this time would be BACKRUB IN THE SACRAL AREA
15. The nurse monitoring the FHR assesses there are indications that the FHR is nonreassuring. This
indicates to the nurse that the fetus is experiencing fetal distress probably related to HYPOXIA
16. A mother is admitted in active labor. The nurse assesses the FHR at 124 bpm and based on that
assessment the nurse will REASSURE THE MOTHER THE RATE IS NORMAL
17. The patient’s membranes have just ruptured. the nurse is with her and knows that the first thing that
must be done is to CHECK FETAL HEART RATE (FHR)
18. The patient arrives at the hospital and is not sure if she is in true labor. The nurse does an assessment
and assures her she is in true labor because THE CERVIX HAS SOFTENED AND EFFACED.
19. The nurse is alarmed as she assesses a protruding umbilical cord from the vagina. The immediate
action the nurse should take is PLACE THE PATIENT IN THE KNEE-CHEST POSITION
20. The nurse is assessing the printout from the fetal monitor. The nurse is legally responsible for
RECOGNIZING DEVIATIONS AND NOTIFYING THE PHYSICIAN
21. The mother is in beginning labor and asks the nurse how long this will last. The nurse explains that the
first stage of labor lasts from the beginning of regular contractions to FULL DILATION OF CERVIX
22. The nurse is admitting a pt. to the labor unit. While doing the initial assessment its most important to
assess THE TIMING OF CONTRACTIONS
23. During labor the patient screams at her husband to get out of her sight. The nurse’s most appropriate
action would be to ASSURE THE HUSBAND THAT SUCH BEHAVIOR IS NORMAL
24. The patient is admitted to the labor unit, this is her first baby and upon initial assessment the baby is
found to be engaged. The nurse knows this means that the WIDEST DIAMETER OF THE PRESENTING
PART HAS REACHED THE PELVIC OUTLET
25. The physician has decided to induce labor with prostaglandin gel and an amniotomy. The nurse
assures the patient that labor will probably start in 1 HOUR
26. The mother has entered the second stage of labor. The nurse states that this stage begins with
complete dilation of the cervix and ends with DELIVERY OF THE BABY
27. As the second stage of labor begins the mother has an urge to push the nurse encourages her to use
her abdominal muscles to assist with pushing because THE CERVIX IS COMPLETELY DILATED
28. After the delivery of the baby, the placenta is delivered in the 3rd stage of labor. Oxytocin is
administered. The nurse explains that the purpose of the drug is to STIMULATE UTERINE
CONTRACTIONS
29. After the delivery of the newborn, the nurse first action to meet the priority need of the newborn is to
SUCTION THE NOSE AND MOUTH
30. The physical condition of the infant is done at birth through the use of an Apgar score. If the infant has
a heart rate of 105bpm, is crying, has a pink body with blue limbs, sneezes, has some flexion 5 minutes
after delivery the baby’ s APGAR score is 8
31. Following delivery, the nurse must assess the mother to identify physiological changes during this
stage. For the 1st hour, this assessment is done every 15 MINUTES
32. When the nurse performs the Nitrazine test on vaginal secretions of a primigravida who thinks her
membranes have ruptured the paper turns yellow. The nurse assess this finding to indicate ACIDIC
DISCHARGED, MEMBRANES INTACT.
Chapter 27
1. 12 hours following the delivery of a baby, the mother is being evaluated by the nurse. As the nurse
palpates the level of the fundus of the uterus, it’s found to be FIRM AND THE UMBILICUS
2. The vaginal discharge following delivery is called lochia. It changes color over time and has different
names. The initial discharged is charted by the nurse as LOCHIA RUBRA
3. The nurse explains that the following delivery, the return of the menstrual cycle, which is anovulatory,
depends on the return of the estrogen to normal levels. The return may be from 6 WEEKS TO 6 MONTHS.
4. The new mother is breastfeeding the baby. She asks about the milk from her breasts. The nurse
explains that the first secretions produced by the breast is called COLOSTRUM
5. The nurse tells the new mother that the prepregnant weight is usually achieved without dieting within 6
TO 8 WEEKS
6. The postpartum patient complains of discomfort in her breasts. Explaining engorgement to the mother,
the nurse states that it IS FIRST OBSERVED IN THE AXILLARY REGION
7. The nurse instructing the nursing mother explains the engorgement is most likely to occur when the
BREAST TISSUE BECOMES CONGESTED
8. When describing colostrum to the new mother, the nurse states that colostrum is SLIGHTLY YELLOW
AND PROVIDES ANTIBODIES
9. The new mother has decided not to breastfeed her baby. The recommendations the nurse makes to
suppress the milk supply are to APPLY A FIRM BRA AND ICE PACKS
10. During the immediate postpartum period, the mother has a temperature of 100.2F, pulse 52,
respirations 18, BP 138/84. What should the nurse do? REPORT THAT VITAL SIGNS ARE NORMAL
11. When the breastfeeding mother asks about nutritional needs while she is breastfeeding, the nurse
gives her a brochure showing the recommended nutritional requirements during breastfeeding as WELL-
BALANCED DIET WITH 500 ADDITIONAL CALORIES
12. Within the first hour following a vaginal delivery the nurse is assessing the mother and finds the fundus
is firm and there is a trickle of bright red blood. The nurse knows that THIS IS A NORMAL OCCURRENCE
13. The nurse is assessing the fundus of a newly delivered mother. The proper way to perform this
procedure is by using ONE HAND ON THE LOWER UTERINE SIDE WHILE THE OTHER HAND
LOCATES THE FUNDUS OF THE UTERUS
14. The new mother is one day postpartum and is asking about bathing. The nurse provides her with
information and recognizes the responsibility to LET THE PATIENT SHOWER AND CHECK ON HER
FREQUENTLY
15. The postpartum mother is telling the nurse she is afraid to have a bowel movement due to her painful
episiotomy. The nurse does which of the following to help her? OFFERS HER STOOL SOFTENERS AS
PRESCRIBED
16. The new mother had spinal anesthesia to deliver by cesarean section. She now has a desire to void
and can wiggle her toes. She wants to go to the bathroom. The nurse’s action would be to PUT SLIPPERS
ON HER FEET
17. A mother delivered her baby at 12am and its now 9am. She wants to sleep and asks the nurse to take
care of the baby. The nurse recognizes this as an example of NORMAL “TAKING IN” RESPONSE
18. the finding the nurse would assess as normal of a one-day postpartum patient is COMPLAINING OF
“AFTER PAINS”
19. An Asian mother tells the nurse that when she goes home, her mother-in-law will be caring for the baby
while she rests. The nurse is concerned and her response would be to EXPLORE WAYS TO BLEND THIS
WITH SAFE HEALTH TEACHING
20. The nurse is in the newborn nursery. Before giving her the first feeding to an infant, the nurse must
assess for the presence of the SWALLOW REFLEX
21. Following delivery of the newborn, the nurse attends to the highest priority for the newborn, who is to
be WARMED
22. The nurse is performing an Apgar score on the newborn. Cyanosis,, which is considered normal would
be found on the FEET
23. The nursery nurse identifies that the newborn is jaundiced within the first 24 hours and with jaundice
over bony prominences of the face and the mucous membranes. She recognizes that this is ABNORMAL
24. The newborn is covered with cream cheese-like substance, which protects the infant’s skin from the
amniotic fluid. This substance is called VERNIX CASEOSA
25. the nurse explains that in order to detect inborn errors of metabolism, state law requires that certain
diagnostic test be performed on the newborn such as PKU PHENYLKETONURIA
26. when assessing the newborn the nurse identifies a finding that suggests a chromosomal disorder which
is LOW-SET EARS
27. the nursery nurse explains that vitamin k by injection is given to the newborn who is at risk for
hemorrhage because BACTERIA WHICH SYNTHESIZES VITAMIN K ARE NOT PRESENT IN
NEWBORNS
28. Discussing the care of her circumcised infant after discharged from the hospital, the nurse tells the
mother to APPLY STERILE PETROLATUM GAUZE AFTER EACH DIAPER CHANGE
29. The nurse is caring for a newborn who has just been circumcised. The nurse alters the care of plan to
include the implementation of OBSERVING FOR BLEEDING FOR FIRST 12 HOURS
30. During an initial assessment of a newborn the nurse identified which finding believed to be abnormal in
the infant? PERSISTENT HIGH-PITCHED CRY
31. The mother who has been breastfeeding her infant for 5 days asks if the baby’s stools are normal. The
nurse describes the normal breastfed stool as PALE YELLOW AND FREQUENT
32. The new mother calls the nurse to her room to show her how her baby is “jerking around”. When she
changes his position the nurse explains this response is the normal MORO REFLEX
33. The nurse is giving a bath demonstration for a group of new mothers. An important piece of information
she gives this group is to CLEANSE THE PERINEUM FROM FRONT TO BACK.
Chapter: 28
1. The pregnant woman is admitted to the hospital with hyperemesis gravidarum. The woman is bordering
on starvation and is severely dehydrated. The nurse alters the care plan to include IV FLUIDS AND
ELECTROLYTE REPLACEMENT
2. The woman with hyperemesis gravidarum is asking the nurse what would happen if she hadn’t come to
the hospital. The nurse explains that if untreated, it could result in MATERNAL AND FETAL DEATH.
3. The nurse uses a picture to explain that twins who share a placenta and come from one fertilized ovum
and are identical are identified as Monozygotic
4. When assessing the woman is pregnant with multiple fetuses, the nurse takes into account that the
delivery will probably be COMPLICATED BY LOSS OF UTERINE TONE.
5. The woman is admitted to the hospital with signs of an ectopic pregnancy. The nurse modifies the care
plan to include SURGERY TO REMOVE THE PREGNANCY
6. A woman was admitted following a spontaneous abortion. The nurse attempting to console the woman
tells her the percentage of first trimester pregnancies that abort is 15%
7. During an antepartum visit, the nurse tells the mother that one sign that must be reported immediately,
no matter what stage of the pregnancy is VAGINAL BLEEDING
8. The woman 22 weeks pregnant came to the hospital complaining of bright red painless vaginal bleeding.
From this information alone the nurse assesses a PLACENTA PREVIA
9. The pregnant woman comes to the hospital 3 weeks before her estimated date of birth complaining of
severe pain and a rigid abdomen. The nurse assesses theses as signs and symptoms of ABRUPTIO
PLACENTAE
10. The patient presents symptoms of Abruptio placentae. In order to facilitate uterine placental perfusion,
the nurse positions the patient in SIDE-LYING POSITION.
11. The pregnant woman is making a clinic visit during her 13th week of pregnancy. The nurse identifies
edema, hypertension, and proteinuria. These signs lead to the nurse to assess PREGNANCY-INDUCED
HYPERTENSION
12. The pregnant woman who has been diagnosed with PIH is asking the nurse what caused it. The nurse
explains that there are many theories, but the cause is UNKNOWN.
13. During prenatal visits, the nurse keeps a record of the woman’s blood pressure in order to make an
early assessment of possible PREGNANCY INDUCED HYPERTENSION
14. The woman’s blood pressure is taken on two separate occasions 6hrs apart and was found to be
160/110. The nurse anticipates an order for MAGNESIUM SULFATE
15. The nurse is assessing a “kick count” on a woman with preeclampsia. A serious cause for concern is a
count of fewer than THREE
16. The nurse discussing the problem of toxoplasmosis infection during pregnancy, cautions the woman to
avoid EMPYING CAT LITTER BOXES BARE-HANDED
17. When the mother is diagnosed with gestational diabetes, the nurse cautions that a major complication
is that during the early pregnancy the fetus suffers from HYPERGLYCEMIA
18. A pregnant mother who has type 2 diabetes may often have to begin administering insulin. When the
woman asks the nurse why this is necessary, the nurse responds that ORAL HYPOGLYCEMIC AGENTS
MAY BE TERATOGENIC.\
19. A major concern for the diabetic woman who is pregnant is the effect of the blood glucose control has
on the fetus. The fetus is totally dependent on the mother for this control because insulin DOESNT CROSS
THE PLACENTA
20. When assessing a newly admitted pregnant woman to the clinic, the nurse identifies a history of
rheumatic heart disease. To prevent further stress on the heart, the nurse anticipates a protocol of IRON
21. The 14 year old pregnant adolescent arrives at the hospital in early labor. The nurse knows that
because the adolescent is still growing herself, she is at greater risk for CEPHALOPELVIC
DISPROPORTION.
22. When the infant is delivered, it’s important for the nurse to determine the gestational age of the baby
within 2-3 HRS OF AGE
23. The newborn infant is determined to be preterm and has oxygenation problems and lack of
subcutaneous fat. The nurse assess the gestational age of the preterm infant as 0-37 COMPLETE WEEKS
OF PREGNANCY
24. The nurse explains that mortality and morbidity rate for preterm infants is higher than that of an older
infant of comparable weight by 3-4 TIMES
25. Respiratory distress syndrome is the greatest potential problem for the preterm infant resulting from the
immature respiratory system. The nurse explains this lack of oxygenation results because the lungs have
not produced adequate SURFACTANT
26. The neonate is born with weak muscle tone, the extremities are frog like and ears fold easily. From
these observations the nurse places the gestational age at PRETERM
27. The nurse closely monitors a baby born to a diabetic mother for the presence of HYPOGLYCEMIA
28. A primigravida is Rh negative and her husband is Rh positive. She is concerned about the health of the
fetus. The nurse explains that the only danger to the fetus is if its Rh positive from the father and the
mother became sensitized during delivery. This means she would produce __ in subsequent pregnancies.
Rh POSITIVE ANTIBODIES
29. the nurse assures a patient who has become sensitized to the Rh antigen that she can be protected for
future pregnancies by receiving injections of RhoGAM
30. The nursery nurse is assessing the newborn and discovers there’s a yellowing of the skin. This
jaundice appeared at birth and is considered PATHOLOGICAL
31. The nurse teaching class of primigravidas explains that while the mother is pregnant the physician may
order a blood test to identify the maternal level of Rh antibodies. This test is called INDIRECT COOMBS’
TEST
32. The nursery nurse is implementing photo-therapy for the jaundiced infant. The nurse explains that the
phototherapy CONVERTS BILIRUBIN TO WATER-SOLUBLE FORM TO BE EXCRETED IN THE URINE.
33. The home health nurse cautions the pregnant woman who ingests alcohol or drugs that she places
herself at risk and endangers her fetus because alcohol and drugs CROSS THE PLACENTAL BARRIER.
34. The nurse uses a chart to demonstrate the cognitive impairment, facial abnormalities, and growth
retardation in the fetus caused by FETAL ALCOHOL SYNDROME
35. When the PIH patient is hospitalized, the nurse monitors the DEEP TENDON REFLEXES
36. The nurse is administering magnesium sulfate to the human with eclampsia knows there’s the risk of
toxic levels. The nurse assures the availability of the antidote for magnesium sulfate toxicity, which is
CALCIUM GLUCONATE
37. The mother who delivered her baby 4weeks ago is calling the nurse because she is feeling very
depressed. The nurse recognizes this call for help as a symptom of postpartum depression and that one of
the prominent features of this is REJECTION OF THE INFANT
38. For the mother suffering from Post-partum depression the gradual improvement occurs over a 6 month
period. When this does not occur, the usual treatment is PHARMACOLOGICAL INTERVETNTIONS.
CHAPTER 29
1. The nurse stresses that regular physical activity has been identified as a leading health indicator.
Regular physical activity has which of the following positive effects on children? INCREASES BONE AND
MUSCLE STRENGTH
2. A nurse speaking to parents ‘group cited a study that found that 11% of children between 6 and 19 were
overweight or obese. The nurse explained goal of Healthy People 2010 is to reduce this to 5 %
3. The school nurse and the PE teacher designed a home program to increase physical activity in children
while at home in order to reduce the time spent in front of the TV. The present average amount of time
children spend in front of the TV per day is estimated at 6 ½ HOURS
4. the nurse tells a group of adolescents that the single most preventable cause of death and disease in
the United States today is CIGARETTE SMOKING
5. the school nurse mounts a campaign to make parents aware of how their smoking can contribute to an
increased risk of heart and lung disease in their children due to ENVIRONMENTAL SMOKE
6. problems such as domestic violence sexually transmitted diseases, school failure, and motor vehicle
accidents are attributed to SUBSTANCE ABUSE
7. the college counselor stresses safe sex because he is aware that half of all new HIV cases are among
people younger than 25YEARS
8. the nurse cited the law that states that a rear-facing safety seat secured in the back seat is required for
any child BIRTH TO 20 POUNDS
9. The pediatric nurse reminds the parent of a 2-year old that by this age the child should be protected
against __ vaccine-preventable childhood disease. 10
10. A major dental problem among very young children is bottle mouth caries. The nurse suggests which of
the following ways to prevent these caries? OFFER WATER AT BEDTIME
11. A pediatric nurse makes a point to remind parents of their responsibility in reducing the number of
accidents involving children by consistently practicing ANTICIPATORY GUIDANCE
12. To prevent accidental poisoning of a child, parents are instructed by the home health nurse to place
medicines IN A LOCKED CUPBOARD
13. The home health nurse stresses to parents that the leading cause of fatal injury in children younger
than 1year of age is from ASPHYXIATION
14. The home health nurse assesses the home for possible dangers because of her awareness that the
second leading cause of accidental death in children 1-4 years of age is BURNS
15. The school nurse points out that lack of physical activity and increased consumption of fast food are
causative factors contributing to the problem of WEIGHT GAIN
16. The nurse sets up a sample physical activities schedule to fit the Dietary Guidelines for Americans that
recommends that children get at least __minutes of physical activity per day. 60 MINUTES
17. The school nurse focuses a drug awareness program on the age group that has the largest increase
drug use. That age group is 12 TO 13 YEAR OLDS
18. Because of the Healthy People 2010 findings relative to adolescents’ health needs, the public health
nurse led the move to create a citywide program for TEENAGE SUICIDE HOTLINE
19. The pediatric nurse makes sure all parents coming to the clinic are aware that the childhood
immunization schedule of 2001 for the US has a major change from 2000. The new schedule contains
PVC PNEUMOCOCCAL
20. Because the water in the infant’s area is not fluoridated, the nurse suggests that the water the infant
drinks should be supplemented with fluoride when the child is 6MONTHS