Ch. 35 (Ped1)

9) Which immunization will the nurse provide parental education during the health maintenance visit for a 4-year-old child? 1. Hepatitis B #3 2. Haemophilus influenzae type B #2 3. Inactive poliovirus #3 4. Measles, mumps, and rubella #1

Answer: 3 Explanation: 1. The third hepatitis B vaccine is administered between 6 and 18 months of age. 2. The second Haemophilus influenzae type B vaccine is administered 6 months after the first vaccine, which is scheduled at 12 months of age. 3. The third inactive poliovirus vaccine is often administered between 4 and 6 years of age. The nurse would provide parental education during the health maintenance visit. 4. The first measles, mumps, and rubella vaccine is administered between 12 and 15 months of age.

10) The nurse is teaching the parents of a toddler-age child about injury prevention. Which statement by the parent indicates the need for further education? 1. "I will turn the handles of the pots outward while I am cooking dinner." 2. "We will make sure that our child always wears a life vest when we are out in the boat." 3. "I will keep all our medications out of reach and ensure child-resistant containers." 4. "We will provide safe climbing toys for our child."

Answer: 1 Explanation: 1. Handles of the pots should be turned inward and not outward to prevent toddler injury. This statement indicates the need for further education. 2. A life vest should be worn by the toddler when near water or on a boat. This statement indicates correct understanding of the information presented. 3. All medications should be kept out of reach from the toddler and the parents should ensure child-resistant containers are used. This statement indicates correct understanding of the information presented. 4. Parents should supervise toddlers closely and provide safe climbing toys for the child. This statement indicates correct understanding of the information presented.

19) Which interventions will the nurse recommend for a toddler-age client who is biting other children at daycare? Select all that apply. 1. Using a time-out as a form of discipline for the child's behavior 2. Separating the child from the situation 3. Telling the child it is not okay to hurt another person 4. Inquiring whether the child is getting enough sleep 5. Implementing distraction to avert the behavior

Answer: 1, 2, 3, 4 Explanation: 1. A time-out is an appropriate intervention for the nurse to suggest when a toddler-age child is exhibiting behaviors that include other people, such as biting. 2. Separation of the child from the situation is an appropriate intervention for the nurse to suggest when a toddler-age child is exhibiting behaviors that include other people, such as biting. 3. It is appropriate to encourage the parents to tell the child that the behavior is unacceptable when the child is exhibiting behaviors that include other people, such as biting. 4. When a child is exhibiting behaviors that include other people, such as biting, it is appropriate to assess the amount of sleep the child is getting each night. Lack of sleep is a common cause for behaviors such as biting. 5. Distraction is appropriate for undesirable behaviors exhibited by the child; however this is not an appropriate when the child is exhibiting behaviors that include other people, such as biting.

14) Which action should the nurse include when providing education regarding methods to enhance health promotion during a scheduled health maintenance visit for a 4-year-old child? 1. Recognizing that food jags are common 2. Involving the child in snack selection and preparation 3. Encouraging the use of a highchair with a safety strap 4. Recommending the child consumes high-fat foods

Answer: 2 Explanation: 1. Food jags are not common for a 4-year-old child. This is more common for the 2-year-old child. 2. A 4-year-old child should be involved in snack selection and preparation. 3. The use of a highchair with a safety strap is not information that should be included for a 4-year-old child during a health maintenance visit. This is more appropriate for a toddler-age child. 4. Low-fat, not high-fat, foods should be encouraged during the health maintenance visit.

13) The nurse is planning health promotion activities for a toddler-age child during a scheduled health maintenance visit. Which action by the nurse is appropriate during this visit? 1. Connecting developmental skills with risks for injury 2. Recognizing that childcare attendance increases the risk for communicable disease 3. Planning education for treatment of common disease processes 4. Illustrating developmental progression on a screening tool

Answer: 4 Explanation: 1. Connecting developmental skills with risks for injury is an action that prevents disease and injury. This is not a health promotion activity. 2. Recognizing that attendance at a daycare center increases the risk for communicable disease is an action that prevents disease and injury. This is not a health promotion activity. 3. Planning treatment for common disease processes is an action that prevents disease and injury. This is not a health promotion activity. 4. Illustrating developmental progression on a screening tool is a health promotion action.

5) The visiting nurse is evaluating the home environments of several preschool-age children as they relate to child safety. The nurse visits the home of each child and gathers the following data. Which activity noted during the visit places a child at the greatest risk for bodily harm? 1. The parents are in a methadone program. 2. The parents consume alcohol on a daily basis. 3. The child watches television for 2 hours each day. 4. The child is permitted to swim in the family pool unsupervised.

Answer: 4 Explanation: 1. Drug and alcohol use or past use places the child at risk; however, this is not the priority risk assessed. 2. Drug and alcohol use or past use also place the child at risk; however, this is not the priority risk assessed. 3. A child who is allowed to watch excessive amounts of television each day is at risk for obesity and other health problems; however, this is not the priority risk assessed. 4. A child should be supervised while swimming at all times. This observation places the child at the greatest risk for bodily harm.

3) During a well-child visit with a 4-year-old girl the nurse notes that the parents speaks harshly to the child and used negative remarks when speaking with the nurse. Which statement by the nurse would be beneficial in this situation? 1. "Perhaps you should leave the room so that I can speak with your child privately." 2. "I am going to refer you for counseling since your interactions with your child seem so negative." 3. Addressing the child, the nurse says, "Are you unhappy when mommy talks to you like this?" 4. "Let's talk privately. We should discuss the way you speak with your child and possible ways to be more positive."

Answer: 4 Explanation: 1. Since the child is only 4 years old, it would be difficult to ask the parent to leave the room. If the nurse wants to speak alone with the child, it would be best to escort the child to another area and speak briefly with the child. 2. Referring to counseling without a discussion with the parent is not appropriate. 3. The nurse should not ask the child if she is "unhappy" with the parent. 4. The best approach to this encounter would be for the nurse to discuss concerns with the parent privately, since the nurse wants to help the parent develop a good relationship with the child. The child should not be a part of this conversation.

7) Parents of a preschool-age child report that they find it necessary to spank the child at least once a day. Which response by the nurse is appropriate based on this information? 1. "Can you try spanking the child only every other day for 1 week and see how that affects your child's behavior?" 2. "Spanking is one form of discipline; however, you want to be sure that you do not leave any marks on the child." 3. "I think you are not parenting properly, so let's talk about ways to improve your parenting skills." 4. "Let's talk about other forms of discipline that have a more positive effect on the child."

Answer: 4 Explanation: 1. The behavior reported by the parents was excessive. The only appropriate response is to seek a more positive way to influence behavior in a child of this age. The nurse's response must reflect these feelings and should address other forms of discipline that have a more positive effect on the child. To suggest that spanking is an appropriate form of discipline is inappropriate, especially when the parent is describing daily spanking of the child. 2. The behavior reported by the parents was excessive. The only appropriate response is to seek a more positive way to influence behavior in a child of this age. The nurse's response must reflect these feelings and should address other forms of discipline that have a more positive effect on the child. To suggest that spanking is an appropriate form of discipline is inappropriate, especially when the parent is describing daily spanking of the child. 3. The behavior reported by the parents was excessive. The only appropriate response is to seek a more positive way to influence behavior in a child of this age. The nurse's response must reflect these feelings and should address other forms of discipline that have a more positive effect on the child. To suggest that spanking is an appropriate form of discipline is inappropriate, especially when the parent is describing daily spanking of the child. 4. The behavior reported by the parents was excessive. The only appropriate response is to seek a more positive way to influence behavior in a child of this age. The nurse's response must reflect these feelings and should address other forms of discipline that have a more positive effect on the child. To suggest that spanking is an appropriate form of discipline is inappropriate, especially when the parent is describing daily spanking of the child.

1) Which is the priority nursing action when performing a physical assessment on a toddler? 1. Leaving intrusive procedures such as eye and ear examinations until the end 2. Explaining each part of the examination to the child before performing it 3. Performing the assessment from head to toe 4. Asking the mother to tell the child not to be afraid

Answer: 1 Explanation: 1. Intrusive procedures such as examinations of the eyes, ears, throat, and genitals should be done last to decrease the anxiety of the child during the initial phases of the examination, which include heart and lungs. 2. A toddler is too young to understand the medical terminology. 3. Intrusive procedures such as examinations of the eyes, ears, throat, and genitals should be done last to decrease the anxiety of the child during the initial phases of the examination, which include heart and lungs. 4. Asking the mother to tell the child not to be afraid is an inappropriate response.

12) The nurse is teaching the parents of a toddler-age child information regarding toy and playground safety. Which parental statement indicates the need for further education? 1. "I allow my child to play with the packaging material for new toys." 2. "I will avoid buying my child toys that are battery operated." 3. "I allow my child to play with age-appropriate toys as indicated on the packaging." 4. "I don't let my child play on the playground without supervision."

Answer: 1 Explanation: 1. The toddler-age child should not be allowed to play with packaging material for new toys as this increases the risk of injury. This statement indicates the need for further education. 2. The toddler-age child should not be allowed to play with battery-operated toys. This is not appropriate until the child is 8 years of age. This statement indicates appropriate understanding of the information presented. 3. The toddler-age child should be provided with toys that are age-appropriate. A parent who buys the child toys based on the age range on the packaging is appropriate and does not indicate the need for further education. 4. The toddler-age child should not be allowed to play on the playground without supervision. This statement indicates appropriate understanding of the information presented.

17) Which assessment questions are appropriate when the nurse is assessing the mental health of a preschool-age client? Select all that apply. 1. "Is your child experiencing nightmares?" 2. "Does your child ask questions about the genitalia?" 3. "How do you implement punishment for your child when a rule is broken?" 4. "Is your child up-to-date on recommended immunizations?" 5. "Does your child wear safety equipment when riding a bicycle?"

Answer: 1, 2, 3 Explanation: 1. The nurse inquires about nightmares when assessing the mental health of a preschool-age client. 2. The nurse inquires about sexual exploration when assessing the mental health of a preschool-age client. 3. The nurse inquires about implementing punishment for broken rules when assessing the mental health of the preschool-age client. 4. Assessing immunization status is not included in a mental health assessment for a preschool-age client. 5. Assessing the use of safety equipment is not included in a mental health assessment for a preschool-age client.

11) Which assessment finding for a toddler-age child indicates an increased risk for an unhealthy self-concept? 1. A parent who praises the child for his or her accomplishments 2. A parent who is attempting potty training but who understands that accidents will happen 3. A parent who is observed spanking a child for taking a toy from another child in the waiting room 4. A parent who reads a book to the toddler-age child each night before bed to encourage cooperation

Answer: 3 Explanation: 1. Praise from a parent to a toddler-age child for his or her accomplishments does not place the child at risk for an unhealthy self-concept. 2. A parent who attempts potty-training for a toddler-age child but expects accidents to happen does not place the child at risk for an unhealthy self-concept. 3. Physical discipline is a risk factor for the toddler to develop an unhealthy self-concept. 4. A parent who reads a book to a toddler-age child each night to encourage cooperation is not at risk for an unhealthy self-concept.

18) Which nursing actions are appropriate when conducting a mental health assessment for a toddler-age child? Select all that apply. 1. Observing the child's interaction with family members 2. Asking the caregiver to describe the child's typical day 3. Giving the child a crayon to assess ability to use 4. Determining the number of hours the child sleeps each night 5. Inquiring about recent exposure to communicable diseases

Answer: 1, 2, 3, 4 Explanation: 1. When conducing a mental health assessment for a toddler-age child it is appropriate for the nurse to observe the child's interaction with family members. 2. When conducting a mental health assessment for a toddler-age child it is appropriate for the nurse to ask the caregiver to describe the child's typical day. 3. When conducting a mental health assessment for a toddler-age child it is appropriate to determine whether the child is mastering age-appropriate skills, such as the use of a crayon for a toddler-age child. 4. When conducting a mental health assessment for a toddler-age child it is appropriate to inquire about the number of hours of sleep the child gets each night. 5. The nurse assesses exposure to communicable diseases during a typical health maintenance visit; however, this action is not appropriate when assessing the toddler's mental health.

20) Which recommendations will the nurse make to the parents of a preschool-age child who is experiencing frequent nightmares? Select all that apply. 1. Reassure the child by back rubbing. 2. Repeat a nighttime routine, such a reading a story. 3. Bring the child to the parental bed. 4. Allow the child time to settle back into sleep. 5. Place a television in the child's room for distraction.

Answer: 1, 2, 4 Explanation: 1. It is appropriate for the parent to reassure the child by back rubbing when a nightmare occurs. 2. It is appropriate for the parent to repeat a nighttime ritual, such as reading a story. 3. It is not recommended for the parent to bring the child to the parental bed as the child may continue to awaken at night to continue this practice. 4. It is appropriate to allow the child time to settle back into sleep. 5. It is not recommended to place a television in the child's room as a form of distraction for the nightmare.

16) Which will the nurse assess in the family of a 3-year-old child during a pediatric clinic visit scheduled due to regressive behavior? Select all that apply. 1. Change in parental marital status 2. Level of education for each parent 3. Health of child's siblings 4. Maternal depression 5. Child's exposure to communicable diseases

Answer: 1, 3, 4 Explanation: 1. Changes that occur with the family members of a 3-year-old child could be the source of the regressive behavior being exhibited. It is appropriate for the nurse to assess for a change in parental marital status. 2. The nurse would not need to assess the level of education for each parent for a 3-year-old child exhibiting regressive behavior. This information will already be compiled in the child's medical record. 3. A change in the health of the child's siblings could cause regressive behavior. This is appropriate for the nurse to include in the family assessment. 4. Maternal depression can be associated with poor self-concept and could be a reason for regressive behavior. This is appropriate for the nurse to include in the family assessment. 5. While it is appropriate for the nurse to assess the child's exposure to communicable disease, this is not included in the family assessment for regressive behavior.

6) The parents of a 2-year-old girl inquire about information to help their child transition to bed each night. Which response by the nurse is appropriate? 1. Let the child cry self to sleep a few nights to adjust to the transition. 2. Play a favorite video at bedtime on a television in the child's room to enhance relaxation. 3. Read a book to the child just before bedtime each night. 4. Let the child fall asleep while playing and then put the child in bed.

Answer: 3 Explanation: 1. A child of this age will not just learn to fall asleep on her own if left alone. Letting the child cry for an extended period of time can affect attachment issues. 2. Having a television in a 2-year-old child's room is not a healthy practice. This can lead to decreased physical activity. 3. Developing a quiet routine just before bedtime can help calm the child and give an expectation to what will happen next: going to bed. 4. Letting the child fall asleep while playing is not healthy, as it allows the child to get to the point of exhaustion without any limits set.

4) Which action by the nurse is appropriate when teaching the parents of a 2-year-old child during a scheduled health maintenance visit? 1. Encouraging the parents to allow the child to pour liquids using a pitcher 2. Being sure that all major foods group have been introduced to the child 3. Teaching the parents that it is appropriate to switch from whole to 2% milk 4. Educating the child about food groups

Answer: 3 Explanation: 1. It is not appropriate to encourage the parents to allow the child to pour liquids using a pitcher until 3 years of age. 2. The nurse should ensure that all major foods groups have been introduced to the child at 1 year of age. 3. The nurse will teach the parents that it is appropriate to switch from whole to 2% milk during the 2-year-old's health maintenance visit. 4. The nurse would not educate the child about food groups until the age of 4 years.

8) Which parental statement during a scheduled health maintenance assessment for a preschool-age child would cause the nurse concern? 1. "We have dinner together as a family each evening." 2. "We are so proud that our child is able to recognize letters of the alphabet." 3. "Our child wakes up each night screaming because of nightmares." 4. "Our child attends a daycare program 3 days per week."

Answer: 3 Explanation: 1. Parents are encouraged to spend time with their children each day. The statement about eating dinner together each evening as a family would not cause the nurse concern. 2. A preschool-age child should be able to recognize letters of the alphabet. Parents who verbalize pride in their child would not cause the nurse concern. 3. A child who awakens each night due to nightmares may be indicative of a mental illness. This statement would cause the nurse concern. 4. Many children attend daycare due to both parents in the house working. The nurse should further assess the interactions between the parents and the caregivers; however, this statement would not cause the nurse concern.

15) The nurse is conducting a physical assessment for a preschool-age child. When plotting the child's body mass index (BMI) the nurse notes that the child's is at the 90th percentile. Which action by the nurse is appropriate? 1. Referring the child to a nutritionist 2. Conducting a developmental assessment 3. Assessing the child's level of activity 4. Checking a blood glucose level

Answer: 3 Explanation: 1. While the nurse will need to assess a detailed dietary intake for the child it is not appropriate to refer the child to a nutritionist at this time. 2. There is no reason for the nurse to conduct a developmental assessment based on the current assessment data. 3. A child with a BMI that is 85% or greater should have a detailed dietary intake assessment conducted along with assessing the child's level of activity. 4. The current assessment data do not support the need to check the child's blood glucose level.

2) At which age will the nurse begin to calculate body mass index (BMI) as a part of the nursing assessment process? 1. 12 months 2. 18 months 3. 2 years 4. 4 years

Answer: 3 Explanation: 1. While the nurse will plot a child's growth at 12 months of age a BMI is not included in the physical assessment at this time. 2. While the nurse will plot the child's growth at 18 months of age, a BMI is not included in the physical assessment at this time. 3. BMI is first calculated at 2 years of age, and gives information about the relationship between the height and weight of the child. With this information, the nurse would be able to develop strategies that can reduce the incidence of obesity. 4. The nurse will not initiate BMI calculation for a 4 year old; this action should be implemented into the nursing assessment prior to 4 years of age.