Chapter 27: Children and Adolescents

Children develop speech in a predictable manner. Which of the following statements is true regarding speech development in children? By 18 months of age, a child has a vocabulary of approximately 50 words A child uses two-word sentences by the age of 1 year By the age of 2, sentences are completely understandable to most people A child says his or her first word by 6-8 months of age

By 18 months of age, a child has a vocabulary of approximately 50 words At birth, the child cries. He or she then learns to coo and babble as well as how to gesture. By 10 to 15 months of age, the child says the first word; by 18 months, he or she has a vocabulary of approximately 50 words. Most children use two-word sentences by 2 years of age. By 3 years of age, sentences are more complicated, and their speech is completely understandable to most people.

During the health assessment interview, which question should the nurse ask the parents of a preschooler to determine the child's level of motor development? "Can your child run, hop, and skip?" "Can your child walk up and down steps?" "Can your child jump with both feet?" "Can your child spontaneously scribble?"

"Can your child run, hop, and skip?" The most appropriate question for the parents of a preschooler would be to ask if the child can run, hop, and skip. Running, hopping, and skipping indicate the level of motor development in the child. The nurse need not ask the parents if the child can scribble, because at 15 months the child can spontaneously scribble. Parents of a toddler should be asked if their child can walk up and down the steps and jump with both feet.

The nurse is conducting an assessment of Maggie, an 12-year-old child. Which statement by the mother would concern the nurse most? "Maggie started to develop breasts when she was 11." "Maggie's dresses and shirts don't hang right." "Maggie wears contacts to correct her nearsightedness." "Maggie had her tonsils removed when she was 8."

"Maggie's dresses and shirts don't hang right." Maggie's clothes may not fit well due to an unevenness in shoulder height, which may be a sign of scoliosis. Breast development in girls occurs after age 8 years. While it is important for the nurse to know Maggie wears contacts and had her tonsils removed, they are not of concern to require follow-up.

A nurse is assessing the moral development of an 11-year-old-child. The nurse determines normal moral development has been achieved when the parents make which of the following statements? "It's like our child does not know what is right or wrong." "Our child is a handful, always getting into trouble." "We use distraction to prevent our child from doing dangerous things." "Our child is always trying to please us."

"Our child is always trying to please us." Between the ages of 10 and 13 years of age, children are at the conventional level of Kohlberg's moral development theory. The school-age child wants to please and conform to social norms. If a school-age child is not conforming and is always getting into trouble, they have not met the conventional level. Knowing what is morally right and wrong occurs at the postconventional level of morality during adolescence (13 and older). Distraction to prevent injury is used with toddlers who are in the substage of the preconventional stage, which involves punishment and reward.

The nurse is discharging a 9-year-old child from the hospital and is transporting him via wheelchair to the parents' car. The father states, "Go ahead and put him in the front seat." What response from the nurse would be most appropriate? "The child should be riding in a booster seat in the back. The air bag may deploy and harm the child." "The child should be riding in the back seat of the car until age 10 years. The air bags may deploy and harm him." "The child should sit in the back seat until 12 years old or of adult size. The air bags can cause harm if deployed." "How far are you going? It is okay if the child rides home in the front seat if you will be going only a few miles."

"The child should sit in the back seat until 12 years old or of adult size. The air bags can cause harm if deployed." Once a child is out of a booster seat, he or she should ride in the back with a seat belt fastened securely. A child may move to the front seat after 12 years old if he or she is of adult size. Front air bags have been known to hurt younger and smaller children as a result of the force with which they are deployed.

The nurse is examining a 3-year-old girl who becomes distressed during the examination. What should you tell the parents? "This behavior shows inability to adjust." "This behavior is socially inappropriate." "This behavior shows a lack of discipline." "This behavior is developmentally appropriate."

"This behavior is developmentally appropriate." Reassure parents that resistance to examination is developmentally appropriate.

The nurse is conducting a prenatal history. Which question would be included in a prenatal history? "Did the child develop like other children?" "Were there any difficulties with the pregnancy?" "Did the baby go home with the mother from the hospital?" "Did the baby have treatment for jaundice?"

"Were there any difficulties with the pregnancy?" In a prenatal history, the nurse would ask, "Were there any difficulties with the pregnancy?" The nurse would ask, "Did the baby have jaundice?" and "Did the baby go home with the mother from the hospital?" in a postnatal history. When conducting a developmental history, the nurse would ask, "Did the child develop like other children?"

During the developmental evaluation, the nurse should utilize the Denver Developmental Screening Test II for which age child? 5 year old 9 year old 11 year old 7 year old

5 year old The Denver Developmental Screening Test II (DDST-II) (Frankenburg, Dodds, Archer, Shapiro, & Bresnick, 1992) is one of several standardized developmental screening tests used in the examination of the child and required for early and periodic screening and developmental testing. The DDST-II is considered the standard criterion for the developmental evaluation of children aged 1 month to 6 years. It evaluates four developmental areas of interest: personal/social, language, fine motor/adaptive, and gross motor.

At what year of age should a nurse expect to observe a child's respiratory rate and pattern change to become like those of an adult? 2 to 4 5 to 7 8 to 10 11 to 13

8 to 10 A child's respiratory rate and pattern become like those of an adult between ages 8 and 10 years.

The nurse is experiencing challenges in eliciting information during the health interview of a 4-year-old boy. How can the nurse best foster communication with the child? Actively engage the child in play. Explain the purpose of the interview in simple terms. Ask the child to talk about himself in the third person. Set a time limit for completing the interview.

Actively engage the child in play. Play is one of the most valuable communication techniques when working with children; it allows for the discovery of important cues to children's development and illness behaviors. Setting a time limit is unlikely to promote communication, and asking the child to refer to himself in the third person is not a commonly used strategy. A 4-year-old child is unlikely to respond positively to an explanation of the purpose of the interview.

The school nurse has received approval to begin a series of health classes for adolescents focusing on contraception and sexually transmitted infections (STIs). What would be the importance of targeting adolescents? Adolescents are now beginning to think about sex and are contemplating relationships. Adolescents aren't ready for sexual relationships and should be discouraged from entering into them. Adolescents are unprepared for the emotional responsibilities that accompany having a sexual relationship. Adolescents are more likely than adults to have multiple sex partners and engage in unprotected sex.

Adolescents are more likely than adults to have multiple sex partners and engage in unprotected sex. Adolescents are more likely than adults to have multiple sexual partners and short-term relationships, to engage in unprotected intercourse, and to have partners at high risk for STIs.

A young child refuses to allow a nurse to palpate the abdomen because it tickles. How can the nurse decrease the child's ticklishness to facilitate completion of the exam? Speak to the child about the importance of cooperation Allow the child to place the hand under the examiner's hand Turn the child to the left side and draw up the legs to release tension Use the stethoscope to begin, and then slide the hand off when the child is distracted

Allow the child to place the hand under the examiner's hand To decrease ticklishness, have the child help by placing the hand under the nurse's hand, using age-appropriate distraction and conversation focused on something other than the exam.

A parent brings their toddler (2 years old) to the clinic for a regular screening. What approaches should the nurse use to assess a toddler? Allow the toddler to sit on the parent's lap during the examination. Use storytelling or puppet play to engage the toddler. Ask the parent to leave the room. Explain procedure and allow toddler to manipulate the equipment.

Allow the toddler to sit on the parent's lap during the examination. According to Erikson's psychosocial development theory, toddlers are attempting to achieve trust versus mistrust. Allowing the toddler to stay on the parent's lap will lessen the toddler's anxiety because the parent is trusted. The nurse would explain the procedure to a school-aged child and allow them to manipulate the equipment, like the blood pressure cuff or stethoscope. Storytelling and puppet play are used with preschool-age children. The nurse would not ask the parent to leave the room, because this would increase the child's anxiety.

A 4-year-old boy is brought to the emergency department by his parents, who state that he has been crying and saying his "tummy hurts." Which method would be most appropriate for the nurse to initially assess the problem? Ask the child to describe the character of his pain. Determine the time and character of the child's last bowel movement. Inspect, palpate, percuss, and then auscultate the abdomen. Ask the child to point with one finger where it hurts.

Ask the child to point with one finger where it hurts. Asking the child to point to where it hurts is most appropriate because it helps to get the most accurate information. Since the abdomen is painful, this area would be examined last. In addition, the nurse would inspect, auscultate, percuss, and then palpate the area. After gaining information from the child about where it hurts, the nurse would gather additional information about onset, duration, and intensity. A child of this age may have difficulty describing the character of the pain. The time and character of the last bowel movement, if determined to be important, would be gathered later in the assessment.

A school nurse plans to test hearing acuity in kindergarten through sixth grades. Which of the following would be most appropriate method? Weber test Audiometry Whisper test Loud noise screening

Audiometry Audiometry would be most appropriate for testing hearing acuity in school-age children because it measures the threshold of hearing for frequencies and loudness. At this age, hearing acuity is almost complete. Initially, hearing acuity can be evaluated by the whisper test. The Weber test would be used if a hearing deficit is noted to distinguish between a conductive and sensorineural hearing loss.

When assessing adolescent girls, the nurse should know that what usually appears first? Menses onset Axillary hair Pubic hair Breast buds

Breast buds Breast development occurs first. This is followed by the growth of pubic hair, axillary hair, and then menarche.

A mother of a 4 year old child calls the clinic nurse because her child has swallowed some type of cleaning agent. What is the nurse's best response? Bring the child to the emergency department for administration of activated charcoal. Call the Poison Help Line #1-800-222-1222 for instructions on treatment. Monitor the child closely and bring to the clinic if symptoms appear. Administer ipecac syrup per directions on bottle.

Call the Poison Help Line #1-800-222-1222 for instructions on treatment. The American Association of Poison Control Centers (AAPCC, n.d.) provides information needed for the home or hospital treatment of a child who has ingested a toxic substance. The Poison Help Line number is 1-800-222-1222. Recommendations might include use of ipecac syrup, activated charcoal, or both. Parents can buy these medications without a prescription; however, they should be used only when instructed to do so by the AAPCC. Currently, these medications are not recommended for home use because they have been used inappropriately in the past. The AAPCC provides telephone stickers or magnets with its emergency phone number to be posted on or near telephones. The nurse's best response is to instruct the mother to call the Poison Help line.

A 12 year old adolescent female presents to the clinic alone requesting birth control and testing and treatment suspected chlamydia. What is the nurse's priority action? Inform the client that her parents must be notified first. Prepare client for vaginal and cervical examination. Obtain urine sample from client. Check state regulations about testing and treatment of minors.

Check state regulations about testing and treatment of minors. Most states permit contraception and treatment for sexually transmitted infections at 13 years of age; therefore the nurse should first check state regulations regarding a 12 year old seeking treatment before collecting urine sample or cervical exam is performed.

A nurse is providing an in-service presentation to a group of new pediatric nurses and reviewing differences in assessment of children and adults. When describing the heart sound typically auscultated in children in comparison to an adult, which characteristic would the nurse describe? Children typically have less harsh heart sounds. Children typically have higher pitched heart sounds. Children typically have softer heart sounds. Children typically have heart sounds of longer duration.

Children typically have higher pitched heart sounds. The heart sounds of a child typically are louder, higher pitched, and of shorter duration than those of an adult.

Tommy, an 18-month-old, is seen in the clinic for otitis media. The nurse notes that Tommy coos and babbles but does not say distinct words. Which nursing diagnosis is most appropriate? Disturbed sensory perception Readiness for enhanced growth and development Readiness for enhanced family processes Delayed growth and development

Delayed growth and development Tommy is not exhibiting expected language/speech development for an 18-month-old and requires further evaluation immediately. Nursing diagnoses with "readiness" indicate the family is operating at a level that supports the well-being of family members and desires to promote the health of the family and function at a higher level. Whether Tommy is experiencing disturbed sensory perception related to altered hearing, which may contribute to his delay in language/speech development, is not clear.

A nurse is assessing the mobility of the tympanic membrane of a 6-year-old client. Which of the following should the nurse do to correctly perform this assessment? Whisper questions from a distance of approximately 8 feet Direct a puff of air against the tympanic membrane using a pneumatic bulb Pull the pinna down and back and insert the otoscope Create a seal by using the smallest speculum that will comfortably fit into the ear canal

Direct a puff of air against the tympanic membrane using a pneumatic bulb Assess the mobility of the tympanic membrane by pneumatic otoscopy. This consists of creating pressure against the tympanic membrane using air. To do this, you need to create a seal in the external canal and direct a puff of air against the tympanic membrane. Create the seal by using the largest speculum that will comfortably insert into the ear canal. Cover the tip with rubber for a better and more comfortable seal. Attach a pneumatic bulb to the otoscope and squeeze the bulb lightly to direct air against the tympanic membrane. Pulling the pinna down and back is performed in otoscopic inspection of an infant's ear. Whispering questions from 8 feet away tests hearing acuity.

A nurse reviews the vital signs of a 1-year-old client: Temperature: 98.6° F (37° C), pulse 135 beats per minute, respiratory rate 30 breaths per minute. What is the best action of the nurse? Ask another nurse to reassess the respiratory rate. Document findings. Report abnormal findings. Reassess pulse.

Document findings. Because the vital signs are within normal range, the nurse would document the findings. Normal vital signs for a 1-year-old include temperature 98.6° F (37° C), pulse for 3-month-old to 2-year-old is 80 to 150 beats per minute, respiratory rate from ages 1 to 2 years is 22 to 37 breaths per minute. Because these are normal signs the nurse does not need to report the findings, reassess the pulse, or ask another nurse to reassess the respiratory rate.

A teacher refers a child to the school nurse, concerned that the child's speech is difficult to understand and not at the same level as other children in the age group. What information would be a priority for the nurse to obtain from the parent of this child? Does the child have a history of frequent ear infections? Does the child have any difficulty with vision? Has the child experienced a traumatic event in his or her life? Does the child have siblings with the same problem?

Does the child have a history of frequent ear infections? A delay in speech development may signal hearing loss or mental health concerns. Traumatic events, vision problems, and siblings with speech difficulties are not indicators or causes of speech delays.

The nurse is meeting the parents of an ill child for the first time and is preparing to perform the health interview. In addition to gathering health data, what additional goal should the nurse prioritize during this interaction? Gauge the parents' own levels of health. Emphasize the importance of adherence to treatment. Identify the family's socioeconomic status. Foster trust with the child's parents.

Foster trust with the child's parents. Establishing trust and rapport with the child's parents is imperative during early interactions. Each of the other listed goals may be appropriate and applicable to many families, but therapeutic care is not possible in the absence of trust between the nurse and the family.

One of the Healthy People goals for children and adolescents is to reduce the proportion who are overweight or obese. What intervention by the school nurse would help to meet this goal? Have the students meet to discuss the pressures and concerns they have in their lives. Answer questions regarding sexuality and sexual health. Attend each class and review healthy habits, such as getting enough sleep and rest. Go to each class and give a presentation with discussion of healthy snacking and exercise.

Go to each class and give a presentation with discussion of healthy snacking and exercise. Several interventions can help with meeting the goals of Healthy People for children and adolescents to reduce obesity. Increasing exercise and nutritious snacking are two programs a school nurse can institute with classroom discussions to reach a large population of children and adolescents.

The nurse obtains the following data about a 3-year-old child during an assessment at the neighborhood health clinic. Which finding would indicate a need for further evaluation of the child? Still has some temper tantrums. Is unable to hop on one foot. Constantly asks questions, especially "why." Has an undescended testes.

Has an undescended testes. The testes should descend into the scrotal sac by age 6 months. Surgical intervention usually occurs before age 2 years to decrease the risk for decreased fertility. All of the other options are normal behaviors for a 3-year-old.

Which activity may assist the nurse in assessing the breath sounds of a 5-year-old child? Have the child say 99, 99, 99. Have the child skip around the room. Have the child hop on one foot. Have the child blow a pinwheel.

Have the child blow a pinwheel. The nurse can assure adequate deep breaths for assessment of lung sounds by having the child blow a pinwheel. Having the child say 99, 99, 99 assesses the density of the lung tissue not breath sounds. Hopping on one foot and skipping around the room gives the nurse information regarding the child's sense of balance and motor development.

The nurse's inspection of a young child's anus reveals the presence of hemorrhoids. How should the nurse best interpret this assessment finding? Hemorrhoids are unusual in children and warrant further assessment. Hemorrhoids are a common indication of deficient fluid intake in children. Hemorrhoids in a child younger than 10 are suggestive of colorectal cancer. Hemorrhoids are common in children until they attain bowel continence.

Hemorrhoids are unusual in children and warrant further assessment. Hemorrhoids are unusual in children and could be due to chronic constipation but may be caused by sexual abuse or abdominal pressure from a lesion. Further assessment is thus warranted. This finding is not suggestive of a fluid deficit or cancer.

The mother of an 8 year old girl expresses concern about feeling a lump at each of the child's areolas. What is the nurse's best response? Pubertal changes at age 8 are abnormal and require further evaluation. She will likely be prescribed hormonal replacement therapy. It is likely a breast bud which is a normal finding at this age. Is there a history of breast cancer in your family?

It is likely a breast bud which is a normal finding at this age. Breast development begins with a "breast bud" or enlargement of the areola followed by enlargement of breast tissue. The onset of pubertal changes before 8 years in girls and 9 years in boys may be too early and needs further evaluation.

During palpation of the abdomen, the nurse assesses the liver of a 4-year-old client. Which of the following would the nurse expect to find? It is unpalpable. It can be palpated 4 cm below the right costal margin. It is found at the left costal margin. It is located 2 cm below the right costal margin.

It is located 2 cm below the right costal margin. The liver is usually palpable 1 to 2 cm below the right costal margin in young children; therefore, the nurse should not expect the liver to be unpalpable. An enlarged liver with a firm edge that is palpated more than 2 cm below the right costal margin usually indicates a pathologic process.

The nurse is beginning a physical assessment of a 3-year-old child, who becomes restless and begins to cling to the parent. Which assessment is a priority before the child becomes upset? Listen to heart sounds. Obtain a urine specimen. Get the child's weight. Listen to breath sounds.

Listen to heart sounds. If a child is predicted to become upset, listen to heart sounds first and the breath sounds. This is best done while the child is sitting on the parent's lap.

A nurse finds that a 14-year-old girl's breasts are red, edematous, and tender. Which of the following conditions should she suspect? Trauma Mastitis Gynecomastia Precocious puberty

Mastitis Redness, edema, and tenderness in the breasts indicate mastitis. Enlargement of the breasts in adolescent boys suggests gynecomastia. Masses in the adolescent female breast usually indicate cysts or trauma. Breast development before age 8 may indicate precocious puberty or thelarche.

A nurse measures an 18-month-old child's head circumference (HC) and finds that it is in the 3rd percentile. Which of the following conditions should the nurse suspect in this child? Separation of cranial sutures Microcephaly Normal Macrocephaly

Microcephaly HC not within the normal percentiles may indicate pathology. A finding greater than 95% may indicate macrocephaly. A finding under the 5th percentile may indicate microcephaly. Increased HC in children older than 3 years may indicate separation of cranial sutures due to increased intracranial pressure.

When the nurse palpates the abdomen of a preschool boy, he begins to giggle and draw his legs up onto his abdomen. What would be most appropriate for the nurse to do? Palpate with the child's hand under the nurse's hand. Explain the purpose of the exam to the child. Ask the parent to discipline the child. Omit the entire abdominal exam.

Palpate with the child's hand under the nurse's hand. The child appears ticklish. To decrease this, the nurse should have the child help by placing his or her hand under the nurse's using age-appropriate distraction techniques and maintaining conversation focused on something other than the examination. Omitting the exam or asking the parent to discipline the child would be inappropriate. Although explaining the purpose might help, it should have already been done and most likely would have little effect on the child's ticklishness.

Which information would a nurse include when taking a health history on a child, but omit with an adult? Review of systems Immunization history Past medical history Prenatal history

Prenatal history Certain childhood problems and conditions can be associated with the prenatal, intrapartal, and/or neonatal periods. This information is not necessary for an adult.

A nurse has completed an assessment of a school-age child. The nurse has identified several "soft signs" of potential neurologic impairment. How should the nurse best interpret these findings? Recognize the need for an emergency neurological assessment. Recognize that the findings may or may not indicate the presence of a neurologic problem. Recognize that the findings are related to developmental tasks, not neurologic pathology. Recognize that the findings need to be interpreting in light of the child's education level.

Recognize that the findings may or may not indicate the presence of a neurologic problem. Soft signs of neurologic problems are controversial, because these signs do not always indicate a pathologic process. Referral may be necessary, but not likely on an emergency basis. These signs are unlikely to be closely related to educational level or developmental tasks.

Which of the following is the most accurate method of determining the length of a child under 24 months of age? Length measured in the left lateral position Standing height with shoes removed Estimation of length to the nearest centimeter or inch Recumbent length measured in the supine position

Recumbent length measured in the supine position Recumbent length is used to measure the height of children less than 2 years of age. Children under the age of 2 years may not able to stand erect. All heights/lengths should be measured and documented accurately.

Which test would the nurse perform to detect the presence of a congenital cataract? Red reflex Tumbling E Random dot E stereo test Snellen chart

Red reflex The nurse would observe the red reflex; the reflex will be absent in the presence of a congenital cataract. Distance visual acuity is assessed using the Snellen chart and the Tumbling E. Ocular alignment is assessed using the random dot E stereo test at 40 cm.

During the health assessment interview, a nurse should ask the parents of a 9-year-old male questions related to which activities to elicit age-related development of psychosexual stage? Pleasure centers on masturbation and genitalia Engages in masturbation and sexual activities Relative sexual indifference and interaction with same-sex peers Activity centers on expulsion and retention of body waste

Relative sexual indifference and interaction with same-sex peers School-age children who are in the latency period of the psychosexual development stages have sexual indifference and tend to interact with same-sex peers. In a preschooler, pleasure is centered on masturbation and genitalia. Adolescents engage in masturbation and sexual activities with others. In toddlers, the erogenous zones are the anus and buttocks, and their activities are centered on expulsion and retention of body waste.

The nurse would suspect appendicitis as the cause of pain if the child pointed to what location? Right upper quadrant Right lower quadrant Left upper quadrant Left lower quadrant

Right lower quadrant If a child points to pain in the right lower quadrant, appendicitis should be ruled out.

The nurse is conducting a health education program on sexual health for adolescents. Which would be inappropriate for the nurse to include? Self-breast examination Pregnancy prevention Testicular exam STI promotion

STI promotion The nurse would include information on preventing sexually transmitted infections and pregnancy and self exam of the breasts and testes.

When interviewing an adolescent, which health issue would be least appropriate to discuss with the client while a parent is present? Immunizations Nutrition Sleep patterns Sexuality

Sexuality Sensitive issues such as sexuality, drugs, and alcohol use are best handled without the parents present to preserve privacy, confidentiality, and trust. General health issues, such as nutrition, sleep patterns, and immunizations, may or may not be discussed with the parent present.

A 14-year-old girl comes to the clinic and requests to be seen for suspicion of a sexually transmitted disease (STD). What is the nurse's responsibility for treatment of this adolescent? The nurse understands that it is not necessary to have parental consent to treat an STD in a child 13 years or older. The nurse should refuse treatment until consent can be obtained from the parent. The nurse should call social services to inform them that this adolescent is having sexual relations at age 14. The nurse understands that both the parent and the adolescent must consent for treatment of an STD.

The nurse understands that it is not necessary to have parental consent to treat an STD in a child 13 years or older. Legal consent for health care treatment is 18 years of age. Most states, however, permit contraception and treatment for STDs at 13 years of age.

The nurse is performing an assessment on a toddler and observes a protuberant abdomen. What is the significance of this finding? The toddler may have toxic megacolon. The toddler may have an intestinal obstruction. This is a normal finding for a toddler. The toddler may have worms.

This is a normal finding for a toddler. A protuberant abdomen is a common finding for a toddler.

A nurse recognizes that which deep tendon reflex is absent in children until the age of 6? Biceps Patellar Triceps Brachioradialis

Triceps The triceps reflex is absent until the age of 6 years.

The nurse determines the heart rate of 100 beats per minute for a 5-year-old client as being: Evidence of a valve disorder Within normal limits Supraventricular tachycardia Sinus bradycardia

Within normal limits The average heart rate of a 5-year-old client is 103 beats per minute, with the range being from 68 to 138 beats per minute. Sinus bradycardia is a heart rate less than 60 in a 5-year-old client. A heart rate of 100 beats per minute in a 5-year-old client is not evidence of a valve disorder. A heart rate of up to 240 beats per minute would be assessed in supraventricular tachycardia.

While assessing a 4-year-old child, the nurse observes that the child's nails are concave in shape. The nurse should assess the child for a deficiency of magnesium. zinc. vitamin C. iron.

iron. Concave shape, "spoon nails" (koilonychia) indicate iron deficiency anemia.

It is often difficult to assess the location of pain in a child because generally children cannot feel their pain acknowledge their pain sense their pain isolate their pain

isolate their pain Children usually cannot isolate pain to one specific area.

The nurse is going to examine a child with suspected sexual abuse. What piece of data would be a strong indicator of sexual abuse? marked dilatation of the anus in knee-chest position condyloma acuminata in a child older than 3 years of age herpes in the anogenital area beyond the neonatal period perianal lacerations extending to external sphincter

perianal lacerations extending to external sphincter

After examining the breast development of a 13-year-old girl, the nurse records breast and nipples appear as small mounds with areolar development evident. The appropriate stage of maturity would be stage 4 stage 3 stage 1 stage 2

stage 2

A nurse is assessing a 2-year-old for achievement of normal developmental milestones. Which of the following skills demonstrates normal cognitive development for a 2-year-old? uses two- to three-word phrases possesses 1,500-word vocabulary able to point at an object and make sounds and tones able to identify four or more colors

uses two- to three-word phrases At the age of 2, toddlers possess a 300-word vocabulary and can state two- to three-word phrases. At the age of 4, a preschooler has a 1,500-word vocabulary. Five-year-old preschoolers are able to state four or more colors. Younger toddlers at the age 15 months use expressive jargon (pointing at objects and making sounds and tones).