developmnt

A clinic nurse is meeting with a mother and her 3-year-old son. The toddler is acting out, and the mother asks what a good form of discipline would be for her son. The nurse recommends a "time-out" for the child. Which statement regarding a time-out is most accurate? 1. The child should sit still for as many minutes as he misbehaved 2. The child should sit still at a time-out for as many minutes as his age in years 3. The child should be able to read a book during time-out 4. Children should not be expected to sit still until they are in school

2. The child should sit still at a time-out for as many minutes as his age in years

A 10-month-old child reaches the 9-12 month developmental stage. Which nursing action is most appropriate for providing tactile stimulation for this child? 1. Caress the child while diaper changing 2. Give the child a soft squeeze toy 3. Swaddle the child at nap time 4. Let the child squash and mash food while sitting in a high chair

4. Let the child squash and mash food while sitting in a high chair

A nurse is caring for a 3-month-old infant. Based on the developmental age of the child, which motor skill should the nurse expect to see during an assessment? 1. Bangs objects held in hand 2. Begins to grab objects using a pincer grasp 3. Grabs objects using a palmar grasp 4. Looks and plays with his own fingers

4. Looks and plays with his own fingers

The mother of a toddler asks a nurse when it is safe to place the car safety seat in a face-forward position. The best nursing response is which of the following? A) When the toddler weighs 20 lbs B) The seat should not be placed in a face-forward position unless there are safety locks in the car C) The seat should never be place in a face-forward position because the risk of the child unbuckling the harness D) When the weight of the toddler is greater than 40 lbs

A. The transition point for switching to the forward facing position is defined by the manufacturer of the convertible car safety seat but is generally at a body weight of 9 kg or 20 lb and 1 year of age. Convertible car safety seats are used until the child weighs at least 40 lb. Options b, c, and d are incorrect

The nurse observes a 10-month-old infant using her index finger and thumb to pick up pieces of cereal. This behavior is evidence that the infant has developed: a. the pincer grasp. b. a grasp reflex. c. prehension ability. d. the parachute reflex.

ANS: A By 1 year, the pincer-grasp coordination of index finger and thumb is well established.

The nurse discusses child-proofing the home for safety with the mother of a 9-month-old. The statement made by the mother that indicates an unsafe behavior is: a. "I put covers on all of the electrical outlets." b. "In the car, she rides in a front-facing car seat." c. "There are locks on all of the cabinets in the house." d. "I have a gate at the top and bottom of the stairs."

ANS: B A rear-facing infant car seat should be used for infants younger than 1 year of age.

The nurse would advise a parent when introducing solid foods to: a. begin with one tablespoon of food. b. mix foods together. c. eliminate a refused food from the diet. d. introduce each new food 4 to 7 days apart.

ANS: D Only one new food is offered in a 4- to 7-day period to determine tolerance.

17) Which parental statements during the nutrition assessment for a toddler would cause the nurse concern? Select all that apply. 1. "My child drinks 20 ounces of fat-free milk each day." 2. "My child drinks 6 ounces of 100% fruit juice each day." 3. "We eat at fast-food restaurants several times each week." 4. "We only give our child pasteurized fruit juices." 5. "My child likes to drink water with snacks."

Answer: 1, 3 Explanation: 1. Toddlers should consume whole milk until the age of 2 years at which time 2% milk should be used. Fat-free milk is not appropriate for the toddler. 2. It is appropriate for the toddler-age child to consume 6 ounces of 100% fruit juice each day. 3. Consumption of fast food should be restricted to only one time per week. 4. It is appropriate for a toddler-age child to drink only pasteurized fruit juices. 5. It is appropriate for the toddler-age child to drink water with snacks.

A maternity nurse is providing instruction to a new mother regarding the psychosocial development of the newborn infant. Using Erikson's psychosocial development theory, the nurse would instruct the mother to A) Allow the newborn infant to signal a need B) Anticipate all of the needs of the newborn infant C) Avoid the newborn infant during the first 10 minutes of crying D) Attend to the newborn infant immediately when crying

A) Allow the newborn infant to signal a need. Trust vs Mistrust stage-This will allow the infant opportunity to gain trust.

Most infants begin to fear strangers at age: a. 2 months c. 6 months b. 4 months d. 12 months

ANS: C Between ages 6 and 8 months fear of strangers and stranger anxiety become prominent and are related to the infant's ability to discriminate between familiar and nonfamiliar people. At age 2 months infants are just beginning to respond differentially to the mother. At age 4 months the infant is beginning the process of separation individuation when the infant begins to recognize self and mother as separate beings. Twelve months is too late and requires referral for evaluation if the child does not fear strangers at this age.

The most appropriate activity to recommend to parents to promote sensorimotor stimulation for a 1-year-old would be to: a. ride a tricycle. b. spend time in an infant swing. c. play with push-pull toys. d. read large picture books.

ANS: C Push-pull toys are appropriate to promote sensorimotor stimulation for a 1 year old

When assessing development in a 9-month-old infant, the nurse would expect to observe the infant: a. speaking in 2-word sentences. b. grasping objects with palmar grasp. c. creeping along the floor. d. beginning to use a spoon rather sloppily.

ANS: C The 9-month-old tries to creep, has developed pincer movement, and can grasp a spoon without keeping food on it.

The nurse is aware that the earliest age at which an infant is able to sit steadily alone is _____ months. a. 4 b. 5 c. 8 d. 15

ANS: C The infant can sit alone without support at about 8 months of age.

The abnormal finding in an evaluation of growth and development for a 6-month-old infant would be: a. weight gain of 4 to 7 ounces per week. b. length increase of 1 inch in 2 months. c. head lag present. d. can sit alone for a few seconds.

ANS: C The infant should be holding the head up well by 5 months of age. If head lag is present at 6 months, the child should undergo further evaluation.

The statement made by a parent that indicates correct understanding of infant feeding is: a. "I've been mixing rice cereal and formula in the baby's bottle." b. "I switched the baby to low-fat milk at 9 months." c. "The baby really likes little pieces of chocolate." d. "I give the baby any new foods before he takes his bottle."

ANS: D New solid foods should be introduced before formula or breast milk to encourage the infant to try new foods.

The helpful measure the nurse would suggest to the parent is to: a. sing songs to the infant in a soft voice. b. place the infant in a well-lit room. c. walk around and massage the infant's back. d. rock the fussy infant slowly and gently.

ANS: D One technique the nurse can offer parents of a fussy infant is to rock the infant gently and slowly while being careful to avoid sudden movements.

A 17-month-old child would be expected to be in what stage according to Piaget? a. Trust b. Preoperations c. Secondary circular reaction d. Tertiary circular reaction

ANS: D The 17-month-old is in the fifth stage of the sensorimotor phase: tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Trust is Erikson's first stage. Preoperations is the stage of cognitive development usually present in older toddlers and preschoolers. Secondary circular reactions last from about ages 4 to 8 months.

11) Parents are in the pediatric clinic with their infant for a 1-month checkup. Which assessment question regarding immunizations should the nurse ask the infant's parents? 1. "Did your baby receive the influenza vaccine prior to hospital discharge?" 2. "Did your baby receive the hepatitis B vaccine prior to hospital discharge?" 3. "Did your baby receive the rubella vaccine prior to hospital discharge?" 4. "Did your baby receive the rotavirus vaccine prior to hospital discharge?"

Answer: 2 Explanation: 1. The influenza vaccine is not administered at birth. 2. Hepatitis B is given routinely at birth. 3. The rubella vaccine is not administered at birth. 4. The rotavirus vaccine is not administered at birth

3) Which statement should the nurse include when teaching parents of an infant about normal growth and development regarding weight gain? 1. "Your baby's weight should triple by 9 months of age." 2. "Your baby's weight should double by 5 months of age." 3. "Your baby's weight should triple by 6 months of age." 4. "Your baby's weight should double by 1 year of age."

Answer: 2 Explanation: 1. The normal infant's birth weight triples by 1 year of age. 2. It is expected that the infant would double in weight by 5 months of age. 3. The infant's birth weight should double by 5 months of age. A child whose weight triples by 6 months of age has gained weight too rapidly. 4. The child's birth weight should triple by 1 year of age. This child may not be growing adequately.

A clinic nurse assesses the communication patterns of a 5-month-old infant. The nurse determines that the infant is demonstrating the highest level of developmental achievement expected if the infant: A) Uses simple words such as "mama" B) Uses monosyllabic babbling C) Links syllables together D) Coos when comforted

B. Using monosyllabic babbling occurs between 3 and 6 months of age. Using simple words such as "mama" occurs between 9 and 12 months. Linking syllables together when communicating occurs between 6 and 9 months. Cooing begins at birth and continues until 2 months.

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.

In terms of fine motor development, the infant of 7 months should be able to: a. Transfer objects from one hand to the other. b. Use thumb and index finger in crude pincer grasp. c. Hold crayon and make a mark on paper. d. Release cubes into a cup.

ANS: A By age 7 months infants can transfer objects from one hand to the other, crossing the midline. The crude pincer grasp is apparent at about age 9 months. The child can scribble spontaneously at age 15 months. At age 12 months the child can release cubes into a cup.

In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? a. Roll from abdomen to back. b. Roll from back to abdomen. c. Sit erect without support. d. Move from prone to sitting position.

ANS: A Rolling from abdomen to back is developmentally appropriate for a 5-month-old infant. The ability to roll from back to abdomen usually occurs at 6 months old. Sitting erect without support is a developmental milestone usually achieved by 8 months. The 10-month-old infant can usually move from a prone to a sitting position.

The parent of a 3-month-old infant asks the nurse, "At what age do infants usually begin drinking from a cup?" The nurse would reply: a. 5 months. b. 9 months. c. 1 year. d. 2 years.

ANS: A The infant can usually drink from a cup when it is offered at about 5 months.

A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. The nurse should interpret this as: a. Normal development. b. Significant developmental lag. c. Slightly delayed development caused by prematurity. d. Suggestive of a neurologic disorder such as cerebral palsy.

ANS: A This indicates normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. No evidence of neurologic dysfunction is present.

A parent of an 18-month-old boy tells the nurse that he says "no" to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. The nurse's best interpretation of this behavior is that: a. This is normal behavior for his age. b. This is unusual behavior for his age. c. He is not effectively coping with stress. d. He is showing he needs more attention.

ANS: A Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and the use of the word "no." Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old.

In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? Choose all that apply. a. Roll from abdomen to back b. Put feet in mouth when supine c. Roll from back to abdomen d. Sit erect without support e. Move from prone to sitting position f. Adjust posture to reach an object

ANS: A, B Rolling from abdomen to back and placing the feet in the mouth when supine are developmentally appropriate for a 5-month-old infant.

The nurse cautions that children who have unmet hunger needs will likely display which characteristic(s)? Select all that apply. a. Irritability b. Ineffective feeding patterns c. No predictable sleep-wake cycle d. Distrust e. Effective parent bonding

ANS: A, B, C, D Children who experience frequent hunger do not have effective parental bonding. All other options are probable outcomes for a child who has unmet hunger needs

What should the teaching plan include about infant fall precautions? Select all that apply. a. Remove all unsteady furniture. b. Keep crib rails up and in locked position. c. Steady infant with hand when on changing table. d. Use tray attachment on high chair as restraint. e. Keep infant seat on the floor.

ANS: A, B, C, E The tray attachment to a high chair is an inadequate restraint. All other options are good precautions to prevent an infant from a fall.

A parent brings a 6-month-old infant to the pediatric clinic for her well-baby examination. Her birth weight was 8 pounds, 2 ounces. The nurse weighing the infant today would expect her weight to be at least _____ pounds. a. 12 b. 16 c. 20 d. 24

ANS: B Birth weight is usually doubled by 6 months of age.

The nurse is aware that the earliest age at which the infant should be able to walk independently is _____ months. a. 8 to 10 b. 12 to 15 c. 15 to 18 d. 18 to 21

ANS: B For the majority of children, the milestone of walking alone is achieved between 12 and 15 months.

The nurse knows that an infant's birth weight should be tripled by: a. 9 months. b. 1 year. c. 18 months. d. 2 years.

ANS: B The infant usually triples his or her birth weight by

Various children are being seen in the clinic for various well-baby checks. By what age should a nurse expect a child to begin to use simple words to communicate needs? 1. Age 10-12 months 2. Age 1-2 years 3. Age 6-9 months 4. Age 2-3 years

1. Age 10-12 months

Which interventions are appropriate for the care of an infant? Select all that apply. 1. Provide swaddling. 2. Talk in a loud voice. 3. Provide the infant with a bottle of juice at nap time. 4. Hang mobiles with black and white contrast designs. 5. Caress the infant while bathing or during diaper changes. 6. Allow the infant to cry for at least 10 minutes before responding.

1. Provide swaddling. 4. Hang mobiles with black and white contrast designs. 5. Caress the infant while bathing or during diaper changes.

The mother of a 3-year-old is concerned because her child still is insisting on a bottle at nap time and at bedtime. Which of the following is the appropriate suggestion to the mother? 1. Allow the bottle if it contains juice. 2. Allow the bottle if it contains water. 3. Do not allow the child to have the bottle. 4. Allow the bottle during naps but not at bedtime.

2. Allow the bottle if it contains water.

An 8-month-old baby girl, who is developing appropriately, is admitted to a pediatric unit for respiratory syncytial virus (RSV). The baby is crying and being held by her mother. A nurse wants to provide appropriate care based on Erikson's developmental stages. In which stage is this baby, according to Erikson's theory? 1. Punishment versus obedience orientation 2. Oral stage 3. Initiative versus guilt 4. Trust versus mistrust

4. Trust versus mistrust

The nurse is aware that the age at which the posterior fontanelle closes is _____ months. a. 2 to 3 b. 3 to 6 c. 6 to 9 d. 9 to 12

A

The nurse would expect a 4-month-old to be able to: a. hold a cup. b. stand with assistance. c. lift head and shoulders. d. sit with back straight.

ANS: C Because development is cephalocaudal, of these choices, lifting the head and shoulders is the one that the infant learns to do first. The infant can usually sit with support at about 5 months of age and can sit alone at about 8 months.

A clinic nurse is completing a school physical on an adolescent girl. The girl is concerned because she is 13 years old and has not yet starting menstruating. Which statement by the nurse should be most helpful when addressing the girl's concerns? 1. "The average age for a girl to experience menarche is 12.5 years. That means some girls will be younger and some will be older than 12.5 years." 2. "Don't worry about it; your period will come." 3. "I can see why you are concerned, since some girls get their period when they are 10 years old." 4. "I can refer you to a specialist who can answer your questions."

1. "The average age for a girl to experience menarche is 12.5 years. That means some girls will be younger and some will be older than 12.5 years."

3) The parents of a toddler are concerned that their child seems different from their other child, stating, "He just doesn't seem to like new people and wants us with him in these situations." Which response by the nurse is appropriate when using the temperament theory to respond to the toddler's parents? 1. "Your child seems to withdraw from new situations. This is typical with slow-to-warm-up children." 2. "Your child is having an intense reaction to the environment and new people and we will need to investigate this more closely." 3. "Difficult children often display a negative mood. Does your child often throw temper tantrums?" 4. "Slow-to-warm-up children are often diagnosed with autism spectrum disorder."

1. "Your child seems to withdraw from new situations. This is typical with slow-to-warm-up children." Explanation: 1. Slow-to-warm-up children adapt slowly to new situations and initially will withdraw. 2. Having intense reactions to the environment is a characteristic of "difficult" children. The child in this scenario is not displaying this temperament. This response is inaccurate and not appropriate. 3. Displaying a predominately negative mood to the environment is a characteristic of "difficult" children. The child is this scenario is not displaying this temperament. This response is inaccurate and not appropriate. 4. Slow-to-warm-up children are not often diagnosed with autism spectrum disorder. This statement is inaccurate and not appropriate.

A student explains to an instructor that the infant period is categorized as the "oral phase" according to Freud's theory. Which statements by the student suggest an understanding of this phase? Select all that apply. 1. An infant sucks for nourishment as well as pleasure 2. An infant does not find pleasure in sucking but does find enjoyment from the nourishment 3. An infant may have more pleasure in breastfeeding than bottle feeding because it expends more energy 4. An infant does not find pleasure in use of a pacifier 5. An infant explores the world through the mouth 6. An infant begins to explore the genital area to learn sexual identity

1. An infant sucks for nourishment as well as pleasure 3. An infant may have more pleasure in breastfeeding than bottle feeding because it expends more energy 5. An infant explores the world through the mouth

A 7-year-old child lived in foster homes when he was an infant. He was adopted at the age of 1 year to an intact family who provided him with love and security. Which developmental task was this child most likely unable to complete as an infant? 1. Trust versus mistrust 2. Industry versus inferiority 3. Autonomy versus shame and doubt 4. Initiative versus guilt

1. Trust versus mistrust

A clinic nurse is caring for a 2-year-old client. During the examination the child's parents ask the nurse when their toddler should be toilet trained. Which response by the nurse is most appropriate? 1. "Children should be placed on the potty chair often so they get used to the task and should be rewarded immediately for staying on the potty chair." 2. "Children need sphincter control, cognitive understanding of the task, and the ability to delay immediate gratification." 3. "Children should be ready toilet train at about 2 years old." 4. "First put training pants on your child so the child gets used to not wearing a diaper."

2. "Children need sphincter control, cognitive understanding of the task, and the ability to delay immediate gratification.

A nurse is preparing a 4-year-old boy for surgery. Which nursing action is appropriate for preoperative teaching based on Erikson's developmental stages? 1. Allowing the child to make a project related to the surgery 2. Having the child put a surgical mask on a doll 3. Asking the child how he feels about surgery 4. Allowing the child to listen to music without further instructions

2. Having the child put a surgical mask on a doll

4) The parents of a 12-month-old client ask the nurse for suggestions regarding age-appropriate toys for their child. Which toys are appropriate for the nurse to recommend for this client? Select all that apply. 1. Soft toys that can be mouthed 2. Toys with black-and-white patterns 3. Toys that can pop apart and go back together 4. Jack-in-the-box toys 5. Push-and-pull toys

3. Toys that can pop apart and go back together 4. Jack-in-the-box toys 5. Push-and-pull toys 1. A 12-month-old client is more mobile and shows less interest in soft toys that can be placed in the mouth. 2. A 12-month-old client will tend to enjoy colorful toys, not toys with black-and-white patterns. 3. A 12-month-old client has gross and fine motor skills that are becoming more developed and enjoys toys that can help them refine these skills. 4. A 12-month-old client enjoys toys that can be manipulated and that grabs his or her attention. A jack-in-the-box toy allows both. 5. A 12-month-old client is learning to walk and will enjoy toys that promote mobility.

2) The nurse is conducting a physical assessment for a pediatric client. Which part of Bronfenbrenner's ecologic theory of development is the nurse assessing when discussing the parents' work environment in relation to the client? 1. Chronosystem 2. Mesosystem 3. Macrosystem 4. Exosystem

4. Exosystem 1. The chronosystem involves the perspective of time in the child's life. 2. The relationships of one microsystem to another involve a child's mesosystem. 3. Political and cultural beliefs comprise a child's macrosystem. 4. A child's exosystem is composed of the settings that influence a child even though he or she is not in daily contact with that system.

5) While assessing the development of a 9-month-old client, the nurse asks the mother if the child actively looks for toys when they are placed out of sight. Which is the nurse assessing with this question to the parent? 1. Transductive reasoning 2. Conservation 3. Centration 4. Object permanence

4. Object permanence 1. Transductive reasoning is when a child connects two events in a cause-effect relationship because the events occurred at the same time. 2. Conservation is when a child knows that matter is not changed when its form is altered. 3. Centration is when a child focuses on only one particular aspect of a situation. 4. A child who has developed object permanence has the ability to understand that even though something is out of sight, it still exists.

A nurse in a clinic is asked to teach a 13-year-old boy diagnosed with asthma. The nurse assesses that the child is developmentally on task. Which consideration should the nurse include when teaching this client? 1. The client is unable to differentiate cause and effect, so keep it simple. 2. The client is discovering new properties of objects and events, so expect many questions. 3. The client is not developmentally able to remember information, so handouts are necessary. 4. The client needs explanations of the physiology of asthma and demonstrations of appropriate interventions.

4. The client needs explanations of the physiology of asthma and demonstrations of appropriate interventions.

The nurse notes that a 5 month old has significant head lag when she attempts to pull the infant to a sitting position. What does the nurse recognize based on this assessment of the infant? a.the infant needs further assessment and evaluation b.the infant has some degree of mental retardation c.the infant is developing normally d.the infant has been neglected by the parents

A

Which nursing strategies are important when talking with teenagers about sexuality? a. Include sex education in school and give information about STIs. b. Tell the teens to watch television programs about meaningful relationships. c. Arrange for a group of teens to talk about their sexual experiences. d. Provide verbal explanations about sex.

A

Which stage of development is most unstable and challenging regarding development of personal identity? A) Adolescence B) Toddler hood C) Childhood D) Infancy

A

Which strategy by the nurse is best when communicating with a 3 year old? a. Avoid telling the toddler about the hernia repair procedure too far in advance. b. Talk and sing frequently during care. c. Make sure to speak in a high-pitched voice to ensure the toddler pays attention. d. Teach the toddler to count backwards from 10 in order to relax before the procedure.

A

5) A vegetarian adolescent is placed on iron supplementation secondary to a diagnosis of iron-deficiency anemia. Which will the nurse encourage the adolescent to drink when taking the daily iron supplement? 1. Orange juice 2. Black or green tea 3. Milk 4. Tomato juice

Answer: 1 Explanation: 1. Acidity increases absorption of iron. 2. Foods containing phosphorus, such as in milk; oxalates, such as in tomatoes; and tannins, such as in teas, all decrease absorption of iron. 3. Foods containing phosphorus, such as in milk; oxalates, such as in tomatoes; and tannins, such as in teas, all decrease absorption of iron. 4. Foods containing phosphorus, such as in milk; oxalates, such as in tomatoes; and tannins, such as in teas, all decrease absorption of iron.

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.

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.

19) The nurse is preparing for a health maintenance visit for a 9-month-old infant. Which teaching topics are appropriate for the nurse to include during the scheduled visit? Select all that apply. 1. Using iron-fortified formula 2. Encouraging self-feeding of finger foods 3. Increasing the number of daily milk feedings 4. Encouraging cups for all feedings 5. Introducing burping techniques

Answer: 1, 2 Explanation: 1. The nurse should teach the parents the importance of continuing to use an iron-fortified formula until the infant reaches 12 months of age. 2. The nurse should encourage the parents to allow for self-feeding opportunities with finger foods. 3. The number of daily milk feedings should be decreased, not increased, at this stage of development. 4. While the cup should be introduced by 9 months of age, it is not appropriate for the nurse to encourage the use of a cup for all feedings until 12 months of age. 5. While it may be appropriate for the nurse to reinforce burping techniques through the first year of life, the nurse would not introduce this teaching at 9 months of age

Answer: 3 Explanation: 1. Cobedding is not encouraged because it is associated with an increased risk for SIDS. 2. A prone sleeping position is not encouraged because it is associated with an increased risk for SIDS. 3. Placing the infant in a crib with a tight-fitting, firm mattress will help keep the infant's mouth free of obstructions. This is the recommended sleeping position and environment for all newborns but is especially important due to the history of SIDS. 4. Quilts, blankets, and other soft items are not recommended as these increase the risk for SIDS. Put the newborn in a blanket sleeper instead.

Answer: 1, 2, 3 Explanation: 1. It is appropriate for the nurse to include information regarding metabolic screening when teaching preventative disease strategies to the parents of an infant. 2. It is appropriate for the nurse to include information regarding hearing screening when teaching preventative disease strategies to the parents of an infant. 3. It is appropriate for the nurse to include information on the risks of environmental smoke exposure when teaching preventative disease strategies to the parents of an infant. 4. Stranger danger strategies are more appropriate for the parents of a preschool-age child. 5. Bike safety is more appropriate for the parents of preschool-age and school-age children.

18) What is the purpose of making general observations during the assessment process for an infant during a scheduled health maintenance visit? Select all that apply. 1. To invite discussion with the parents 2. To validate positive parenting efforts 3. To promote a partnership between healthcare providers and parents 4. To decrease the risk of communicable diseases 5. To meet standards required for The Joint Commission accreditation

Answer: 1, 2, 3 Explanation: 1. One purpose for making general observations during the infant assessment process is to invite discussion with the parents. 2. One purpose for making general observations during the infant assessment process is to validate positive parenting efforts. 3. One purpose for making general observations during the infant assessment process is to promote a partnership between healthcare providers and parents. 4. Decreasing the risk for communicable diseases is not the purpose for making general observations during the assessment process for an infant. 5. Meeting The Joint Commission accreditation standards is not the purpose for making general observations during the assessment process for an infant.

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

17) Which actions are appropriate when the nurse is performing general observations during the assessment process for an infant? Select all that apply. 1. Asking the family how they are adjusting to having the infant in the home 2. Monitoring the parents for clinical manifestations associated with fatigue 3. Assessing for behaviors that indicate appropriate bonding 4. Placing the infant on the scale for a weight and length assessment 5. Auscultating heart and lung sounds while the infant is asleep

Answer: 1, 2, 3 Explanation: 1. When performing general observations during the assessment of an infant the nurse will ask the parents how they are adjusting to having an infant in the home. 2. When performing general observations during the assessment of an infant the nurse will monitor the parents for clinical manifestations associated with fatigue. 3. When performing general observations during the assessment of an infant the nurse will assess for behaviors that indicate appropriate bonding. 4. Placing the infant on the scale to measure height and weight is not an appropriate action when performing general observations during the assessment process. 5. Auscultating heart and lung sounds is not an appropriate action when performing general observations during the assessment process.

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.

20) The nurse is educating the parents of a 2-month-old infant when to contact the healthcare provider. Which statements by the parents indicate the need for further instruction? Select all that apply. 1. "We will contact the doctor if our baby does not have a bowel movement each day." 2. "We will contact the doctor if our baby is vomiting." 3. "We will contact the doctor if our baby has a temperature greater than 99°F." 4. "We will contact the doctor if our baby does finish each bottle." 5. "We will contact the doctor if our baby develops a skin rash."

Answer: 1, 3, 4 Explanation: 1. Each infant will develop a pattern for bowel movements; some infants will have several each day, while others may have a bowel movement once every couple of days. This parental statement indicates the need for further education. 2. Infants are prone to dehydration; therefore, it is appropriate for the parents to contact the healthcare provider for vomiting. 3. Parents are instructed to contact the healthcare provider for a temperature greater than or equal to 99.3°F. This parental statement indicates the need for further education. 4. Failure to eat is a reason to contact the healthcare provider; however, failure to finish each bottle is not a reason to contract the healthcare provider. This parental statement indicates the need for further education. 5. A skin rash is a reason to contact the healthcare provider. This statement indicates appropriate understanding of the information presented.

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.

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.

14) The nurse is assessing a small-for-gestational-age newborn who had an older sibling who died of sudden infant death syndrome (SIDS). Which should the nurse include in the newborns plan of care based on these data? 1. Encourage the parents to sleep with the newborn for close observation. 2. Encourage the parents to place the newborn on the abdomen to sleep. 3. Encourage the parents to place the newborn in a crib with a tight-fitting, firm mattress. 4. Encourage the parents to place the newborn in a crib with a soft mattress with extra blankets.

Answer: 3 Explanation: 1. Cobedding is not encouraged because it is associated with an increased risk for SIDS. 2. A prone sleeping position is not encouraged because it is associated with an increased risk for SIDS. 3. Placing the infant in a crib with a tight-fitting, firm mattress will help keep the infant's mouth free of obstructions. This is the recommended sleeping position and environment for all newborns but is especially important due to the history of SIDS. 4. Quilts, blankets, and other soft items are not recommended as these increase the risk for SIDS. Put the newborn in a blanket sleeper instead.

13) Which observation in a health supervision visit leads the nurse to have concerns about the infant's mental health? 1. A 1-month-old is swaddled by the parent because of crying after an immunization. 2. A 7-month-old infant grabs her mother and cries when the nurse attempts touch. 3. A 9-month-old avoids eye contact with parents and the nurse. 4. A 10-month-old reportedly sleeps about 12 hours total per night.

Answer: 3 Explanation: 1. Crying after a painful procedure, such as an immunization, is a normal reaction by the 1-month-old infant. Swaddling the infant for comfort is a normal reaction by the parent. 2. Grabbing for her mother and crying when the nurse attempts touch is a normal reaction for a 7-month-old infant. 3. The nurse should expect the 9-month-old to have eye contact with the parents and the nurse. If no eye contact is made, the nurse should implement a more detailed assessment of the infant's mental health. 4. Sleeping 12 total hours per night is considered normal behavior for a 10-month-old infant.

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.

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.

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.

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.

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.

5) A parent says to a nurse, "How do you know when my baby needs these screening tests the doctor just mentioned?" Which response by the nurse is most appropriate? 1. "Screening tests are done in the newborn nursery, and from these results, additional screening tests are ordered throughout the first 2 years of life." 2. "Screening tests are done at each office visit." 3. "Screening tests are most often done when the doctor suspects something is wrong with the child." 4. "Screening tests are administered at the ages when a child is most likely to develop a condition."

Answer: 4 Explanation: 1. This provides incorrect information to the parent. Abnormal newborn screening tests require immediate follow-up. 2. This provides incorrect information to the parent. Screening tests are not done at each office visit. 3. This provides incorrect information to the parent. Screening tests are done to detect the possibility of problems, and are not done when a problem is suspected. 4. "Screening tests are administered at ages when a child is most likely to develop a condition" provides a definition for screening tests.

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: 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.

The nurse teaches parents how to help their children learn impulse control and cooperative behaviors. This would occur during which of the stages of development defined by Erikson? A.Trust versus mistrust B.Initiative versus guilt C.Industry versus inferiority D.Autonomy vs. Shame and doubt

B) Initiative vs Guilt. The stage of initiative versus guilt occurs from ages 3 to 6 years, during which children develop direction and purpose. Teaching impulse control and cooperative behaviors during this stage help the child to avoid risks of altered growth and development. In the autonomy versus sense of shame and doubt stage, toddlers learn to achieve self-control and willpower. Trust versus mistrust is the first stage, during which children develop faith and optimism. During the industry versus inferiority stage, children develop a sense of competency.

A nurse is evaluating the developmental level of a 2-year-old. Which of the following does the nurse expect to observe in this child? A) Uses a fork to eat B) Uses a cup to drink C) Uses a knife for cutting food D) Pours own milk into a cup

B. By age 2 years, the child can use a cup and can use a spoon correctly but with some spilling. By ages 3 to 4, the child begins to use a fork. By the end of the preschool period, the child should be able to pour milk into a cup and begin to use a knife for cutting.

A nurse is preparing to care for a 5-year-old who has been placed in traction following a fracture of the femur. The nurse plans care, knowing that which of the following is the most appropriate activity for this child? A) Large picture books B) A radio C) Crayons and coloring book D) A sports video

C. In the preschooler, play is simple and imaginative and includes activities such as crayons and coloring books, puppets, felt and magnetic boards, and Play-Doh. Large picture books are most appropriate for the infant. A radio and a sports video are most appropriate for the adolescent.

The nurse explains that by the age of 6 months an iron-rich formula should be offered because the infant has: a. limited ability to produce red blood cells. b. ineffective digestive enzymes. c. exhausted maternal iron stores. d. need of the iron to support dentition.

C

A mother of a 3-year-old tells a clinic nurse that the child is rebelling constantly and having temper tantrums. The nurse most appropriately tells the mother to: A) Punish the child every time the child says "no", to change the behavior B) Allow the behavior because this is normal at this age period C) Set limits on the child's behavior D) Ignore the child when this behavior occurs

C) Set limits on the child's behavior-According to Erikson, the child focuses on independence between ages 1 and 3 years. Gaining independence often means that the child has to rebel against the parents' wishes. Saying things like "no" or "mine" and having temper tantrums are common during this period of development. Being consistent and setting limits on the child's behavior are the necessary elements.

A 16-year-old is admitted to the hospital for acute appendicitis, and an appendectomy is performed. Which of the following nursing interventions is most appropriate to facilitate normal growth and development? A) Allow the family to bring in the child's favorite computer games B) Encourage the parents to room-in with the child C) Encourage the child to rest and read D) Allow the child to participate in activities with other individuals in the same age group when the condition permits

D. Adolescents often are not sure whether they want their parents with them when they are hospitalized. Because of the importance of the peer group, separation from friends is a source of anxiety. Ideally, the members of the peer group will support their ill friend. Options a, b, and c isolate the child from the peer group.

A nurse is planning to teach a prenatal class. Which topic is most appropriate at this time? a. Nutrition b. Physical activity c. Oral health d. Sleep patterns

a. Nutrition Feedback: Nutrition evaluation and teaching make important contributions to general health and foster growth and development. Teaching about physical activity, oral health, and sleep patterns are important also, but not priority at this time.

Which toy is most age-appropriate for a 2 year old? a.mobile b.toy vacuum c.nesting cups d.playhouse

b.toy vacuum

During the assessment of a 6-year-old, the mother tells the nurse that she uses fluoride supplements. What does the nurse understand about the child's dental habits based on this knowledge? a. The child has been allowed to eat too many sweets. b. The child does not eat enough dairy, which would supplement fluoride. c. The tap water is not fluoridated above 0.7 mg/L d. The child is drinking too many sodas, which decreases fluoride absorption.

c. The tap water is not fluoridated above 0.7 mg/L Feedback: Fluoride supplements should be used when the water supply is not fluoridated (fluoride concentration below 0.7 mg/L). Eating too many sweets or not enough dairy products, or drinking too many sodas, does not warrant fluoride supplements.

1) While being comforted in the emergency department, the 6-year-old male sibling of a pediatric trauma victim blurts out to the nurse, "It's all my fault! When we were fighting yesterday, I told him I wished he was dead!" Which response by the nurse is most therapeutic? 1. Asking the child if he would like to sit down and drink some water 2. Sitting the child down in an empty room with markers and paper so that he can draw a picture 3. Reassuring the child that it is normal to get angry and say things that we do not mean, but that we have no control over whether an accident happens 4. Discussing the catheters, tubes, and equipment that the sibling requires, and explaining why they are needed

3. Reassuring the child that it is normal to get angry and say things that we do not mean, but that we have no control over whether an accident happens 1. Ignoring the child's outburst will not help the child understand it really was not his fault. 2. Asking the child to draw a picture might be appropriate later, but the nurse first needs to make sure the child knows the trauma did not occur because of anything he said. 3. Magical thinking is the belief that events occur because of one's thoughts or actions, and the most therapeutic way to respond to this is to correct any misconceptions that the child might have and reassure him that he is not to blame for any accident or illness. 4. Addressing the sibling's needs and equipment reinforces the child's magical thinking that the trauma was his fault.

6) A nurse is assessing language development in all the pediatric clients presenting at the healthcare provider's office for well-child visits. At which age would the nurse further assess language development if the client is unable to verbalize the words "dada" and "mama"? 1. 3 months 2. 6 months 3. 8 months 4. 12 months

4. 12 months Explanation: 1. By 3 months of age, infants vocalize during play and with familiar people. The infant may also begin to laugh. At this time, they do not use these as names for the parents. 2. By 6 months of age, infants will be making the sounds "mamamamam" and "dadadada" because they like to repeat sounds. At this time, they do not use these as names for the parents. 3. By 8 months of age, infants will be making the sounds "mamamamam" and "dadadada" because they like to repeat sounds. At this time, they do not use these as names for the parents. 4. By 12 months of age, children should be able to verbalize "mama" or "dada" to identify their mother or father. This client would require further assessment by the nurse.

18) Which nursing actions are developmentally appropriate when caring for a hospitalized school-age child? Select all that apply. 1. Knocking on the school-age child's hospital room door prior to entering 2. Giving clear instructions about details of treatment 3. Providing brochures regarding sexuality 4. Offering medical equipment to play with prior to a procedure 5. Using toys for distraction during a painful procedure

Answer: 1, 2 Explanation: 1. It is developmentally appropriate for the nurse to knock on the school-age child's door prior to entering the hospital room to provide care. 2. It is developmentally appropriate for the nurse to give clear instructions to the school-age child regarding details of the treatment. 3. Information regarding sexuality is more appropriate for the adolescent versus the school-age child. 4. Offering medical equipment to play with prior to a procedure is more appropriate for the preschool, not the school-age, child. 5. Using toys for distraction during a painful procedure is more appropriate for the preschool, not the school-age, child.

1) Which instruction from the nurse is appropriate when conducting teaching to new parents regarding infant care and feeding? 1. Delay supplemental foods until the infant is 4 to 6 months old. 2. Begin diluted fruit juice at 2 months of age, but wait 3 to 5 days before trying a new food. 3. Add rice cereal to the nighttime feeding if the infant is having difficulty sleeping after 2 months of age. 4. Delay supplemental foods until the infant reaches 15 pounds or greater.

Answer: 1 Explanation: 1. Age 4 to 6 months is the optimal age to begin supplemental feedings. The infant does not need supplemental foods earlier, and introducing supplemental foods earlier does not promote sleep. 2. Fruit juice and rice cereal are not well tolerated by infants at 2 months of age as they lack the digestive enzymes to take in and metabolize many food products. 3. Fruit juice and rice cereal are not well tolerated by infants at 2 months of age as they lack the digestive enzymes to take in and metabolize many food products. Introducing cereal at this stage will not help promote sleep. 4. Earlier feeding of nonformula foods, regardless of the infant's weight, is more likely to cause the development of food allergies.

11) The nurse is preparing to administer an intramuscular injection to a toddler-age client. Which is the most appropriate statement by the nurse prior to this procedure? 1. "It is all right to cry. After we are done, you can go to the box and pick out your favorite sticker." 2. "We will give you your shot when your mommy comes back." 3. "I will wipe your skin with a magic wipe and then hold the needle like this and say 'one, two, three, go' and give you your shot. Are you ready?" 4. "This is a magic sword that will give you your medicine and make you all better."

Answer: 1 Explanation: 1. The most appropriate response would be to acknowledge the child's feelings and allow the child to pick out a sticker at the conclusion of the injection. 2. Waiting for the mother to come back would be inappropriate because toddlers do not have an understanding of time. 3. Giving elaborate descriptions and using colorful language are inappropriate because the instructions are unclear and lengthy. 4. The nurse should not make statements that are not true and might confuse the child.

9) While trying to inform a 5-year-old child about what will occur during an upcoming CT scan, the nurse notices that the child is engaged in a collective monologue, talking about a new puppy. Which response by the nurse is age appropriate? 1. "You must be so excited to have a new puppy! They are so much fun. Now let me tell you again about going downstairs in a wheelchair to a special room." 2. Redirect the child by saying, "Please stop talking about your puppy. I need to tell you about your CT scan." 3. "I'll come back when you are ready to talk with me more about your CT scan." 4. Ignore the information regarding the puppy and state, "I need to teach you about going to the special room later today."

Answer: 1 Explanation: 1. When a child becomes engaged in a collective monologue, it is best to respond to the content of her conversation and then attempt to reinsert facts about the content that needs to be covered. 2. Asking the child to stop talking about her puppy and then abruptly talking about the CT scan will alienate the child and possibly make her shut down. 3. Coming back later is not usually an option, as radiologic exams are scheduled for a certain time. The nurse needs to address the inattention but should listen for a few moments before directing the client's attention. 4. Ignoring the child's obvious lack of attention will not help prepare her for the upcoming procedure

18) Which assessment findings would cause the nurse to believe that a school-age child is not receiving enough vitamin C in the diet? Select all that apply. 1. Dermatitis 2. Bleeding gums 3. Scaling of the skin 4. Muscle weakness 5. Headaches

Answer: 1, 2 Explanation: 1. Dermatitis is a clinical manifestation associated with a vitamin C deficiency. 2. Bleeding gums is a clinical manifestation associated with a vitamin C deficiency. 3. Scaling of the skin is a clinical manifestation associated with a vitamin A, not C, deficiency. 4. Muscle weakness is a clinical manifestation associated with a vitamin D, not C, deficiency. 5. Headache is a clinical manifestation associated with an excess of vitamin A, not a deficiency of vitamin C.

20) The nurse is assessing a 6-month-old infant during a scheduled well-baby check-up. Which are expected findings for this infant? Select all that apply. 1. No head lag when pulled for sitting 2. Ability to turn from back to abdomen 3. Manipulates objects 4. Transfers objects from one hand to the other 5. A pincer grasp is noted.

Answer: 1, 2, 3 Explanation: 1. A 6-month-old infant should not have head lag when pulled for sitting. This is an expected finding. 2. A 6-month-old infant should be able to turn from back to abdomen. This is an expected finding. 3. A 6-month-old infant is able to manipulate objects. This is an expected finding. 4. The nurse would not anticipate that the 6-month-old infant would be able to transfer objects from one hand to the other. This is an unexpected finding. 5. The nurse would not anticipate that the 6-month-old infant would use a pincer grasp. This is an unexpected finding.

20) The nurse is providing care for an infant who is diagnosed with colic. Which interventions will the nurse include in the infant's plan of care? Select all that apply. 1. Using a front-carrying sling 2. Recommending swaddling 3. Suggesting frequent burping 4. Recording all feedings in an intake journal 5. Removing gluten from the diet

Answer: 1, 2, 3 Explanation: 1. A front-carrying sling is often useful for an infant diagnosed with colic. 2. Infant swaddling is often useful for an infant diagnosed with colic. 3. Frequent burping is often useful for an infant diagnosed with colic. 4. Recording all feedings in an intake journal is an appropriate intervention for an infant diagnosed with failure to thrive (FTT), not colic. 5. Removing gluten from the diet is an appropriate intervention for an infant diagnosed with celiac disease, not colic.

16) The nurse is teaching the parents of a 6-month-old infant about the introduction of solid foods. Which foods will the nurse include in the teaching session? Select all that apply. 1. Rice cereal 2. Fruits 3. Vegetables 4. Meats 5. Nut products

Answer: 1, 2, 3 Explanation: 1. Rice cereal is typically the first solid food that is introduced at 6 months of age. It is appropriate to include this food in the teaching session. 2. Fruits are introduced at 6 to 8 months of age. It is appropriate to include this food in the teaching session. 3. Vegetables are introduced at 6 to 8 months of age. It is appropriate to include this food in the teaching session. 4. Meats are not introduced until 8 to 10 months of age. 5. Nut products are not introduced until 2 to 3 years of age.

11) A 2-month-old infant is admitted to the hospital with a diagnosis of "failure to thrive" (FTT). Which possible causes for FTT will the nurse include in the infant's plan of care? Select all that apply. 1. Overdilution of formula concentrate 2. Parental neglect 3. Rumination 4. Malabsorption syndromes 5. Pica

Answer: 1, 2, 3, 4 Explanation: 1. Adding too much water to formula concentrate will lead to inadequate caloric intake and could lead to a diagnosis of FTT. 2. Parental neglect should be evaluated in a baby who is not gaining weight adequately. 3. Rumination involves regurgitation of recently ingested food followed by rechewing and reswallowing. It is often associated with sensory deprivation and may result in growth failure. 4. Malabsorption syndromes, such as cystic fibrosis, can cause nutrients to be excreted instead of absorbed. 5. Pica is an eating disorder characterized by ingestion of nonfood items. It would not be an issue in a 2-month-old infant.

22) Which activities will the nurse suggest to the parents of a preschool-age child to enhance fine motor skills? Select all that apply. 1. Using scissors 2. Playing with clay 3. Riding a bicycle 4. Throwing a ball 5. Tying shoe laces

Answer: 1, 2, 5 Explanation: 1. Using scissors is an activity that will enhance fine motor skills during the preschool years. 2. Playing with clay is an activity that will enhance fine motor skills during the preschool years. 3. Riding a bicycle is an activity that will enhance gross, not fine, motor skills during the preschool years. 4. Throwing a ball is an activity that will enhance gross, not fine, motor skills during the preschool years. 5. Tying shoe laces is an activity that will enhance fine motor skills during the preschool

2) A nurse is teaching an African American mother of a 3-month-old infant, born in the late fall, who is being exclusively breastfed. Which is the priority nutrient for the nurse to include in the teaching session? 1. Iron 2. Vitamin D 3. Calcium 4. Fluoride

Answer: 2 Explanation: 1. An infant's iron stores are usually adequate until about 4 to 6 months of age. 2. This infant will have limited exposure to sunlight due to decreased sun exposure in the fall and winter months. The limited sun exposure combined with the infant's dark skin means the infant may need additional vitamin D. 3. The infant should be receiving sufficient amounts of calcium from breast milk. 4. Fluoride supplementation, if needed, does not begin until the child is approximately 6 months old.

12) A vegetarian adolescent is prescribed iron supplementation secondary to a diagnosis of iron-deficiency anemia. Which food will the nurse encourage the adolescent to increase intake of based on the current diagnosis? 1. Black tea 2. Eggs 3. Fresh fruit 4. Milk

Answer: 2 Explanation: 1. Black tea contains tannins, which decrease the absorption of iron. 2. Eggs are one type of food rich in iron. 3. Dried fruit, not fresh fruit, is rich in iron. 4. Foods containing phosphorus, such as milk, decrease absorption of iron.

13) The home health nurse is conducting a home visit for a family. The toddler-age child, who is potty training, has an "accident." The mother becomes angry with the child and calls him a baby for messing himself. Which is the nurse concerned with regarding the toddler's development, based on the mother's reaction? 1. The child's cognitive development 2. The child's sense of independence 3. The child's conscience 4. The child's superego

Answer: 2 Explanation: 1. Erikson's theory is related to psychosocial development. The mother's criticism will not affect the child's ability to think. 2. Erikson's toddler stage is autonomy (independence) versus shame and doubt. The mother's criticism may hinder the child's sense of independence. 3. Conscience is what controls our knowledge of right and wrong and is a component of Kohlberg's theory. The mother's criticism will not affect the child's conscience, according to Kohlberg. 4. In Freudian theory, the superego is the moral and ethical system of the personality. The mother's criticism will not affect the child's superego.

15) As children grow and develop, their style of play changes. Place the descriptions of play styles in order from infancy to school age. 1. Plays beside but not with other children 2. Plays games with other children and is able to follow the rules of the game 3. Plays alone with play directed by others 4. Plays with others in loose groups

Answer: 3, 1, 4, 2 Explanation: 1. This describes parallel play, seen in toddlers. 2. This describes cooperative play, seen in the school-age child. 3. This describes infant-style play, called solitary play. 4. This describes associative play, which is seen in the preschooler.

12) An adolescent client diagnosed with cystic fibrosis suddenly becomes noncompliant with the medication regimen. Which nursing intervention would most likely improve compliance? 1. Give the client a computer-animated game that presents information on the management of cystic fibrosis. 2. Set up a meeting with other adolescents with the cystic fibrosis who have been managing their disease effectively. 3. Arrange for the primary healthcare provider to sit down and talk to the client about the risks related to noncompliance with medications. 4. Discuss with the client's parents that privileges, such as a cell phone, can be taken away if compliance fails to improve.

Answer: 2 Explanation: 1. Interest in games might begin to wane during adolescence. 2. Providing adolescents with positive role models who are in their peer group is the intervention most likely to improve compliance. 3. Adult opinions, even from a primary healthcare provider, could be viewed negatively and challenged. 4. Threatening punishment could further incite rebellion.

6) The nurse is working with first-time parents. Which activity will the nurse suggest to encourage the development of good muscle tone in their infant? 1. Placing the infant in an infant seat rather than lying down in a crib 2. Surrounding the infant with toys and other stimulating items to encourage motor movement 3. Swaddling the infant 4. Putting the infant to bed each night at 8 p.m., even if the infant protests with crying

Answer: 2 Explanation: 1. Placing the infant in an infant seat is more restrictive than lying in a crib, which allows free moment. 2. Encouraging movement best assists the infant to obtain good muscle tone. 3. Swaddling the infant, while calming for a young infant, restricts movement. 4. The bedtime has nothing to do with development of infant muscle tone.

4) The nurse is teaching the parents of a 4-month-old infant about good feeding habits. Which is the rationale for not letting the baby go to sleep with the bottle? 1. To decrease the risk for aspiration 2. To decrease the risk for dental caries 3. To decrease the risk for malocclusion problems 4. To decrease the risk for sleeping disorders

Answer: 2 Explanation: 1. There have been limited data to date showing a positive correlation to putting a baby to sleep with a bottle and increased risk of aspiration. 2. Infants should not be put to bed with a bottle as this increases the risk for developing dental caries. 3. The primary concerns related to putting an infant to bed with a bottle are dental caries and otitis media. Poor dental alignment is not a significant problem. 4. Sleeping disorders have not been found to be related to letting an infant go to sleep with a bottle.

12) A nurse is assessing an 11-month-old infant, and notes that the infant's height and weight are at the 5th percentile on the growth chart; the infant was previously plotted at the 25th percentile. Psychosocial history reveals that the parents are separated and are planning to divorce. Which is the priority when planning this infant's care? 1. Parental anxiety 2. Risk for failure to thrive 3. Excessive nutritional intake 4. Risk for injury

Answer: 2 Explanation: 1. While parental anxiety due to the situation may be occurring, this is not the priority when planning this infant's care. 2. This infant's growth curve indicates poor growth which places the infant at risk for failure to thrive. 3. Since height and weight are at the 5th percentile, there is no indication of increased nutritional intake. 4. While the infant may be at a risk for injury, the priority is risk for failure to thrive.

19) Which nursing actions are developmentally appropriate when providing care to a hospitalized toddler-age child? Select all that apply. 1. Using a crib mobile for distraction during a procedure 2. Having a potty-chair available 3. Allowing self-feeding opportunities 4. Showing equipment that will be used during the scheduled surgery 5. Assessing drawings to determine concerns

Answer: 2, 3 Explanation: 1. A crib mobile would be more developmentally appropriate for the infant, not the toddler-age, child. 2. Many toddlers are potty training; therefore, it is appropriate for the nurse to have a potty-chair available for the child. 3. It is appropriate for the nurse to allow for self-feeding opportunities as this is developmentally appropriate for a toddler-age child. 4. Showing equipment that will be used during a scheduled surgery is not a developmentally appropriate intervention for a toddler-age child. This is more appropriate for the preschool-age child. 5. Assessing drawing to determine concerns is developmentally appropriate for the preschool, not the toddler-age, child.

2) The mother of a newborn asks the nurse what the purpose of the first scheduled health maintenance visit will be. Which are appropriate responses by the nurse to this question? Select all that apply. 1. "To determine if your baby is being abused." 2. "To determine compatibility between you and the provider." 3. "To discuss policies related to provision of care." 4. "To evaluate your understanding of the services offered." 5. "To determine your baby's risk for obesity."

Answer: 2, 3, 4 Explanation: 1. Only under very unusual circumstances would the healthcare providers be able to determine whether the parents are potential child abusers. 2. The initial visit should help to acquaint the parents to office policies and services offered by the office, and to determine whether the parents and healthcare provider will get along well. 3. The initial visit should help to acquaint the parents to office policies and services offered by the office, and to determine whether the parents and healthcare provider will get along well. 4. The initial visit should help to acquaint the parents to office policies and services offered by the office, and to determine whether the parents and healthcare provider will get along well. 5. Only under very unusual circumstances would the healthcare providers be able to determine whether the parents will tend to overfeed the infant and place the infant at risk for obesity

The mother of a 6-week-old male infant tells the nurse that her baby has had colic for several days, crying for up to 3 hours and drawing his legs up on his abdomen. The mother says she is at "wits end" and wonders what she can do. The nurse learns that the infant is being formula-fed and gaining weight satisfactorily. Which recommendations will the nurse make based on the current data? Select all that apply. 1. Breastfeeding the infant 2. Switching to a bottle that has a collapsible bag inside 3. Putting the infant in a baby swing after feeding 4. Burping the baby more frequently 5. Giving the baby a suppository once each morning

Answer: 2, 3, 4 Explanation: 1. The infant is 6 weeks old. Initiating breastfeeding is not a good option at this time. 2. This would reduce the amount of air that the baby swallows. 3. The motion may reduce the abdominal discomfort. 4. This helps the infant expel gas, which is a factor contributing to colic. 5. Suppositories would not be recommended.

8) The parents of a 2.5-year-old boy are concerned about their child's finicky eating habits. While counseling the parents, which statements by the nurse would be accurate? Select all that apply. 1. "Nutritious foods should be made available at all times of the day so that the child is able to 'graze' whenever he is hungry." 2. "The child is experiencing physiologic anorexia, which is normal for this age group." 3. "A general guideline for food quantity at a meal is one quarter cup of each food per year of age." 4. "It is more appropriate to assess a toddler's nutritional demands over a 1-week period rather than a 24-hour one." 5. "The toddler should drink 16 to 24 ounces of milk daily."

Answer: 2, 4, 5 Explanation: 1. Food should be offered only at meal and snack times. 2. Physiologic anorexia is caused when the extremely high metabolic demands of infancy slow to keep pace with the slower growth of toddlerhood, and it is a very normal finding at this age. 3. The correct general guideline for food quantity is 1 tablespoon of each food per year of age. 4. It is not unusual for toddlers to have food jags where they only want one or two food items for that day. So it is more helpful to look at what their intake has been over a week instead of a day. 5. Two to three cups of milk per day are sufficient for a toddler; more than that can decrease his desire for other foods and lead to dietary deficiencies. Children should sit at the table while eating to encourage socialization skills.

14) The nurse collects the weight and height measurements of a child, and calculates the child's body mass index (BMI) to be in the 10th percentile. Previous assessments indicate that the child's BMI was also in the 10th percentile. Which should the nurse include in the discussion of this child's BMI with the parents? 1. Undernutrition 2. Inconsistent growth 3. Consistent growth 4. Overnutrition

Answer: 3 Explanation: 1. Body mass index (BMI) is a calculation that falls between the 10th and 90th percentiles. That a child consistently has a BMI in the 10th percentile reveals consistent growth, and does not necessarily indicate undernutrition. 2. Body mass index (BMI) is a calculation that falls between the 10th and 90th percentiles. That a child consistently has a BMI in the 10th percentile reveals consistent growth. 3. Body mass index (BMI) is a calculation that falls between the 10th and 90th percentiles. That a child consistently has a BMI in the 10th percentile reveals consistent growth, and doesn't necessarily indicate undernutrition. 4. Body mass index (BMI) is a calculation that falls between the 10th and 90th percentiles. That a child consistently has a BMI in the 10th percentile reveals consistent growth, and doesn't indicate overnutrition.

7) Two 3-year-old clients are playing together in a hospital playroom. One is working on a puzzle, while the other is stacking blocks. Which type of play are these children participating in based on this scenario? 1. Cooperative play 2. Solitary play 3. Parallel play 4. Associative play

Answer: 3 Explanation: 1. Cooperative play is when children demonstrate the ability to cooperate with others and to play a part in order to contribute to a unified whole. The school-age child participates in cooperative play. 2. Solitary play is when a child plays alone. Infants' play style is described as solitary. 3. Parallel play is when two or more children play together, each engaging in his or her own activities. 4. Associative play is characterized by children interacting in groups and participating in similar activities. Preschoolers' play style is associative.

14) The clinic administrator has suggested that the nurse teach all children newly diagnosed with diabetes in a single class to save nursing time. The children recently diagnosed range in age from 6 to 15. Which is the rationale for the nursing staff to continue with more than one group session? 1. Freud's theory of psychosexual development, which states that the 6-year-old child's sexual energy is at rest while the adolescent has developed mature sexuality. 2. Erikson's psychosocial theory, which discusses how children learn to relate to others. 3. Piaget's cognitive development theory, which says the 6-year-old child learns by concrete examples, while the 15-year-old adolescent can think abstractly. 4. Kohlberg's theory, which says the young children are conventional in their thinking and will want to learn to please others, while older children can internalize values and will learn for their own principles

Answer: 3 Explanation: 1. This theory would not explain why it would be best to separate the group by age. 2. Erikson's theory is about relationships, not learning ability. 3. The younger child will need to handle the equipment and observe demonstrations, while the older child will require more discussion and less demonstration. 4. Kohlberg's theory may explain the reasons the child learns the material but does not discuss the learning style.

16) A 10-year-old client has been struggling with his self-esteem. Which activity would best help this child have a positive resolution of Erikson's industry versus inferiority stage? 1. Playing sports with his older brother and the brother's friends 2. Having his mother compliment him when he completes his homework 3. Encouraging the child to participate in Boy Scouts and earn badges 4. Suggesting to the mother that she allow the child to babysit his younger siblings

Answer: 3 Explanation: 1. This would not help the child develop a positive self-esteem because the older boys will be more skilled at the sport than this child. 2. Positive reinforcement is beneficial but does not support the development of industry. 3. The badges will be a visible documentation of his accomplishments. 4. The 10-year-old cannot safely babysit the younger children, and this is unrelated to Erikson's sense of industry.

6) The nurse is presenting a program on healthy eating habits to the parents of children attending the clinic. Which parental comment indicates the need for more information about safe food preparation? 1. "We always wash our hands well before any food preparation." 2. "We use separate utensils for preparing raw meat and for preparing fruits, vegetables, and other foods." 3. "We take the meat out of the freezer and then allow it to thaw on the counter for 2 to 3 hours before cooking it thoroughly." 4. "If our baby doesn't drink all the formula in his bottle, we throw the rest out."

Answer: 3 Explanation: 1. Washing hands removes pathogens from the hands and prevents food contamination. 2. Raw meats are a good source of pathogens. Utensils used on raw meat can transfer the pathogens to other foods if they are not prepared in a manner to destroy these pathogens. 3. Allowing meat to sit out on a counter can cause the bacteria counts to increase quickly, and cooking the meat might not effectively destroy all of the bacteria. Frozen meat should be thawed in the refrigerator prior to cooking. 4. While drinking from a bottle, organisms can be transferred from the baby's mouth to the formula. If this formula is saved, the organisms can multiply in the formula.

21) The nurse provides education to the parents of a 7-month-old infant regarding play. Which parental responses indicate accurate understanding of the information presented? Select all that apply. 1. "I should offer my baby toys that are black and white." 2. "My baby will prefer stuffed animals during this stage of development." 3. "I should offer my baby a teething ring during this stage of development." 4. "My baby will want to interact with other people." 5. "I should offer my baby large blocks to stack while sitting on the floor."

Answer: 3, 4 Explanation: 1. Black and white toys are often preferred by infants from birth to 3 months, not at 7 months. The statement indicates the need for further education. 2. Stuffed animals are often enjoyed by infants between 3 months and 6 months, not at 7 months. The statement indicates the need for further education. 3. Many babies are teething by 7 months of age; therefore, it is appropriate to offer the infant a teething ring. This statement indicates accurate understanding of the information presented. 4. By 6 to 9 months of age, the infant will enjoy interacting with other people. This statement indicates appropriate understanding of the information presented. 5. Stacking blocks is not a skill acquired until 9 to 12 months of age. This statement indicates the need for further education.

7) During a 4-month-old infant's well-child checkup, the nurse discusses introduction of solid foods into the infant's diet. Although the nurse recommends delaying the introduction of many foods into the diet, which food(s) will the nurse discuss delaying because they increase the risk for food allergy? 1. Honey 2. Carrots, beets, and spinach 3. Pork 4. Cow's milk, eggs, and peanuts

Answer: 4 Explanation: 1. Although honey can contain botulism spores that cannot be detoxified by the infant younger than 1 year old, it does not cause an allergic reaction. 2. Carrots, beets, and spinach contain nitrates and should not be given before 4 months of age. 3. The addition of pork is delayed until the infant is 8 to 10 months old because meats are hard to digest. 4. Cow's milk, eggs, and peanuts are foods that have been associated with food allergies.

3) During a health supervision visit, the nurse is attempting to develop a partnering relationship with the child and family. Which is the initial action by the nurse? 1. Telling the family what the child should be doing physically for the age level 2. Telling the family that the healthcare provider will answer any questions they might have related to their child's growth and development 3. Setting goals for the family related to the child's health 4. Discussing a plan with the family to address the child's health needs

Answer: 4 Explanation: 1. Not all children develop each skill at the same age. Telling the family what the child should be doing can cause feelings of fear, frustration, and concern for the family if the child is not doing all of the activities listed by the nurse. 2. Telling the family to direct their questions just to the healthcare provider will not allow any teaching opportunities by the nurse, and will not allow for the development of a trusting relationship with the family. 3. The nurse should not set the goals without family involvement. 4. Discussing and developing a plan with the family will actively involve the family members and will build more trust, as they are not just being told what to do.

8) The nurse is teaching new parents how to communicate with their infant. Which response by the parents indicates accurate understanding of the information presented? 1. "I will prop the bottle while my baby is in the carseat so that I can cook dinner." 2. "I will use a low-pitched voice while talking to my baby as this is most appropriate." 3. "I will unwrap my baby when she is upset to allow interaction with the environment." 4. "I will talk and sing to my baby while I am providing daily care, including diaper changes."

Answer: 4 Explanation: 1. Parents should hold their babies during feedings as a method of communicating with their infants. This parental response indicates the need for further education. 2. Parents should use a high-pitched, not low-pitched, voice when talking with their infant children. This parental response indicates the need for further education. 3. Parents should swaddle and hold their infants when they are upset as a communication method. Unwrapping the baby when the baby is upset indicates the need for further education. 4. Parents should talk and sing to their infants while providing daily care, such as diaper changes. This parental response indicates accurate understanding of the information presented

10) The mother of a 6-year-old boy who has recently had surgery for the removal of his tonsils and adenoids complains that he has begun sucking his thumb again. Which defense mechanism will the nurse include when responding to the mother? 1. Repression 2. Rationalization 3. Fantasy 4. Regression

Answer: 4 Explanation: 1. Repression is the involuntary forgetting of uncomfortable situations. The child is not exhibiting repression. 2. Rationalization is an attempt to make unacceptable feelings acceptable. The child is not exhibiting rationalization. 3. Fantasy is a creation of the mind to help deal with an unacceptable fear. The child is not exhibiting fantasy. 4. Regression is a return to an earlier behavior and can often occur during a hospital stay. The nurse will include regression in the response to the mother.

17) Two hospitalized pediatric clients are working on a puzzle together in the hospital playroom. Which type of play are the clients exhibiting? 1. Solitary play 2. Associative play 3. Parallel play 4. Cooperative play

Answer: 4 Explanation: 1. Solitary play is when a child plays alone. 2. Associative play is characterized by children interacting in groups and participating in similar activities. 3. Parallel play is when two or more children play together, each engaging in his or her own activities. 4. Cooperative play is when children demonstrate the ability to cooperate with others and to play a part in order to contribute to a unified whole.

8) While interviewing the parents of a toddler-age client, the nurse notes that the mother is pregnant. At the end of the visit, the nurse decides to give a new pamphlet to the parents about car seat usage for newborns. Which is the purpose of this action by the nurse? 1. Secondary preventative health maintenance 2. Developmental health screening 3. Tertiary preventative health maintenance 4. Primary preventative health maintenance

Answer: 4 Explanation: 1. The secondary level of prevention is focused on diagnosis of a problem, usually medical in nature, in order to address it and make a plan of care. 2. This is education, and not a developmental screening to elicit data. The focus of the teaching is on an unborn child, so developmental level is not a current issue. 3. The tertiary level of preventative care is related to restoring a level of functioning that is below an expected level, such as in a rehabilitation situation. 4. The teaching regarding proper car seat use is an example of an activity that might decrease the opportunity for injury in a newborn; therefore, this is primary preventive health maintenance.

10) An adolescent is admitted to the eating disorders unit with a 2-year history of anorexia nervosa. Assessment data indicate that the adolescent has recently sustained additional weight loss and electrolyte imbalances. Which is the priority when planning care for this client? 1. Individual counseling 2. Family therapy 3. Regulation of antidepressant drugs 4. Nutritional support

Answer: 4 Explanation: 1. This will be an important component of inpatient treatment but is not the priority intervention. 2. Family therapy is usually a component of the treatment of anorexia nervosa but is not the priority intervention. 3. Antidepressant drugs may be used as a component of the treatment, but this is not the priority intervention. 4. Hospitalization usually is in response to the weight loss and electrolyte imbalances, so nutritional support becomes the priority intervention. All other activities can be managed as outpatient therapies.

Which observation is most representative of the type of play usually seen in toddlers? a.the child who dresses up like a fireman b.two children sitting side by side, each playing with a toy truck c.two children putting a puzzle together d.a child who sits on the floor by himself playing with blocks

B

Which intervention should the nurse suggest to the parents of a 12-month-old as the most effective way to reduce the incidence of early-childhood caries? a. Encourage parents to give the child a bottle of juice at bedtime. b. Advise the parents to begin regular visits to the dentist. c. Advise the parents to provide a pacifier instead of a bottle at bedtime. d. Encourage parents to brush the child's teeth daily.

C Feedback: Early-childhood caries is common in young children who take a bottle of juice or milk to bed or who breastfeed at long intervals during the night. Although brushing the child's teeth is important, once-a-day brushing will not prevent caries in a child who sleeps with a bottle of juice or milk. Regular dentist visits generally are not recommended in a 12-month-old. Giving the child a pacifier will provide comfort and help the child sleep but will not promote tooth decay.

A 4 year old has been toilet-trained becomes incontinent when hospitalized for surgery. What is the most appropriate nursing diagnosis based on this assessment finding? a. growth and development, altered r/t incontinence b. ineffective individual coping r/t hospitalization c.urinary elimination, altered r/t incontinence d.Coping, defensive r/t stress of hospitalization

D

The nurse notes that a 6 month old infant who weighed 7 pounds at birth now weighs 15 pounds. What is the nurse's evaluation of the infant's current weight? a. The infant should be hospitalized for failure to thrive. b. The infant needs weekly follow-up to assess weight. c. The infant has been consuming more calories than needed. d. The infant's weight is appropriate for his age.

D

Which intervention is most appropriate in order to facilitate the development of trust in an infant who is hospitalized? a.place pictures of the child's family at the bedside b.play tapes of the mother's voice c.offer the infant a pacifier d.encourage the parents to room in and participate in care

D

A 15-year-old female tells the clinic nurse that she is worried she will get pregnant like her sister did. What questions should the nurse ask to determine what teaching response is needed? (Select all that apply.) a. "Are you sexually active now?" b. "Do your parents know you are sexually active?" c. "What age was your sister when she became pregnant?" d. "What steps are you taking to prevent pregnancy now?" e. "Have you talked to your sister about your fear?"

a. "Are you sexually active now?"; d. "What steps are you taking to prevent pregnancy now?" Feedback: Assessing the adolescent's current sexual activity and what precautions she is taking will allow the nurse to decide how to educate and assist the girl. The age of the sister is not relevant. If the nurse started by asking about whether the adolescent's parents know, the adolescent might become worried that her parents might be told, or that she might be directed to tell her parents. The nurse has to focus on the immediate concern and can address the awareness of the parents about the adolescent's sexual activity later. Exploring whether the adolescent has spoken with her sister will not help determine the nurse's teaching response.

A mother is complaining to the nurse that her 16-year-old son who plays varsity football has been "eating too much junk." Which comment by the nurse is appropriate? a. "Because your son is so active, he might need three thousand or more calories daily." b. "Two thousand calories are more than enough to support his needs." c. "Talk to him about the benefits of good nutrition and stopping all fast food intake." d. "Discuss the need for him to add fruits and vegetables to his diet."

a. "Because your son is so active, he might need three thousand or more calories daily." Feedback: Some adolescent boys require nearly three thousand or more calories daily. When teenagers are active in a variety of sports, these requirements increase further. Most adolescents need well over two thousand calories daily to support their growth spurt. Because adolescents prepare much of their own food and often eat with friends, they need to be taught about good nutrition. Fast food represents a significant intake for many adolescents. It is commonly high in fat, calories, and sodium while being low in essential nutrients such as calcium, folic acid, riboflavin, vitamins A and C, and fiber. Adding fruits and salads and allowing choices can enhance the quality of food intake.

A 2-year-old has been biting other children at daycare. Which response by the nurse to the parent is appropriate? a. "Encourage the daycare staff to separate the child immediately from the situation and use time-out." b. "Ask the daycare staff to call you, then go bite your child, so she understands it hurts." c. "Switch daycares; it's obvious there are problems there with the staff." d. "Tell the child she will be spanked if it happens again and follow through with it."

a. "Encourage the daycare staff to separate the child immediately from the situation and use time-out." Feedback: Since the child is in a daycare, the parents should collaborate with the daycare staff and tell them to separate the child immediately from the situation and use a time-out. The parent should not bite the child, switch daycare, or threaten the child with spanking.

When assessing the food choices of a 4-year-old boy, the nurse learns that the child loves certain foods and has a normal weight and BMI. Which responses by the parent would indicate a need for nutritional teaching? Select all that apply. a. "I give him all the milk he wants because he is a picky eater." b. "He won't eat all vegetables, but he will eat carrots and celery for a snack." c. "I give him an extra dessert most days when he is being good." d. "We have fun preparing foods together when I get home from work." e. "I let him eat as much cheese and yogurt as he wants because it's healthy."

a. "I give him all the milk he wants because he is a picky eater." c. "I give him an extra dessert most days when he is being good." e. "I let him eat as much cheese and yogurt as he wants because it's healthy." Feedback: The nurse should encourage the inclusion of the child in snack selection and preparation and teach the parents how to teach the child about food groups and the importance of nutrition for the body. Intake should be altered only as appropriate and never in excess. Dairy products should be low- or reduced-fat.

During an assessment at the clinic, the father of a 15-month-old boy mentions that he brought home a miniature car collection for the child from his trip to New Orleans. What response by the nurse is appropriate? a. "The cars may not be age-appropriate." b. "What a nice gift, I'm sure he loves them." c. "Consult the U.S. Consumer Product Safety Commission." d. "Has your child had any problems with the cars?"

a. "The cars may not be age-appropriate." Feedback: Select toys intended for the age of the child, as indicated on the label. Some toys have small parts or can break into small parts, and should not be given to children younger than 3 years. The other responses are not appropriate for the situation.

The nurse provides a 2-month-old infant's parents with information related to nutrition during the first 6 months. Which statement by the parents indicates that the teaching session was effective? a. "We will introduce rice cereal when he is 4 months old." b. "We plan to add honey to his cereal to make it taste better." c. "We will need to purchase an infant feeder in a few months." d. "Next month we will add applesauce to the baby's diet."

a. "We will introduce rice cereal when he is 4 months old." Feedback: Solid foods should be introduced at 4-6 months of age. The first food should be rice cereal because it has a lesser chance of allergy and is easily digested. Infant feeders are not recommended. Honey should not be given to infants, because of the increased risk of botulism.

A new mother has questions about breastfeeding and infant formulas. She asks the nurse what the best kind of milk is for her full-term baby. What is the best recommendation by the nurse? a. Breast milk for the first year b. Breast milk with human milk fortifier for the first 3 months c. Iron-fortified formula for 6 months d. Breast milk alternated with iron-fortified formula for the first 6 months

a. Breast milk for the first year Feedback: The American Academy of Pediatrics recommends breastfeeding for the first year. In situations where breastfeeding does not occur, the child should receive iron-fortified formula for the first year. If an infant is not getting enough calories through breastfeeding, supplementing with formula would be appropriate. Human milk fortifier should only be used in premature infants less than 37 weeks' gestation

An overweight 11-year-old girl tells the school nurse she would like to be more active, but her parents do not have time to take her places. What are some suggestions the nurse can make for this child to promote health? (Select all that apply.) a. Encourage the parents to investigate the option of ride-sharing for afterschool activities with a classmate's family. b. Tell the girl to talk to the school nurse each day about the foods she eats. c. Suggest that the family plan an activity night where they ride bikes, take a walk, or go to the park. d. Refer the child to the school psychologist to discuss the weight issue.

a. Encourage the parents to investigate the option of ride-sharing for afterschool activities with a classmate's family; c. Suggest that the family plan an activity night where they ride bikes, take a walk, or go to the park. Feedback: Sharing rides with another family might allow the girl to get involved with a physical activity after school and still have the parents involved. Planning a family activity is a beginning step for all of them to increase physical activity. Telling the nurse all the food she eats each day is like monitoring, and she might feel more self-conscious and different from her peers if this is a daily event. This child has interest in but a lack of opportunity for physical activity. She has not indicated she has an eating disorder or a mental health issue.

The parents of a 2-year-old work out of their home. During the day, they allow their child to watch television as they work. What are some suggestions the nurse can make for this child to promote health? a. Encourage the parents to limit television to no more than 2 hours daily. b. Teach the parents to engage the child in other screen activities. c. Suggest that the family plan play dates with another child the same age. d. Refer the child to a psychologist to discuss the child's inability to socialize.

a. Encourage the parents to limit television to no more than 2 hours daily. Feedback: Television and other screen activities should be limited to no more than 2 hours daily. A play date with another child the same age does not address the issue with the television. The child does not have an inability to socialize and does not need a psychologist.

A first-time mother expresses concern about how much her 9-month-old son cries when she drops him off at the child care center. Which initial action should the nurse take? a. Explain to the mother that this is an expected growth and development stage known as separation anxiety. b. Explain to the mother that this is an expected growth and development stage known as stranger anxiety. c. Report the information to the physician primary healthcare provider immediately. d. Assess the child carefully for signs of physical abuse.

a. Explain to the mother that this is an expected growth and development stage known as separation anxiety. Feedback: During the last 6 months of an infant's first year of life, he might become very upset when he discovers his parents are not present, or are getting ready to leave. This displays a healthy parent-child attachment reaction. Stranger anxiety typically is present before 6 months of age. This is not a priority data point to report immediately to the physician. Based on the age and information provided, one would not suspect abuse as the primary cause.

The parent of a 2-year-old reports that the child drinks six 8-ounce cups of milk per day and eats very little solid food. Based on this information, for what should the nurse further assess in this child? a. Iron deficiency anemia b. Obesity c. Failure to thrive d. Rickets

a. Iron deficiency anemia Feedback: Toddlers should not drink more than 16-24 ounces of milk per day; drinking more keeps them from being hungry for foods and limits the amount of nutrients they receive. Milk does not contain iron; therefore, when the diet consists primarily of milk, the child is at high risk for iron deficiency anemia. The child likely is gaining weight. There is no indication of failure to thrive. Rickets are a problem in children with severe vitamin D deficiency. Based on the information given, obesity is not a concern. Further data would be needed to suspect that the child will become obese.

A parent is concerned that his 4-year-old will eat only Cheerios and chicken nuggets. What is the best anticipatory guidance that the nurse can offer this parent? a. Offer chicken nuggets and Cheerios with other foods at mealtimes. b. Make the child sit at the table until she eats all her food. c. Give the child the desired food between mealtimes. d. Encourage the child to drink at least 24 ounces of juice a day.

a. Offer chicken nuggets and Cheerios with other foods at mealtimes. Feedback: If chicken nuggets and Cheerios are offered with other foods at mealtimes, this will foster and establish good eating patterns. The child needs to learn to eat when food is provided. Preschool-age children should not consume more than 12 ounces of juice daily. Children should not be forced to sit at the table until they eat all of their food. This serves as a type of punishment and does not foster good eating habits.

A new school counselor asks the school nurse to present an educational program for the parents of young adolescents. Which item would be a priority for inclusion in the program? (Select all that apply.) a. Signs and symptoms of substance abuse b. Signs of depression and substance abuse c. Driver's education classes d. Opportunities available in the community to promote physical activity e. The current clothing styles, so the children can "fit in"

a. Signs and symptoms of substance abuse; b. Signs of depression and substance abuse; d. Opportunities available in the community to promote physical activity Feedback: Not all parents are aware of what to look for in their child to determine whether depression or substance abuse is occurring. Nurses can educate parents on these topics, so that the parents can be proactive instead of reactive. The current clothing style usually is apparent based on society norms. The driver's education classes and sporting groups usually are presented to the parents in writing if their child is interested. These would not be the priority topics to help promote health.

A 16-year-old female complaining of abdominal pain is waiting in the exam room with her mother. It is important that the nurse assess whether the girl is sexually active. What action should the nurse take to gather the data? a. Suggest to the girl and mother that the mother can join her after the exam to discuss any findings with the physician. b. Ask the mother to leave the room when sexual history questions will be asked. c. Ask the girl whether she is sexually active, because the mother needs to know and be involved. d. Let the physician ask the question, so the girl does not have to discuss it twice.

a. Suggest to the girl and mother that the mother can join her after the exam to discuss any findings with the physician. Feedback: The nurse has suggested that the girl be alone for the questions and exam. The girl has the option to allow her mother to come with her. This is easier than asking the mother to leave partway through the exam. The initial assessment questions are the responsibility of the nurse, not the primary healthcare provider. The girl might not answer truthfully if asked about sexuality in front of her mother.

Facilitating health-promotion activities with parents is an important role of the nurse. Which interventions are included in this role? Select all that apply. a. Support breastfeeding during the first year of life. b. Help parents understand the immunization schedule. c. Assist in identifying strategies to initiate with "difficult"-temperament infants. d. Encourage parents not to smoke around the infant. e. Teach parents about anticipated developmental milestones.

a. Support breastfeeding during the first year of life. c. Assist in identifying strategies to initiate with "difficult"-temperament infants. e. Teach parents about anticipated developmental milestones.

Which information obtained during a nursing assessment of a 3-year-old child indicates a need for parent education? a. The child watches cartoons on television while eating. b. The parents expect the child to eat at the table for supper. c. The child knows how to pour liquids from a small pitcher. d. The child only wants to eat pizza and/or chicken fingers

a. The child watches cartoons on television while eating. Feedback: Meals and snacks should not be eaten while watching television; expect the child to sit for a short period at meals with family for socialization. The nurse teaches the parents to engage the child in food preparation and pouring liquids from small pitcher and to recognize that food jags (periods when only one or two foods are eaten) are common.

A mother of a 14-year-old girl calls the health center and asks the nurse at what age a pelvic exam should be done. The girl is menstruating regularly. What other data might suggest to the nurse that the girl should have the exam now rather than wait until she is 18 years of age? a. The girl discusses that she has many boyfriends. b. The girl participates in several sports. c. The mother had her first pelvic exam at 14 years of age. d. The girl has a history of anorexia.

a. The girl discusses that she has many boyfriends. Feedback: She might be sexually active and need the pelvic exam/Papanicolaou test now. If she is sexually active, further screening for sexually transmitted infections might be required. The mother's exam history and the girl's history of anorexia do not lead the nurse to think that the girl is sexually active and, therefore, do not influence the decision.

An 8-month-old is irritable with a skin rash and a cough. Which comment by the telenurse is appropriate? a. "Make sure to give a small dose of over-the-counter children's Benadryl." b. "Contact your primary healthcare provider immediately." c. "Change the detergent that you are using; it's causing an allergic reaction." d. "If your child is still coughing in the morning, call the clinic."

b. "Contact your primary healthcare provider immediately." Feedback: Parents should be instructed to contact their child's primary healthcare provider if the child has an axillary temperature ≥ 99.3°F, seizure, skin rash, purplish spots, bruising, change in activity level or behavior, unusual irritability, lethargy, failure to eat, vomiting, diarrhea, dehydration, and cough. The nurse cannot assess the child over the telephone or make a determination for giving an OTC drug. The nurse does not know whether the child is having an allergic reaction or some other condition, so changing the detergent would be incorrect. Telling the parent to call the clinic in the morning is delaying care for a potentially dangerous situation.

When assessing the food choices of a 9-year-old boy, the nurse learns that the child eats his lunch from the school cafeteria. Which responses by the child would indicate a need for nutritional teaching? (Select all that apply.) a. "I eat all the food they give me." b. "I don't get the vegetables they have, but have carrots after school as a snack." c. "I like to get extra dessert most days because it is so good." d. "If I try to eat all the food they give me, I don't have much time at recess."

b. "I don't get the vegetables they have, but have carrots after school as a snack." c. "I like to get extra dessert most days because it is so good." d. "If I try to eat all the food they give me, I don't have much time at recess." Feedback: Children at this age are not able to maintain a healthy, balanced diet on their own. They have peer and media influences, likes and dislikes, and interest in other activities to distract them from their food intake. They will eat the popular fast foods and skip the healthy ones unless they are provided a quick source of healthy foods, such as pre-cut fresh fruits and vegetables. Having one vegetable snack at home does not meet recommended intake for this food group. Eating desserts will lead to extra calories.

When discussing an infant's growth with parents, the nurse explains the term "percentile." Which statement by a parent indicates appropriate understanding of the term? a. "You said my baby is at the 50th percentile for weight, so that means he is only half of what he should be at his age." b. "Since my baby is at the 50th percentile for height, that means only 5 out of 10 babies would be longer than he is." c. "My baby is at the 95th percentile for weight, so that must mean she will probably be overweight like I am when she gets older." d. "Being at the 95th percentile for head circumference means my baby's brain is growing at almost the perfect size of 100 percent for his age."

b. "Since my baby is at the 50th percentile for height, that means only 5 out of 10 babies would be longer than he is." Feedback: Percentiles are different from percentages. If there is a baby at the 50th percentile for height (length), 5 of 10 babies would be longer and 5 of 10 babies would be shorter than this baby. Being at the 50th percentile does not mean the baby is only half of what he should be. The parent is thinking that the baby is only at 50 percent of the expected size, not the 50th percentile. Growth charts are used to track current growth patterns, and are not to be considered predictors of adult measurements. Being at the 95th percentile does not mean that the baby is near "perfect" head size. It means that this baby would have the largest head circumference in a group with 9 other babies.

A mother is concerned that her 5-month-old infant spits out his rice cereal. She thinks he dislikes it. What is the nurse's best response to the mother? a. "You should try placing the cereal in an infant feeder." b. "This is a normal response in some babies when they are first fed from a spoon." c. "Try wheat cereal and see if the baby likes it better." d. "Your child is not ready for solid foods. Try again in 2 months."

b. "This is a normal response in some babies when they are first fed from a spoon." Feedback: When solid foods first are introduced, the infant might spit out the food because of the normal back-and-forth movement of the tongue. With practice, the infant will learn to feed from a spoon. Changing the type of cereal might not change the spitting out of the cereal. Infant feeders are not recommended. They can lead to choking. In addition, the child needs to learn to eat from a spoon. The infant should be ready for semisolid foods, such as infant cereal, by 4-6 months.

Which response by the school nurse to a 16-year-old would be appropriate when the boy tells the nurse he smokes? a. "If you continue to smoke, you will get lung cancer and die." b. "We need to discuss how smoking can affect your health." c. "You are hurting your family with your secondhand smoke." d. "Did you know that smoking can stunt your growth?"

b. "We need to discuss how smoking can affect your health." Feedback: The nurse should focus on education of risk factors and potential future diseases and illnesses associated with smoking. Scare tactics and threats, such as in the other responses, will not allow a trusting relationship to develop, and the child might feel like the nurse is responding like a parent.

A 13-year-old female and her mother come to the school-based health clinic to obtain birth control pills. The nurse does not personally approve of this measure. After the nurse provides sexuality education, the mother insists on obtaining the pills for her daughter. Which action by the nurse is acceptable? a. Report the parent to child protective services. b. Ask another nurse to work with this situation. c. Refer the child and mother to family counseling. d. Refuse to provide the pills, because the child is so young.

b. Ask another nurse to work with this situation. Feedback: If the nurse has a moral value difference with a situation, he is not required to remain in the situation. The nurse needs to be professional and responsible and find continued care to meet the child and parent's needs. Referring, refusing, or reporting them will not address their immediate request and might result in risky behavior of the child.

The father of a 12-year-old boy asks the nurse about when his son can sit in the front seat of the car and just use the regular seat belt. The nurse measures the child, and he is one inch shorter than the required 4' 9" to be able to sit without a booster seat. What should the nurse advise the father to do? a. Since it is only a 1-inch difference, they can go ahead and let him change to a regular seat belt. b. Continue to use a booster seat until the child meets the minimum height required to use a seat belt. c. Allow the child to sit on a blanket to make him high enough for a seat belt. d. Ask the primary healthcare provider to decide what should be done.

b. Continue to use a booster seat until the child meets the minimum height required to use a seat belt. Feedback: The law requires a child be at least 4' 9" to sit in a car with only a regular seat belt. None of the other options is acceptable, since he does not meet this required criterion.

Which should the nurse recognize as increasing the risk of an accident for a 6-month-old infant? (Select all that apply.) a. A rear-facing car seat b. The ability of the infant to crawl c. The presence of other siblings in the home d. The infant's attendance at a child care facility 2 days per week

b. The ability of the infant to crawl c. The presence of other siblings in the home d. The infant's attendance at a child care facility 2 days per week Feedback: Rear-facing car seats are the appropriate position for an infant up to 12 months and 20 pounds. The 6-month-old infant who can crawl or has other siblings in the home might have access to items that are not safe. Small pieces of games; coins; cords; pencils or pens; and hot beverages are a few examples of what the exploring infant could find and be harmed by. The same potential hazards might exist when there are children of various ages in a child care setting.

An 11-year-old boy is brought to the primary healthcare provider's office complaining of a sore leg. The boy's father tells the nurse that the child might have injured the leg during football practice. As the nurse is examining the leg, she asks the child about his football activities. Which response from the child would concern the nurse and require further discussion with the child and parent? a. The boy discusses how he made a great play, but fell on his leg. b. The boy states, "I know my Dad wants me to play, but I knew I would get hurt playing football." c. The boy is concerned with how many practices he might miss. d. The boy asks whether the primary healthcare provider will need to do anything to his leg that will hurt.

b. The boy states, "I know my Dad wants me to play, but I knew I would get hurt playing football." Feedback: If the child is not interested in the sport, he might not be motivated, and might have low self-esteem and guilt if he does not perform well. He also has a high potential for injury, since he is not interested. The other responses indicate an interest in returning to the activity, or in whether he will be experiencing any pain during treatment.

The nurse is providing information regarding infant nutrition to parents during a well-child visit. Which of the following growth and development milestones must be achieved prior to introducing soft finger foods into an infant's diet? (Select all that apply.) a. The infant drinks formula every 4 hours during the day. b. The infant is able to sit up with support. c. The infant has developed the pincer grasp. d. The extrusion reflex no longer is present. e. The infant has several primary teeth.

b. The infant is able to sit up with support. c. The infant has developed the pincer grasp. d. The extrusion reflex no longer is present. Feedback: When able to sit up, the infant can be in an upright position in a high chair, decreasing the chance of choking while consuming foods. The infant must be able to pick up food and feed herself to indicate readiness for solid foods. Showing an interest in the food others eat often indicates readiness to eat solid foods. Consuming a bottle of formula every 4 hours is considered typical, and does not indicate the readiness for introduction of solid foods. Presence of primary teeth is not essential prior to the introduction of soft solid food.

While in the physician's office, the mother of an 8-month-old girl states, "She always has her bottle with formula in her mouth. I'm worried she will gain too much weight." The nurse should respond to this information by focusing on which potential problem? a. The infant is still drinking formula. b. The infant might be developing early-childhood caries. c. The infant still is consuming fluids from a bottle. d. The mother lets the infant keep the bottle instead of encouraging play with toys

b. The infant might be developing early-childhood caries. Feedback: Allowing the infant to "always" have a bottle of formula in her mouth can promote the development of early-childhood caries. Sugars from the formula will remain on the teeth, causing breakdown. The mother might need to be reminded of dental care for an 8-month-old infant. Formula or breast milk is the fluid nutrition choice for the child under 1 year of age. Drinking from a bottle and nursing are the primary expected methods of fluid consumption at this age. The child should be able to drink from a cup by 1 year of age. No mention was made whether the infant plays with toys even though the bottle is in her mouth. This is not the priority.

Which information obtained during a nursing assessment of a 10-year-old child who is at home alone after school indicates a need for parent education? a. The child just watches cartoons on television until the parent gets home. b. The parent allows the child to make a pizza snack in the oven if he gets hungry. c. The child has to stay in his room until the parents get home. d. On cold days, the child is allowed to make hot chocolate in the microwave.

b. The parent allows the child to make a pizza snack in the oven if he gets hungry. Feedback: Allowing the use of the oven has many injury possibilities. There could be a fire, or the child could get burned. While watching cartoons on television does not promote any mental or physical activity, the risk of injury does not exist. Staying in a room might not be a problem for the child if his hobbies are indoor ones he can do in his room. The hot chocolate might be a potential injury source, but overall, the microwave is safer to use than the oven.

A 14 year old has been diagnosed with insulin-dependent diabetes. Which technique is most appropriate in order to facilitate coping with this diagnosis? a.warn the teen of the consequences of noncompliance b.introduce the adolescent to another teenager who is successfully managing his diabetes c.give the adolescent specific instructions d. encourage increased dependence on the teen's parents for several weeks

b.introduce the adolescent to another teenager who is successfully managing his diabetes

At each healthcare visit, the nurse plots the infant's weight, length, and head circumference on a growth curve. Which growth pattern would necessitate a further inquiry into the infant's growth and development? a. An infant whose weight increases from the 75th percentile at 6 months to the 80th percentile at 9 months b. An infant whose length was at the 50th percentile at 2 months of age and who is at the 25th percentile at 4 months of age c. A 1-month-old infant whose birth weight was at the 25th percentile and whose current weight is at the 5th percentile d. An infant whose head circumference was at the 75th percentile at 4 months and who remains at the 75th percentile at 6 months

c. A 1-month-old infant whose birth weight was at the 25th percentile and whose current weight is at the 5th percentile Feedback: Values above the 90th percentile or below the 10th percentile indicate the need for further evaluation. The other stated patterns are normal.

Which is the most appropriate anticipatory guidance to give parents relative to food allergies in infants? a. Document episodes of fussiness following eating. b. Instruct parents to read all baby food labels carefully. c. Allow 3-5 days between the introductions of new foods. d. Instruct the parents on how to make their own baby food.

c. Allow 3-5 days between the introductions of new foods. Feedback: If a food allergy or intolerance develops in infants, it is important to tell the parents to introduce one new food at a time, waiting at least 3-4 days to introduce another. Documentation of fussiness after eating, instructing parents to read all baby food labels, and making their own baby food are all not appropriate anticipatory guidelines relative to food allergies in infants.

Which nursing intervention is most developmentally appropriate for a hospitalized 10 year old? a. Encourage the child to play with safe medical equipment. b. Encourage dependency on the child's parents while the child is hospitalized. c. Allow the child to assist with dressing changes. d. Obtain a complete health history from the child.

c. Allow the child to assist with dressing changes.

Nutritional assessment of a 10-year-old indicates the following findings. Which does the nurse recognize as a risk alert? (Select all that apply.) a. A BMI in the 25th percentile b. Eating an apple and an orange every day for a snack c. Having been diagnosed with asthma d. Eating one vegetable a day, generally at suppertime e. Playing basketball 5-6 days a week

c. Having been diagnosed with asthma d. Eating one vegetable a day, generally at suppertime Feedback: The presence of a chronic illness is a risk alert. In addition, children should eat at least three servings of vegetables a day. The child's intake of an apple and an orange a day is appropriate. A BMI of 25% is acceptable. Just because the child does not eat broccoli or spinach does not put him at risk. There are many other vegetables from which to choose. The child is participating in physical activity at least 5 days a week, and this is appropriate

At a 2-year-old's checkup, measurement of weight indicates that the infant has lost 4 pounds since his last checkup. What should the nurse do first? a. Plot the weight on a growth chart. b. Assess the child for signs of malnutrition. c. Reweigh the child. d. Ask the mother about the child's daily intake.

c. Reweigh the child. Feedback: The nurse should reweigh the child first to make sure the weight is accurate. Two-year-olds frequently move around when being weighed, so it is most important that the initial action is to verify the results. After verifying the results, the nurse can plot the weight on a growth chart and a full history and physical, including nutritional assessment, can be obtained.

The nurse is caring for a postoperative 14-year-old female on the pediatric unit. Which consideration is most significant in planning care for this child? a. The child will want her mother with her at all times. b. The child of this age will be glad to miss school. c. The child of this age is learning to become independent. d. The child is not going to be concerned with her body image while hospitalized

c. The child of this age is learning to become independent. Feedback: The 14-year-old typically will not want a parent or nurse to do all the care for her. She is interested in her body and wants to start caring for herself. Concern with body image and development of independence are both significant concerns in the adolescent age group. The adolescent probably will want friends present at times instead of a parent at all times. Missing school is not a positive aspect for this age, because frequent contact with peer groups is so important.

A 17-year-old is planning to attend college after high school graduation. The school nurse informs the student that a healthcare visit needs to be scheduled prior to the start of college for what primary purpose? a. To assess whether there are any health problems that could interfere with the student's performance b. To allow the student to obtain birth control pills c. To obtain immunization updates d. To make a nutrition plan for when the student is in classes

c. To obtain immunization updates Feedback: Immunizations are considered to be a prevention strategy during infant, toddler, and school-age years. Most parents do not follow through with the elective boosters or vaccines, because they are not required. The student will be exposed to many new people and might be in a different living environment, so there are immunizations to protect her. If the student has any health problems or needs birth control or nutrition education, this would be determined during questioning by the school nurse

Which statement made by the grandmother of a 7-month-old infant during a health visit would indicate that more teaching regarding nutrition was needed? a. "He seems to know that it is time to eat when we put him in his high chair." b. "He is a little young to use a spoon the right way, but I still let him try." c. "I don't worry if he only takes a few bites of a new food at each meal." d. "I am going to make sure that this grandchild is not a picky eater. I give him whatever we are eating."

d. "I am going to make sure that this grandchild is not a picky eater. I give him whatever we are eating." Feedback: Feeding a child whatever the family is eating is a goal for around 12 months of age, not 7. The consumption of solid foods is still fairly new to an infant of this age, so being offered and expected to eat general table foods would not be realistic. The appropriate setting for an infant learning to self-feed is a high chair. This decreases the chance of choking and incorporates the infant into mealtimes with the family. Promoting familiarity with eating utensils for future use is acceptable, since the expectation that the infant use them correctly was not indicated. Taking a few bites of a new food is typical behavior in this age of infant. It is a realistic expectation that the child will try a new food, but not that he will eat a full serving the first time he tries it.

The parents of a 17-year-old male are concerned about his recent attitude changes, physical changes, and lack of interest in eating. Which intervention should the nurse consider first? a. Refer to a family counselor, so the family can work together on the changes. b. Ask the parents whether they have alcohol in the home. c. Tell the physician to order drug screens to check for substance abuse. d. Ask the teen privately whether he is using any substances such as drugs or alcohol

d. Ask the teen privately whether he is using any substances such as drugs or alcohol Feedback: Asking the teen privately might provide an answer regarding his signs and symptoms. If the teen is using a substance and admits to it, the nurse will need to take further action. If the teen denies it, the nurse must continue the assessment into possible pathological reasons for the changes. Referring to a family counselor, ordering a drug screen, and discussing the presence of alcohol in the home are not the first priority if there is a physiological problem.

A 15-year-old mother of a 2-month-old infant says, "My baby cries all the time. I just don't know what to do." A response by the nurse that could positively influence the infant and mother would be to: a. Suggest the mother give the baby up for adoption. b. Teach the mother to feed the infant when she cries. c. Tell the mother to make sure that the baby's blankets are loose so the baby is comfortable. d. Encourage the mother to call the office if she gets frustrated and does not know what to do.

d. Encourage the mother to call the office if she gets frustrated and does not know what to do. Feedback: The mother needs to be given a directive on what to do when she gets frustrated with her crying baby. When some parents get stressed, especially young parents, they might be tempted to shake or harm the baby. Suggesting adoption is an extreme response at this time. If this were going to be done, it usually would happen right after birth. Infants at this age prefer to be swaddled, not wrapped loosely. Swaddling can calm a fussy baby by providing security, bringing the hands near the mouth, and providing warmth. If the baby is crying, it is recommended that the baby be fed only if it has been 2 hours or more since the last feeding.

Nursing assessment of a 14-year-old reveals a BMI in the 90th percentile and a lifestyle that includes spending 4 hours a day playing video games and eating supper while watching television. What is the priority nursing diagnosis for this adolescent? a. Fatigue related to malnutrition b. Disturbed Body Image related to distorted perception of body size and shape c. Delayed Growth and Development related to inappropriate intake d. Imbalanced Nutrition: More than Body Requirements related to excessive intake and sedentary lifestyle

d. Imbalanced Nutrition: More than Body Requirements related to excessive intake and sedentary lifestyle Feedback: The most appropriate nursing diagnosis is the one that focuses on the core of the problem. The child is overweight because of poor eating habits and a sedentary lifestyle. Fatigue and Altered Development would be more appropriate with a child who is not receiving enough calories. Although the teen might have altered body image, there are no data given that support that. A diagnosis of Disturbed Body Image would be more appropriate with the diagnosis of anorexia nervosa.

Which nursing diagnosis would best reflect potential safety issues related to the older infant? a. Potential for Injury related to "slow-to-warm-up" infant temperament b. Potential for Injury related to car seat use c. Knowledge Deficit: Parents, related to older infant nutrition d. Potential for Injury related to increased capability for mobility

d. Potential for Injury related to increased capability for mobility Feedback: "Baby-proofing" the home involves many steps. For example, when the infant is able to crawl, anything on the floor will attract the infant. The infant might crawl up steps, which has the potential for injury if he falls back down. The electrical cords and outlets pose a hazard. An infant with a "difficult," not a "slow-to-warm-up," temperament has the potential for injury if parents get frustrated and do not know how to respond to their infant. The use of a car seat decreases the potential for injury.

The school nurse is working with a 13-year-old boy who recently was diagnosed with insulin-dependent diabetes. On what item should the nurse focus when providing teaching to this child? a. Referring the boy to a psychologist in order to deal with the new diagnosis b. Making sure the boy tells everyone about his diagnosis in case there is a problem c. Encouraging the boy to tell his friends about healthy nutrition, so they are not tempting him with fast food d. Reminding the boy of the activities in which he can continue to participate just as he did before the diagnosis

d. Reminding the boy of the activities in which he can continue to participate just as he did before the diagnosis Feedback: One of the prevailing experiences of the adolescent period is becoming associated with a peer group. The 13-year-old does not want to appear different from all his peers. This can lead to depression. Focusing on what he can still do (physical activity, groups, hobbies) even though he has a new diagnosis will give him a sense of control and normalcy with his life.