exam 1 peds

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For reasons of anticipatory guidance, nurses should be aware that menarche appears earlier in some ethnic groups than others. In which ethnic group is menarche likely to appear first?

Black Explanation: Black girls on average reach menarche slightly earlier than White, Hispanic, and South Asian girls.

Fungal Infections of the Skin: Tinea cruris - What is it? - What does it look like?

- fungal infection on the groin - erythema, scaling, maceration in the inguinal creases and inner thighs

Causes of Urticaria:

-Foods -Drugs -Animal stings -Infections -Environmental stimuli -Stress

The 8- to 10-year-old child needs ___to ____ hours of sleep per night.

10 to 12

When planning how to respond to a 3-year-old child about telling stories ("tall tales"), the nurse would base the statement on the fact that: a preschooler is in an insecure period. imagination in a 3-year-old is at its peak. a 3-year-old knows the word two but not the concept of two. preschoolers have a limited vocabulary.

imagination in a 3-year-old is at its peak.

During a visit to the school nurse, an adolescent confides in recently having homosexual feelings. How should the nurse best respond to the adolescent? "Would you like to talk about these feelings?" "These feelings are normal for your age." "How long have you been having these feelings?" "Do these feelings make you feel bad about yourself?"

"Would you like to talk about these feelings?"

Origin: Chapter 14, 19 Prior to administering morphine to a 10-year-old child, the nurse reviews the adverse effects of the drug. Which system is primarily affected by the drug, causing most of the adverse effects? A) Central nervous system B) Peripheral nervous system C) Digestive system D) Musculoskeletal system

Ans: A Feedback: Opioid agonists, such as morphine, are associated with numerous adverse effects, resulting primarily from their depressant action on the central nervous system.

Origin: Chapter 14, 16 The student nurse is learning about the effects of heat and cold when used in a pain management plan. What accurately describes one of these effects? A) Cold results in vasodilation. B) Cold alters capillary permeability. C) Heat results in vasoconstriction. D) Heat decreases blood flow to the area.

Ans: B Feedback: Cold results in vasoconstriction and alters capillary permeability, leading to a decrease in edema at the site of the injury. Heat results in vasodilation and increases blood flow to the area.

The nurse is observing a 6-month-old boy for developmental progress. For which typical milestone should the nurse look? a) Puts down a little ball to pick up a stuffed toy b) Enjoys hitting a plastic bowl with a large spoon c) Picks up an object using his thumb and finger tips d) Shifts a toy to his left hand and reaches for another

Puts down a little ball to pick up a stuffed toy

behavioral-cognitive pain management strategies?

Relaxation Distraction Imagery Biofeedback Thought stopping Positive self-talk

The nurse is caring for a preschool child in the hospital with severe developmental delays. The parents have 3 other younger children at home and both parents work full-time outside the home. The family has just moved to this area. Which nursing diagnosis would be the highestpriority in regard to the parents at this time? Imbalanced nutrition, less than body requirements Risk for caregiver role strain Readiness for enhanced parenting Interrupted family processes

Risk for caregiver role strain

Define papule

Rounded, nonpustular, elevation on the skin

The nurse is teaching healthy eating habits to the parents of a 7-month-old girl. Which recommendation is the most valuable advice? a) Provide small portions that must be eaten b) Let the child eat only the foods she prefers c) Serve new foods several times d) Actively urge the child to eat new foods

Serve new foods several times

nurses role in managing chronic pain?

Similar to that for the child experiencing acute pain or procedure-related pain Assessment of the child's pain is key -Onset, duration, intensity, and location of pain -Alleviating or exacerbating factors -Impact on child's daily life -Effect on child and family's stress level -Methods used to alleviate pain (including home remedies or alternative therapies) -Physical examination Multiple nonpharmacologic and pharmacologic strategies combined to provide pain relief

Lea is 3 months old. At what age would it be okay for Lea's mother to introduce carrots to her for dinner? a) Solid food can be introduced at 9 months of age. b) Solid food can be introduced at 7 to 9 months of age. c) Solid food can be introduced at 4 to 6 months of age. d) Solid food can be introduced whenever the child seems ready.

Solid food can be introduced at 4 to 6 months of age.

The nurse is caring for adolescent athlete who is being seen for a fractured arm. The parent reports that this is the third sports injury in the past 2 years. The parent asks the nurse why the adolescent who is healthy overall continues to have injuries. How should the nurse respond? The bones, joints and tendons of adolescents are vulnerable to injury due to their rapid state of growth. Some adolescents are accident prone. These are accidents and random in occurrence. There may be some underlying problems that your adolescent should be evaluated for.

The bones, joints and tendons of adolescents are vulnerable to injury due to their rapid state of growth.

Which gross motor skill would the 4-year-old child have most recently attained? The child can cut his/her food. The child can button his/her clothes. The child can hop on one foot. The child can tie his/her shoelaces.

The child can hop on one foot.

Which of the following shows an example of Erik Erikson's developmental task for the infant? a) The infant cries and the caregiver picks the child up. b) The infant smiles as people walk past the crib. c) The infant cries when they have a wet diaper. d) The infant plays the game peek-a-boo.

The infant cries and the caregiver picks the child up.

The nurse is conducting a physical examination of a 5-month-old boy. Which observation may be cause for concern about the infant's neurologic development? a) His toes hyperextend when the bottom of the foot is stroked. b) The infant grasps a finger when it is placed in his palm. c) The infant displays an asymmetric tonic neck reflex (fencing reflex). d) The anterior fontanel is open and easily palpated.

The infant displays an asymmetric tonic neck reflex (fencing reflex). (Birth-4mos)

A nurse is talking to and making facial expressions at a 9-month-old baby girl during a routine office visit. Which of the following represents the most advanced milestone of language development that the nurse should expect to see in this child? a) The infant says "da-da" when looking at her father b) The infant coos, babbles, and gurgles c) The infant squeals with pleasure d) The infant imitates her father's cough

The infant says "da-da" when looking at her father

In teaching caregivers of preschool children, the nurse would reinforce that which activity would be most important for this age group? The preschool child should be properly restrained when riding in a vehicle. The preschool child should be screened for amblyopia. The preschool child should cover mouth when coughing or sneezing. The preschool child should brush and floss teeth after snacks and meals.

The preschool child should be properly restrained when riding in a vehicle.

In teaching caregivers of preschool children, the nurse would reinforce that which activity would be most important for this age group? The preschool child should brush and floss teeth after snacks and meals. The preschool child should be properly restrained when riding in a vehicle. The preschool child should be screened for amblyopia. The preschool child should cover the mouth when coughing or sneezing.

The preschool child should be properly restrained when riding in a vehicle.

ways to using age appropriate language to assess pain in older children?

Toddlers are likely to understand words such as "owie" or "boo-boo" Preschoolers may need to be coaxed to discuss their pain as they feel it is something to be expected (they think pain is normal) School-age children can usually report type, location, and severity because of their well-developed language skills Teens concern about body image and fear of losing control may result in denying pain or refusing medication

nurses role in managing procedure related pain?

Use topical anesthetic at site of a skin or vessel puncture Use nonpharmacologic strategies for pain relief Prepare child/family ahead of time about the procedure Use therapeutic hugging to secure the child Use the smallest-gauge needle possible Use intermittent infusion device or PICC for multiple samples Opt for venipuncture in newborns instead of heel sticks if large amount needed Use kangaroo care for newborns before and after heel stick Provide nonnutritive sucking before the procedure

When teaching an infant's mother about bathing her, it would be important to instruct her that a) she should never use soap on a baby's hair. b) soap lubricates and oils an infant's skin. c) bath time provides an opportunity for play. d) infants need a daily bath.

bath time provides an opportunity for play.

Anticipatory guidance for an infant for the 4th month should include the fact that she probably will a) have many "blue" or moody periods. b) develop a fear of strangers. c) insist on things being done her way. d) be able to turn over onto the back.

be able to turn over onto the back.

The parent of 3 1/2-year-old preschooler tells the nurse that the child argues quite a bit and says that the child is always right. The nurse interprets this information as indicating: guilt. conservation. centering. initiative.

centering

sickle cell pts some times dont get proper treatment for pain because parents are concerned that their child will become addicted to opioids what do we tell the parents?

children are less likely to form an addiction

The nurse is caring for a 4-year-old girl following an appendectomy. The girl becomes fearful and starts to cry as soon as the nurse walks into the room. When the nurse asks about the crying, the girl says, "Nurses who wear shirts with flowers give shots." The nurse understands that this statement is an example of: transduction. magical thinking. beginning empathy. animism.

transduction

when is nonnutritive sucking good?

with circumcisions and with heel sticks

Origin: Chapter 14, 21 The nurse has applied EMLA cream as ordered. How does the nurse assess that the cream has achieved its purpose? A) Assess the skin for redness. B) Note any blanching of skin. C) Lightly tap the area where the cream is. D) Gently poke the child with a needle.

Ans: C Feedback: The nurse should verify that sensation is absent by lightly tapping or scratching the area. Blanching or redness indicates that the medication has penetrated the skin adequately but does not indicate that sensation is absent. Using a needle to poke the skin would likely frighten the child.

1. The nurse is teaching the mother of a toddler about burn prevention. Which response by the mother indicates a need for further teaching? A) "We will leave fireworks displays to the professionals." B) "I will set our water heater at 130 degrees." C) "All sleepwear should be flame retardant." D) "The handles of pots on the stove should face inward."

13. A nurse is assessing the skin of a child with cellulitis. Which of the following would the nurse expect to find? A) Red raised hair follicles B) Warmth at skin disruption site C) Papules progressing to vesicles D) Honey-colored exudate

2. The nurse is providing parental teaching about home care for an 8-year-old boy with widespread sunburn on his back and shoulders. Which of the following responses indicates a need for further teaching? A) "Cool compresses may help cool the burn." B) "He should manually peel off any flaking skin." C) "Nonsteroidal anti-inflammatory drugs like ibuprofen are helpful." D) "He should avoid hot showers or baths for a couple of days."

20. An instructor is developing a plan for a class of nursing students on the various skin disorders. When describing urticaria, which of the following would the instructor include? A) It is a type IV hypersensitivity reaction. B) Histamine release leads to vasodilation C) Wheals appear first followed by erythema. D) The nonpruritic rash blanches with pressure.

21. A nurse is inspecting the skin of a child with atopic dermatitis. Which of the following would the nurse expect to observe? A) Erythematous papulovesicular rash B) Dry, red, scaly rash with lichenification C) Pustular vesicles with honey-colored exudates D) Hypopigmented oval scaly lesions

22. A nurse is performing a primary survey on a child who has sustained partial thickness burns over his upper body areas. Which of the following would the nurse do first? A) Inspect the child's skin color B) Assess for a patent airway C) Observe for symmetric breathing D) Palpate the child's pulse

4. The nurse is conducting a physical examination of a 9-month-old baby with a flat, discolored area on the skin. The nurse documents this as which of the following? A) Papule B) Macule C) Vesicle D) Scaling

A mother reports to the nurse that her 4-year-old does everything that she does. She says she is becoming somewhat frustrated with these actions. What would be the best response by the nurse to this mother? A) "This is not normal behavior. I am going to get the doctor's advice." B) "Preschoolers' imitating is a healthy behavior. It is part of their imagination and normal growth and development." C) "I am sure there are ways to get your daughter to stop imitating you." D) "I can imagine that it would be very irritating."

B) "Preschoolers' imitating is a healthy behavior. It is part of their imagination and normal growth and development." The nurse needs to inform the mother that preschoolers have an imagination that is keener than it will be at any other stage. They enjoy games using imitation and they mimic exactly what they see parents do. It is a normal part of their development. The other answers are not appropriate.

The nurse is providing teaching to the mother of a 4-year-old girl about bike safety. Which statement by the mother indicates a need for further teaching? A) "Pedal back brakes are better for her age group." B) "She can ride on the street if I am riding with her." C) "The balls of her feet should reach both pedals while sitting." D) "She should always ride on the sidewalk."

B) "She can ride on the street if I am riding with her." The preschooler is not mature enough to ride a bicycle in the street even if riding with adults, so the nurse should emphasize that the girl should always ride on the sidewalk even if the mother is riding with her daughter. The other statements are correct.

The nurse is preparing a presentation for a local health fair depicting the differences in maturity between preadolescents. Which differing factor should the nurse prioritize in the presentation?

Boys grow at a slower, steadier rate than do girls. Explanation: Preadolescent boys grow generally at a slower, steadier rate than do girls. Girls grow more rapidly during preadolescence and then their growth rate slows dramatically after menarche.

how soon before needle stick does emla cream need to be put on childs skin?

1 hour -also put bandage/pressure dressing over to secure to skin -make sure you numb multiple diff spots just incase 1st stick doesnt work do both arms and feet

The infant weighs 6 lbs. 8 oz. at birth. If the infant is following a normal pattern of growth, which of the following would be an expected weight for this child at the age of four months? a) 10 lbs. 8 oz. b) 16 lbs. c) 13 lbs. d) 15 lbs. 4 oz.

13 lbs.

The toddler grows about how many inches in height per year? 1 inch 3 inches 5 inches 7 inches

3 inches The toddler age range is 1 to 3 years of age. Each year the toddler grows about 3 in. (7.62 cm).

ibuprofen after how many months of age

The nurse observing toddlers in a day care center notes that they may be happy and pleasant one moment and overreact to limit setting the next minute by throwing a tantrum. What is the focus of the toddler's developmental task that is driving this behavior? A)The need for separation and control B)The need for love and belonging C)The need for safety and security D)The need for peer approval

A) The need for separation and control Feedback: Emotional development in the toddler years is focused on separation and individuation. The focus in infancy is on love and belonging, and the need for peer approval occurs in the adolescent. Safety and security are concerns in all levels of development, but not the primary focus.

The nurse is providing atraumatic care to children in a hospital setting. Which of the following are principles of this philosophy of care? Select all answers that apply. A) Avoid or reduce painful procedures B) Avoid or reduce physical distress C) Minimize parent-child interactions D) Provide child-centered care E) Minimize child control F) Use core primary nursing

ABF

pharmacologic pain management?

Analgesics, patient-controlled analgesia, local analgesia, epidural analgesia, conscious sedation start with analgesics and work way up

Origin: Chapter 14, 30 The nurse is researching behavioral-cognitive pain relief strategies to use on a 5-year-old child with unrelieved pain. Which methods might the nurse choose? Select all that apply. A) Relaxation B) Distraction C) Thought stopping D) Massage E) Sucking

Ans: A, B, C Feedback: Common behavioral-cognitive strategies include relaxation, distraction, imagery, thought stopping, and positive self-talk. Sucking and massage are examples of biophysical interventions.

Origin: Chapter 14, 27 The nurse is preparing a child for a lumbar puncture. How far ahead of the procedure should the nurse apply the EMLA cream? A) 30 minutes B) 1 hour C) 3 hours D) 4 hours

Ans: C Feedback: For a deeper procedure such as a lumbar puncture, the nurse needs to apply the cream 2 to 3 hours before the procedure. For a superficial procedure, the EMLA cream should be applied at least 1 hour before the procedure.

What activity would the nurse expect to find in an 18-month-old? A)Standing on tiptoes B)Pedaling a tricycle C)Climbing stairs with assistance D)Carrying a large toy while walking

C) Climbing stairs with assistance Feedback: Toddlers continue to progress with motor skills. An 18-month-old should be able to climb stairs with assistance. A 24-month-old should be able to stand on his or her tiptoes and carry a large toy while walking. A 36-month-old would be able to pedal a tricycle.

A nurse is attending to a group of boys at a school. The nurse is required to document the sexual development in boys on a regular basis. The nurse would anticipate which clients having the highest incidence of nocturnal emissions? Clients with strong, muscular appearance Clients in the age group of 18 to 20 years Clients who are showing pubertal changes Clients who have reached adulthood

Clients who are showing pubertal changes

The nurse is watching a 4-year-old child play with another preschool child. The children are playing a game with rules. The nurse notes that the child is demonstrating what type of play? Parallel play Associative play Cooperative play Dramatic play

Cooperative play

The nurse is performing a cognitive assessment of a 2-year-old. Which behavior would alert the nurse to a developmental delay in this area? A)The child cannot say name, age, and gender. B)The child cannot follow a series of two independent commands. C)The child has a vocabulary of 40 to 50 words. D)The child does not point to named body parts.

D) The child does not point to named body parts. Feedback: The 2-year-old can point to named body parts and has a vocabulary of 40 to 50 words. At 30 months old a child can follow a series of two independent commands and at 3-years old a child can say name, age, and gender.

School-age children need to brush their teeth four or five times a day for 4 minutes each time.

False

Define Vesicle

Fluid filled lesions

On physical examination, the nurse discovers that a 6-year-old child's palatine tonsils are somewhat enlarged in the back of the throat. What would be the nurse's best action? You Selected:

Record this as a normal finding in an early school-age child. Explanation: Lymphoid tissue reaches maximum growth in early school-aged children. The tonsils may decrease in size somewhat from the preschool years but they remain larger than those of adolescents. The tonsils and adenoids may appear larger than normal even in the absence of infection. The nurse would be correct to document this as a normal finding. The child would not need pain medication nor an examination for respiratory problems if this a normal finding.

nonpharmalogic pain management techniques?

Relaxation, distraction, guided imagery, massage, hot/cold therapy

During a complete physical assessment of a preteen boy, the nurse correctly recognizes which finding as being the first change of puberty? Deepening voice Development of axillary hair Testicular enlargement Increase in height

Testicular enlargement

The nurse is admitting a 15-year-old adolescent to the hospital pediatric unit. What does the nurse recognize as a priority for this adolescent? The adolescent should be encouraged to call friends often. The adolescent's need for privacy should be respected. The adolescent's need for parental support should be discussed. The adolescent should be given freedom to participate in unit activities as desired.

The adolescent's need for privacy should be respected.

The nurse is assessing an infant at his 4-month well-baby check-up. The nurse notes that at birth the baby weighed 8 lb (3.6 kg)and was 20 in (50.8 cm)in length. Which finding is most consistent with the normal infant growth and development? a) The baby weighs 21 lb (9.5 kg)and is 30 in (76.2 cm) in length. b) The baby weighs 24 lb (10.9 kg) and is 26 (66.0 cm) in in length. c) The baby weighs 15 lb (6.8 kg)and is 24 in (61.0 cm) in length. d) The baby weighs 16 lb (7.3 kg) and is 26 in (66.0 cm) in length.

The baby weighs 16 lb (7.3 kg) and is 26 in (66.0 cm) in length.

The bones, joints and tendons of adolescents are vulnerable to injury due to their rapid state of growth. Explanation: Rapidly growing bones, muscles, joints, and tendons are more vulnerable to unusual strains and fractures. While some people may seem to be accident prone, this adolescent's injuries are most likely the result of the stage of physical growth. There is no evidence the adolescent has any underlying medical conditions.

A father asks you what symptoms he can expect with normal teething in his infant. Which of the following would you tell him? a) The child's gum line will be tender. b) The child will not play or eat for 2 days. c) He can expect his child to be constipated for 2 days. d) The child's temperature may go as high as 102°F.

The child's gum line will be tender.

A 5-month-old infant being assessed was born at 32 weeks. The nurse doing the well-child check-up should compare the baby to what norms? a) The development of a 3-month-old b) The growth of a 5-month-old c) The development of a 10-week-old d) The growth of a 2-month-old

The development of a 3-month-old 40weeks - birth week = months to minus from current age 40-32=8wks (2 months) [5mos-2mos=3mos]

Three daily meals that include choices from each of the food groups; Friday's lunch eaten around 2 p.m. with a small amount of fat and a somewhat larger than usual portion of complex carbohydrates. Explanation: A meal that is low in fat and high in complex carbohydrates, eaten 3 to 4 hours before an event, is appropriate for the teen athlete. Carbohydrate-loading, which some practice during the week before an athletic event, increases the muscle glycogen level to 2 to 3 times normal and may hinder heart function. The other suggested menus would not provide the additional muscle glycogen needed for optimal functioning.

Peers often exert pressure for children to experiment with tobacco and alcohol.

True

The nurse is promoting nutrition to a teen who is going through a growth spurt. Which food should the nurse recommended for its high iron content? Whole grain bread Fat-free milk Organic carrots Fresh orange juice

Whole grain bread

The nurse is promoting nutrition to a teen who is going through a growth spurt. Which food should the nurse recommended for its high iron content?

Whole grain bread Explanation: Whole grain bread contains high amounts of iron and is a type of food the child would not have an aversion to. Milk is a good source of vitamin D. Carrots are high in vitamin A. Orange juice is a good source for vitamin C.

The school nurse is meeting with a 10-year-boy who is concerned about his weight. He reports he doesn't eat much candy but loves fruit, pasta, potatoes, and bread. Which suggestion should the nurse prioritize to help him maintain a healthy weight?

ncourage activities that will increase his physical activity. Explanation: Encouraging daily physical activity and following the dietary standards (such as ChooseMyPlate guidelines) will help the child meet necessary nutritional guidelines. Following popular fad diets or using weight-loss supplements must be avoided because they do not supply adequate nutrients for the growing child. The child is aware of the weight problem, but it would not be beneficial to just ignore it because the child may develop harmful eating habits such as bingeing.

what are benzos and anticonvulsants used for

nerve pain

do children adapt to pain?

no they just are learning to cope with it

number 1 preferred route

oral

When assessing the growth and development of a 4-year-old, which would the nurse note as being appropriate? tells a fantasy story about a bear and a car begins to show logical thought processes scribbles with no discernable pictures/letters has best friends at preschool and sleepovers

tells a fantasy story about a bear and a car

At a physical examination, a nurse asks the father of a 4-year-old how the boy is developing socially. The father sighs deeply and explains that his son has become increasingly argumentative when playing with his regular group of three friends. The nurse recognizes that this phenomenon is most likely due to: regression. preschoolers having a harder time sharing than toddlers. testing and identification of group role. playing in an even-number group of children (four).

testing and identification of group role.

every if child weighs more than the given recommended dose on medication that is recommended for adults when do we max out?

the highest dose possible for an adult daily even if the child could have more due to weighing more

Fungal Infections of the Skin: Diaper candidiasis - What type of medication is generally used?

topical nystatin (antifungal!!)

The mother of a 9-year-old female voices concern to the nurse about her daughter developing breasts "at such a young age." How should the nurse respond?

understand your concern, but girls typically enter puberty around the age of 9 or 10." Explanation: Voicing empathy regarding the mother's concern conveys support, and letting her know that this is normal growth and development helps ease her concerns. The other responses don't address her concerns or show genuine empathy.

While speaking to the caregiver of a 13-year-old girl, the nurse learns the client is struggling to accept the changes occurring to her body as a result of puberty. Which statement will the nurse include while responding to the client's caregiver? "Once puberty ends, your daughter will feel more confident in her body changes." "Adolescents are often uncomfortable with their new body images and must learn to accept it." "Be sure to tell your daughter she is beautiful often to promote a positive self-image." "These are feelings all adolescent girls experience. Have your daughter talk to her peers."

"Adolescents are often uncomfortable with their new body images and must learn to accept it."

A parent calls the health care provider about the 7-year-old child's dental hygiene. The child has had three cavities. The parent does not know what to do and asks the nurse for guidance. How should the nurse respond?

"Are you able to supervise your child's brushing?" Explanation: Dental caries is the leading chronic disease in the United States. Children need help with toothbrushing until they are between 7 and 10 years of age. The parent should monitor the toothbrushing to make sure it is thorough, observe for any abnormal tooth alignment, and schedule cleanings every 6 months. Children tend to concentrate on the front teeth, because they can see them easily and "forget" the teeth in the back. Parental oversight is needed to be sure those teeth are brushed carefully.

The nurse is educating the parents of a 10-year-old girl in ways to help their child avoid tobacco. What suggestion should be part of the nurse's advice?

"As parents, you need to be good role models." Explanation: The nurse would recommend that the parents be good role models and quit smoking. Locking up or hiding your cigarettes and going outside to smoke is not as effective as having a tobacco-free environment in the home.

The mother of a 4-year-old girl reports her daughter has episodes of wetting her pants. The nurse questions the mother about the frequency. The nurse determines these episodes occur about once every 1 to 2 weeks. Which response by the nurse is indicated? "Consider restricting your daughter's fluid intake." "Discipline should be applied after these times." "At this age it is helpful to remind children to go to the bathroom." "The frequency of these wetting episodes may be consistent with a low-grade urinary tract infection."

"At this age it is helpful to remind children to go to the bathroom."

The parents of a 5-year-old tell the student nurse, "Our daughter takes after her father's lack of athletic ability. We have worked with her but she can't seem to throw a ball at all when we are playing with her." Which responses by the student are not appropriate? Select all that apply. "Athletic ability is often hereditary, so it is good you are aware of her lack of athleticism while she is young." "I am sure she will catch on as she plays with more children and when she starts taking physical education classes at school. "It may not be athletic ability. Most preschoolers are able to throw a ball by the age of 5 years. Have you discussed this with your pediatrician?" "I know how annoying that has to be. Neither my brother nor I have any athletic ability and neither do our parents." "Enrolling your daughter in a preschool softball or baseball program might help her athletic and motor skills."

"Athletic ability is often hereditary, so it is good you are aware of her lack of athleticism while she is young." "I know how annoying that has to be. Neither my brother nor I have any athletic ability and neither do our parents." "I am sure she will catch on as she plays with more children and when she starts taking physical education classes at school. "Enrolling your daughter in a preschool softball or baseball program might help her athletic and motor skills."

A 16-year-old girl has arrived for her sports physical with a new piercing in her navel. Which response by the nurse is best?

"Be sure to clean the navel several times a day." Explanation: The best response is to describe the proper care using frequent cleansing with antibacterial soap. It is too late for warnings about the dangers of piercing such as skin- or blood-borne infections, or disease from unclean needles.

A first-time father calls the pediatric nurse stating he is concerned that his 4-year-old daughter still wets the bed almost every night. Remembering his own experience of being punished for wetting the bed at 4 years old, he is not sure punishment is the best approach to address this. Which nursing instruction is the most appropriate? "Bedwetting is not uncommon in young children. Try to calmly change the bed without showing your frustration." "Nightly bedwetting up to age 12 is developmentally typical, so you will need to practice patience with your daughter." "Setting rules is a parent's job to help the child have acceptable social behavior, so take away a privilege each time she wets the bed." "Disciplining is not likely to be effective, but if the child keeps wetting the bed it may be necessary."

"Bedwetting is not uncommon in young children. Try to calmly change the bed without showing your frustration."

The father of a preschool boy reports concerns about the short stature of his son. The nurse reviews the child's history and notes the child is 4 years old and is presently 41 in (104 cm) tall and has grown 2.5 in (6.35 cm) in the past year. Which response by the nurse is mostappropriate? "Your son is slightly below the normal height for his age group but may still grow to be a normal height in the coming year." "Your son is slightly below the normal height for his age but he had demonstrated a normal growth rate this year." "Is there a reason you are concerned about your child's height?" "Both your son's height and rate of growth are within normal limits for his age."

"Both your son's height and rate of growth are within normal limits for his age."

A high school athlete comes to the emergency department with hypertension, aggressiveness, and psychosis. What question would be important for the nurse to ask the client? "Do you take amphetamines?" "Do you take cocaine?" "Do you take anabolic steroids?" "Do you take human growth hormone?"

"Do you take anabolic steroids?"

The nurse is instructing a 12½-year-old boy who says, "I am too short! Girls are taller than I am. Guess I won't be playing basketball." What instructions are best included in the plan of care? Select all that apply.

"Girls begin to grow rapidly at a younger age than boys do. Boys start later and grow longer." "There are a lot of size differences in your age group now because everyone enters puberty and grows at slightly different times than others." "You could add as much as 12 inches to your height before you stop growing."

The parents of an overweight 2-year-old boy admit that their child is a bit "chubby," but argue that he is a picky eater who will eat only junk food. Which response by the nurse is best to facilitate a healthier diet? "Serve only healthy foods. He'll eat when he's hungry." "You may have to serve a new food 10 or more times." "Give him more healthy choices with less junk food available." "Calorie requirements for toddlers are less than infants."

"Give him more healthy choices with less junk food available." Suggesting that the parents transition the child to a healthier diet by serving him more healthy choices along with smaller portions of junk food will reassure them that they are not starving their child. The parents would have less success with an abrupt change to healthy foods. Explaining calorie requirements and the time line for acceptance of a new food do not offer a practical reason for making a change in diet.

The nurse is discussing sensory development with the mother of a 2-year-old boy. Which parental comment suggests the child may have a sensory problem? "He wasn't bothered by the paint smell." "He was licking the dishwashing soap." "I dropped a pan behind him and he cried." "He doesn't respond if I wave to him."

"He doesn't respond if I wave to him." The fact that the child does not respond when the mother waves to him suggests he may have a vision problem. The toddler's sense of smell is still developing, so he may not be affected by odors. Their sense of taste is not well developed either, and this allows him to eat or drink poisons without concern. The child's crying at a sudden noise assures the nurse that his hearing is adequate.

A mother is discussing her 10-month-old boy with the nurse. Which comment indicates a need for teaching? a) "He loves being in his walker and 'zips' around the house." b) "He gets a few sips of apple juice each day from a regular cup, not a sippy cup." c) "We have safety gates at the top and bottom of our stairs." d) "I wipe my son's teeth every day with a fresh washcloth."

"He loves being in his walker and 'zips' around the house."

The nurse is conducting a well-child exam of a 4-year-old boy. Which statement would alert the nurse that the child is at risk for iron deficiency? "He does not like spinach, but he does like chicken and beef." "He enjoys eggs and fortified cereal for breakfast." "He loves milk and drinks it every time he is thirsty." "He eats a well-balanced diet."

"He loves milk and drinks it every time he is thirsty."

Parents are beginning potty training their 2-year-old child and seek advice from the nurse on how to be successful in this endeavor. Which statement by the parents indicates that further teaching is needed? "I will wait until he is off the toilet before flushing it." "We will place him on the potty for 5 minutes for each session." "I bought him big boy underwear for him to use instead of diapers." "He wants to accompany me to the bathroom but I prefer to go alone."

"He wants to accompany me to the bathroom but I prefer to go alone." Allowing a toddler to observe a parent or older sibling going to the bathroom serves as a positive role model and helps the child understand what they are to do when they are there.

The nurse has completed an educational program on normal growth and development in children. Which statement by a participant would indicate a need for further education? "I am so glad I can get rid of all of those bath toys because they take up so much room." "It is okay for my four-year-old to still play in his sandbox." "I will add some crayons, chalk and finger paints to my three-year-old's birthday gifts." "My four-year-old will be getting a tricycle for her birthday. I'm glad it's a good gift for her."

"I am so glad I can get rid of all of those bath toys because they take up so much room."

A teacher refers a student to the school nurse because the student is frequently falling asleep during class. After talking with the student, the nurse is most concerned by which statement by the student? "I get 7 hours of sleep every night so I don't know why I am so tired." "I just can't seem to stay awake during that class because it's boring." "My mom keeps telling me to turn off my television when I go to bed." "I guess I need to be more careful about my curfew on school nights."

"I get 7 hours of sleep every night so I don't know why I am so tired."

What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition? "When she doesn't eat well at meals we give her nutritious snacks." "She drinks three 6-ounce cups of whole milk each day." "New foods are offered along with ones she likes." "I give my daughter juice at breakfast and when she is thirsty during the day."

"I give my daughter juice at breakfast and when she is thirsty during the day." High juice intake can contribute to either obesity or appetite suppression. None is needed, but if juice is given limit the amount to 4 to 6 ounces daily. Water should be the choice for thirst. The other statements support good toddler nutrition. Whole milk is needed through age 2 years. Two cups daily is adequate. Nutritious snacks support quality intake when quantity is poor. New foods offered with old ones provide sameness along with the new.

The nurse is discussing nutrition with the mother of a 6-year-old boy. What response by the boy's mother indicates a need for further discussion?

"I make him eat some of everything I put on his plate." Explanation: Children will usually accept new foods if they aren't forced upon them. It is better to offer new foods and let the child accept them when ready. Children will go on "food strikes" and they will also go through periods of wanting the same foods. Preference of how the child eats lets the child exert some independence and allows for experimentation.

The nurse is counseling an overweight, sedentary 15-year-old girl. The nurse is assisting her to make appropriate menu choices. Which statement indicates the adolescent understands how to make appropriate dietary selections? "To lose weight my protein intake should be limited to 2 to 4 servings per day." "I need to have 4 servings of fruit each day." "Because of my age, my dairy intake is unlimited." "I avoid all fat intake."

"I need to have 4 servings of fruit each day."

"I notice you have a new piercing. Be sure to clean it twice a day so you don't get an infection." "Did they tell you when you got your piercing how important cleaning it is? Infections can take up to a year to heal in a naval piercing."

During the assessment of a 15-year-old female, the nurse notes a new body piercing in the navel. Which statements by the nurse would be appropriate in regard to this new piercing? Select all that apply. "I really like your belly ring. Where did you get it?" "Did they tell you when you got your piercing how important cleaning it is? Infections can take up to a year to heal in a naval piercing." "I notice you have a new piercing. Be sure to clean it twice a day so you don't get an infection." "You are very young to have a navel piercing. Do your parents know you have this?" "A navel piercing is a lot better than a tattoo. At least the piercing doesn't have to be permanent if you don't want it to be."

A 16-year-old adolescent is talking with the nurse at a local health clinic about skin care. Which comments by the teen does the nurse determine require additional conversation? Select all that apply.

"I only tan before going on spring break to get a base tan so I won't burn." "My favorite time of day to be outside is the middle of the day, around noon." "The more exposure and burns I get now will toughen my skin so I won't get skin cancer when I'm older." Explanation: The nurse should further discuss comments that demonstrate incorrect information about sun exposure. Any exposure to tanning beds should be avoided to prevent skin cancer risks. Other risks for skin cancer include being in the sun between the times of 10:00 am and 4:00 pm, and sun exposure and burns during childhood and adolescence. A minimum SPF of 15 should be used, so SPF 30 is good practice, as is wearing sun-protective clothing when outside during the day.

The mother of a 9-year-old female voices concern to the nurse about her daughter developing breasts "at such a young age." How should the nurse respond? "Do the females in your family typically develop at an early age?" "I understand your concern, but girls typically enter puberty around the age of 9 or 10." "This is rather young to be developing breasts. I will be sure to let the doctor know." "I am sure you are concerned but children develop at different rates."

"I understand your concern, but girls typically enter puberty around the age of 9 or 10."

A 10-year-old child tells the school nurse that she is embarrassed that she is afraid of the dark. Which is the best response by the nurse?

"It is normal for a 10-year-old to be afraid of the dark so there is no need to be embarrassed. Would you like to talk about it?" Explanation: The school-age child needs reassurance that his or her fears are normal for this developmental age. Parents, teachers, and other caretakers should discuss the fears and answer questions posed by the child. However, the adult should not embellish the fear in any way. In addition, telling the child that she will "grow out of it" is not reassuring to the child.

A mother is concerned because her 14-month-old son, who had a big appetite when breast-feeding a few months ago, seems uninterested in eating solid food. She still breast-feeds him daily, but is thinking of weaning him soon. How should the nurse respond to this mother? "It is normal for toddlers to lose their appetites; try weaning him all at once so that he will be more interested in the solid food." "It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." "It is not normal for toddlers to lose their appetites; have him tested for a gastrointestinal condition." "It is not normal for toddlers to lose their appetites; spoon feed him yourself to make sure he gets proper nutrition."

"It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." Because growth slows abruptly after the first year of life, a toddler's appetite is usually less than an infant's. Children who ate hungrily 2 months earlier now sit and play with their food. It is important to educate parents while the child is still an infant this decline in food intake will occur so they will not be concerned when it happens. Because the actual amount of food eaten daily varies from one child to another, teach parents to place a small amount of food on a plate and allow their child to eat it and ask for more rather than serve a large portion the child cannot finish. One tablespoonful of each food served is a good start. The nurse should recommend that the mother wean her son gradually to avoid confrontation, not all at once. Most toddlers insist on feeding themselves and generally will resist eating if a parent insists on feeding them.

An adolescent asks the nurse what the term "puberty" means. What is the nurse's best response?

"It is the age at which one first becomes capable of sexual reproduction." Explanation: Adolescence is a period of rapid growth with dramatic changes in body size and proportions. It is the time between puberty and the end of physical growth. During this time, sexual characteristics develop and reproductive maturity occurs. Puberty is the point at which an individual becomes capable of sexual reproduction. Puberty starts at different ages for males and females. Puberty is defined as sexual maturity only. It does not describe emotional maturity.

A father tells the nurse that his son has been asking questions about his genitals. The father states that he is unsure how to answer the questions of a 4-year-old. How should the nurse respond? "It's best to answer his questions using accurate anatomical names and keep your answers simple." "That is a difficult subject to address. I'm not sure what is the best way to answer that question." "I would suggest getting books with pictures to help explain the differences between male and female genitalia." "You should answer his questions by whatever feels most comfortable to you."

"It's best to answer his questions using accurate anatomical names and keep your answers simple."

When the nurse discharges a new mom and infant, the nurses notices that the car seat is in the front seat of the car. What is the appropriate response for the nurse to make regarding the car seat? a) "Let me go over car seat safety with you, so you can install your car seat properly." b) "You should never put the car seat in the front." c) "With the car seat in front, you can keep an eye on your baby." d) "I see you have a car seat, that is great."

"Let me go over car seat safety with you, so you can install your car seat properly."

The nurse is reinforcing teaching related to the nutritional needs of the infant with a group of caregivers. One caregiver asks why her 6-month-old infant needs to have solid foods when breast milk is such a good source of nutrition. What would be the best response by the nurse? a) "By this age your child is ready to try new skills such as eating solid foods." b) "Breastfeeding will become painful when the child gets more teeth, so the infant needs to eat solid foods." c) "Milk does not provide adequate amounts of iron, which are found in solid foods." d) "The extrusion reflex must be developed and feeding solid foods will help the child to develop this reflex."

"Milk does not provide adequate amounts of iron, which are found in solid foods."

The nurse is providing an in-service for parents of preschoolers regarding nutrition. Which comments by the parents demonstrate successful learning following the in-service? Select all that apply. "The only way I can get my child to consume sources of vitamin C is through fruit juices. I guess it's better than not at all." "I generally give my child choices about foods within each food category, ensuring all food groups are represented." "We very rarely feed our child fast food and when we do we try to keep it as healthy as possible with no soda." "My 4-year-old is above normal in weight but I'm sure it's just baby fat and will be lost with age." "My 4-year-old should be ingesting at least 700 mg of calcium through food daily to promote good bone health."

"My 4-year-old should be ingesting at least 700 mg of calcium through food daily to promote good bone health." "I generally give my child choices about foods within each food category, ensuring all food groups are represented." "We very rarely feed our child fast food and when we do we try to keep it as healthy as possible with no soda."

The mother of a 13-year-old boy confides to the pediatric nurse practitioner that her son has recently had a nocturnal seminal emission. The mother is concerned, and the nurse explains "wet dreams" and the other male traits of puberty to the mother. Which response indicates a need for further discussion? "My son's spontaneous erections and nocturnal emissions are very normal." "My son is developing normally and the traits of puberty vary from child to child." "My son must be sexually active or having overly sexual thoughts to have a nocturnal emission." "My son is not doing anything to cause the nocturnal emissions; they occur spontaneously."

"My son must be sexually active or having overly sexual thoughts to have a nocturnal emission."

The nurse is caring for a 6-year-old child. During the course of a routine wellness examination, the parent proudly reports that the child eats whatever the parent puts on the plate. The nurse wants to emphasize the importance of allowing the child to make some choices regarding the types of foods eaten. How should the nurse communicate this to the parent?

"Now is the time to let your child choose some of the meals."

28s Report this Question The nurse is caring for a 6-year-old child. During the course of a routine wellness examination, the parent proudly reports that the child eats whatever the parent puts on the plate. The nurse wants to emphasize the importance of allowing the child to make some choices regarding the types of foods eaten. How should the nurse communicate this to the parent?

"Now is the time to let your child choose some of the meals." Explanation: Diet preferences are established in the preschool years and continue to develop as the child ages. The diet is influenced by family, peers, and media. Because of these influences and the child striving for independence, it is important to involve the child in helping select the food choices and guiding the child to healthy food choices. With parents, as well as children, it is more effective and less a matter of personal opinion to say "now is the time" rather than "you need," "I want you to," or "you must" do something. The nurse can emphasize the importance of the child participating in meal selection while encouraging the child's independence in a gentle manner.

The nurse is caring for a 3-year-old at a well-child checkup. The parent states that her child still has an afternoon nap but she has a friend whose toddler no longer naps in the afternoon. She is seeking advice on what do to. When providing anticipatory guidance to the parent about sleep patterns, what is the most appropriate response by the nurse? "Children no longer nap in the afternoon after 1 year." "Children begin to give up afternoon napping at 2 years." Since they are in school now all day, napping ends at 6 years. "Often, the afternoon nap will be no longer needed after 4 years."

"Often, the afternoon nap will be no longer needed after 4 years."

An adolescent's parent states not knowing what to do with the adolescent. The parent reports the teenager is taking two or three showers a day when not that long ago the parent could barely get the teen to take a shower at all. What should the nurse's reply be to the parent? "Reevaluate the adolescent's ability to perform hygiene care since showering is so frequent." "Do not encourage multiple baths; it can be very drying to the skin." "Reinforce the family rules but also allow the adolescent to develop one's own routine." "Remind the adolescent about needing to be on a schedule so as to not disrupt the family."

"Reinforce the family rules but also allow the adolescent to develop one's own routine."

The parents of an 8-year-old girl with a slow-to-warm temperament are concerned about their daughter's reaction when she visits the dentist for the first time after having a cavity filled at the last visit. How should the nurse respond?

"Remind her in simple terms what will happen in the dentist's office." Explanation: Due to the girl's temperament, it is best if the parent's talk to the dentist before the first visit to find out exactly what the dentist will be doing and then describe to the child in simple terms what will occur. Reminding the child about the importance of proper oral hygiene is unhelpful. Telling the child that the dental checkup is just like going to see the pediatrician is untrue. It is inappropriate to advise the parents to not prepare the girl in advance.

The nurse is preparing a safety presentation for a health fair for families. Which instruction should the nurse prioritize when illustrating car safety and the family? "Set a good example. Wear your own seat belt every time you drive." "Reward the child with candy or some other treat each time the child keeps the seat belt on." "Explain that wearing a seat belt is a law and the police officer will give a ticket if the seat belt is not buckled." "Stop the car any time the preschooler unbuckles the restraints."

"Set a good example. Wear your own seat belt every time you drive."

The nurse is providing teaching to the mother of a 4-year-old girl about bike safety. Which statement by the mother indicates a need for further teaching? "The balls of her feet should reach both pedals while sitting." "She should always ride on the sidewalk." "Pedal back brakes are better for her age group." "She can ride on the street if I am riding with her."

"She can ride on the street if I am riding with her."

The nurse is providing teaching about proper dental care for the parents of a 5-year-old girl. Which response indicates a need for further teaching? "We should use only a pea-sized amount of toothpaste." "She needs to floss her teeth before brushing." "Too much fluoride can contribute to fluorosis." "She should see a dentist every 6 months."

"She needs to floss her teeth before brushing."

The nurse has completed an education program on normal communication abilities in the preschool-age child. Which statement by a participant indicates a need for further education? "I am glad to know that my 4-year-old child asking so many questions is normal." "Stating his name and address is too hard for my 5-year-old child; it will be another year before he can do that." "When my child counts numbers, it is only to 10 and we are slowing working on counting higher." "My child is finally talking in a way that most of my friends can understand her speech."

"Stating his name and address is too hard for my 5-year-old child; it will be another year before he can do that."

The nurse has provided an education conference for a group of teachers about suicide risks for adolescents. Which statement by a teacher indicates a correct understanding of the nurse's teaching?

"Teens who have attempted suicide once are at increased risk to try to commit suicide again." Explanation: Teens who have attempted suicide are at an increased risk for attempting to take their own lives again. Homosexual teens are at an elevated risk for suicide. Risk factors for suicide include a multitude of mental health disorders and is not limited to depression.

A 3½-year-old shouts, "Look out for Boo-ga-loo!" as the nurse enters the exam room. The father explains Boo-ga-loo is his daughter's imaginary friend. How should the nurse respond? "Tell me about Boo-ga-loo." "I don't see anyone." "Are you kidding me?" "Where did you get that funny name?"

"Tell me about Boo-ga-loo."

During an assessment, a preschool-aged child tells the nurse about having 12 siblings. The nurse is aware that the child has two older brothers. What would be the nurse's best response? "I guess you don't know much about counting yet." "Does it make you feel more important when you add on brothers?" "Don't lie to me. That's never a nice thing to do to someone." "That is a good pretend answer but tell me the names of the brothers you really have."

"That is a good pretend answer but tell me the names of the brothers you really have."

The parent of a black adolescent voices concern to the nurse because the daughter, "has gotten her period before all of her friends." How should the nurse respond? "I will be sure to let the health care provider know this. We don't want to miss something that may be wrong." "How old are most of her friends? Maybe that's the issue instead of it being a sign of something abnormal." "Some girls just get their period earlier than others." "That must be difficult, but on average black girls start their period earlier than other ethnicities."

"That must be difficult, but on average black girls start their period earlier than other ethnicities."

The nurse is providing anticipatory guidance to the parents of a 15-year-old who voice concerns with their teenager's sleep habits. They state, "Left to her own devices, I'm sure she'd stay up until 3:00 in the morning on the weekends and sleep until after lunchtime." Which should the nurse explain to the parents?

"That must be hard for you to manage. Perhaps we can explore some strategies with her to establish more predictable sleep patterns." Explanation: It is common for adolescents to adopt habits of going to bed late and awakening late, especially on weekends. Despite the fact that this is common, it is not ideal; the nurse should explore strategies for changing the adolescent's behavior in a collaborative and inclusive manner. Simply communicating that it is unacceptable is unlikely to bring about change.

The parents are concerned their 14-year-old child is always eating. The child weighs 54 kg and is 65 inches (165 cm) tall. What is the best explanation the nurse can give the parents? "The calories help his body increase muscle mass." "He needs the calories because he participates in sports." "His calorie intake predisposes him to future obesity." "He is substituting food for unfilled needs."

"The calories help his body increase muscle mass."

The mother of an infant questions the nurse about her baby's teething. The nurse provides client education. Which statement by the mother indicates understanding of the information provided? a) "My baby's first tooth will likely appear between 5 and 6 months." b) "The first teeth that will likely appear are the lower incisors." c) "My baby will most likely have his upper middle teeth come in first." d) "By 1 year my baby should have about three teeth."

"The first teeth that will likely appear are the lower incisors."

The nurse is conducting a health screening for a 3-year-old boy as required by his new preschool. Which statement by the parents warrants further discussion and intervention? "The school has a looser environment, which is a good match for his temperament." "The school is quite structured and advocates corporal punishment." "There is a very low student-teacher ratio, and they do a lot of hands-on projects." "The school requires processed foods and high sugar foods be avoided."

"The school is quite structured and advocates corporal punishment."

The parents of a 3-year-old boy have asked the nurse for advice about a preschool for their child. Which suggestion is most important for the nurse to make? "Look for a preschool that is clean and has a loving staff." "Make sure that you can easily get an appointment to visit." "Check to make sure your child can attend with the sniffles." "The staff should be trained in early childhood development."

"The staff should be trained in early childhood development." The nurse would recommend a preschool where the staff is trained in early childhood development and cardiopulmonary resuscitation. Cleanliness and a loving staff are not enough without competence. Good hygiene procedures require that a sick child not be allowed to attend. It is also important that parents are allowed to visit any time without an appointment.

A 15-year-old client's parent comments on the fact that the adolescent seems to always choose the opposite of what everyone else wants and that mood swings are a common occurrence. What statement shows the nurse that the client's parent understands these changes? "I know that my adolescent is doing this because of all the hormones." "My adolescent will never find anyone to live with if the adolescent acts like this." "This is common for this age group and it will get better with time." "This is my adolescent's temperament, and we will have to learn how to deal with it."

"This is common for this age group and it will get better with time."

The parents of a toddler are concerned their child is not developing correctly and are questioning the nurse concerning the child's lack of effort to join other children in a group activity. Which response should the nurse prioritize in answering the parents? "This is normal for this age group. It's referred to as solitary independent play." "Perhaps getting your child interested in sports will improve their other play habits." "Your child is involved with others, just indirectly. See how they sit next to the other children and play with the same toys?" "You should try to get your child involved in a local Boys and Girls club to encourage more interaction."

"This is normal for this age group. It's referred to as solitary independent play."

The parents of a 3-year-old tell the nurse that their child constantly says "no" to everything and they are very frustrated. They ask the nurse what they should do. Which responses by the nurse are appropriate? Select all that apply. "Asking your child the reason why most responses are 'no' might help you understand this negative behavior." "This is normal for this age. If measures to stop this behavior don't work, you should make the decision for your child on move on with whatever activity is occurring." "An occasional light spank on the bottom is often helpful when your child continually says 'no'." "Have you tried using "time-outs" for negative behavior?" "Giving your child choices instead of posing "yes" or "no" questions may decrease the "no" response."

"This is normal for this age. If measures to stop this behavior don't work, you should make the decision for your child on move on with whatever activity is occurring." "Have you tried using "time-outs" for negative behavior?" "Giving your child choices instead of posing "yes" or "no" questions may decrease the "no" response." As the toddler separates from the parent and recognizes his or her own individuality, and exerts autonomy, it is very common for the child to display negativism. Time-outs are helpful ways of disciplining for this age group. Offering choices, such as "Do you want the red or blue shirt?" lends to autonomy. If measures fail the parent needs to calmly make choices for the child. Spanking is not recommended for any age. Asking the child to explain is not developmentally appropriate for this age.

A mother brings her 8-year-old daughter into the doctor's office because over the past year her tonsils have increased in size to the point that the mother is concerned that her breathing will be obstructed. The girl has no pain, fever or other symptoms. Following this data collection, which instruction is best?

"This may be normal growth of lymphatic tissue for this age." Explanation: The immunoglobulins IgG and IgA each reach adult levels during the school-age period; lymphatic tissue continues to grow in size until about age 9. The resulting abundance of tonsillar and adenoid tissue in schoolchildren is often mistaken for disease as the tonsils seem to fill the entire back of the throat. The fact that there are no other symptoms indicates that this child's enlarged tonsils are simply a result of the normal growth of lymphatic tissue for this age.

Parents of a preschooler tell the nurse that their child often refuses to go to sleep at night. Which suggestion by the nurse would be helpful? Select all that apply. "Avoid having your child watch frightening shows on TV before bedtime." "Keep the door closed and the lights off so that your child can fall asleep faster." "Try using a night light in the child's room." "Try reading a favorite story before bedtime." "Set up some familiar bedtime rituals for your child."

"Try using a night light in the child's room." "Set up some familiar bedtime rituals for your child." "Avoid having your child watch frightening shows on TV before bedtime." "Try reading a favorite story before bedtime."

The mother and father of a 5-year-old boy are discussing bicycle safety with the nurse. What comment indicates further teaching is needed? "He never rides in the street." "Our son always wears a helmet." "He is able to ride without training wheels." "We just got him a new bike he can grow into."

"We just got him a new bike he can grow into."

During an admission assessment the nurse is discussing the developmental level of the child with the parents. Which comments by the parents demonstrate a good understanding of developmental expectations of the preschool-aged child? Select all that apply. "We have been talking about enrolling in a morning preschool program since this is our only child." "I am very concerned that our child is acting too much like some of the other children at our day care." "Our child attends a wonderful preschool 3 times per week." "My parents are the only babysitters our child has ever had. I think contact with mostly adults is important for this age." "We think it is important to have play dates with our friend's preschool children."

"We think it is important to have play dates with our friend's preschool children." "Our child attends a wonderful preschool 3 times per week." "We have been talking about enrolling in a morning preschool program since this is our only child."

The parents of a 9-year-old child voice concern that the child seems to be gaining weight rapidly. The nurse reviews the medical record and notes the child has increased weight by 6 or 7 lb (2.7 to 3.2 kg) per year for the past 2 years. What response by the nurse is indicated? You Selected:

"Weight gains of about 7 lb (3.2 kg) per year are normal for children in this age range." Explanation: Children who are between the ages of 6 and 12 years usually gain about 7 lb (3.2 kg) per year. The child in the scenario is gaining weight at a normal rate.

A 15-year-old client tells the nurse he has been having wet dreams and is ashamed and afraid he will get into trouble because he believes his parents think he is too young to understand or know about sex. To which statement would be the most appropriate for the nurse to respond?

"Wet dreams are not the result of anything you are doing but are simply the body's way of ridding itself of excess semen." Explanation: Boys who are unprepared for nocturnal emissions may feel guilty, believing that they have caused these "wet dreams" by sexual fantasies or masturbation. They need to understand that this is a normal occurrence and is simply the body's method of getting rid of surplus semen. The other suggestions do not address the situation in a professional manner.

A 5-year-old girl is pretending to be a crocodile during a physical examination. Her mother just smiles and rolls her eyes at the nurse. What would be the best response for the nurse to give the child? "What happened to my client? Did you eat her?" "What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile." "My dear, you are a girl, not a crocodile. Now sit still so that I can examine you." "Oh no! I have a crocodile in my room. Please don't bite me!"

"What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile."

The father of a 2-year-old girl tells the nurse that he and his wife would like to begin toilet training their daughter soon. He asks when the right time is to begin this process. What should the nurse say in response? "It is best to wait a little longer, until she is 3; only then will she be socially developed enough to understand what you are asking her to do." "When she starts tugging on a wet or dirty diaper, she is letting you know she's ready." "She's well past the age to begin toilet training; most children are ready by age 1, when they have developed the needed nervous system control." "The best time to start toilet training is as soon as the child begins walking."

"When she starts tugging on a wet or dirty diaper, she is letting you know she's ready." The markers of readiness are subtle, but as a rule children are ready for toilet training when they begin to be uncomfortable in wet diapers. They demonstrate this by pulling or tugging at soiled diapers. Because physiologic development is cephalocaudal, the rectal and urethral sphincters are not mature enough for control in most children until at least the end of the first year, when tracts of the spinal cord are myelinated to the anal level. A good way for a parent to know a child's development has reached this point is to wait until the child can walk well independently. Toilet training need not start this early, however, because cognitively and socially, many children do not understand what is being asked of them until they are 2 or even 3 years old.

An adolescent who is depressed states, "Nothing ever seems to be right in my life." Which would be the most appropriate response by the nurse? "Being a teenager is hard work." "Things will be better when you go off to college." "Try to look at the bright side of things." "You are feeling sad right now. It's a hard time."

"You are feeling sad right now. It's a hard time."

The school nurse is meeting with a group of 11-year-old girls to discuss expected puberty changes in their bodies. When one of the girls states, "I just feel like my whole body is changing and I don't know why" what should the nurse point out to this group? "Your other friends are feeling like this too." "You may feel like you are changing, but you still look the same." "You will feel better about yourself as you get older." "You have lots of hormone changes going on right now."

"You have lots of hormone changes going on right now."

The nurse is assessing a 14-year-old male client when the client's parent jokes about the changes in the client's voice and the hair under his armpits. Which response by the nurse to the client's parent is most appropriate? "Based on your child's age, changes in hair distribution and voice pitch are expected." "Your child can become modest and self-conscious and teasing may cause embarrassment." "I remember that time in my life, it was so awkward and uncomfortable." "It would be helpful to discuss with your child your trials with puberty and the changes you experienced."

"Your child can become modest and self-conscious and teasing may cause embarrassment."

"Your child can become modest and self-conscious and teasing may cause embarrassment." Explanation: It is never appropriate to discuss what is happening with a client in a way that is demeaning and hurtful. A 14-year-old adolescent is experiencing many bodily changes and is very self conscious. The nurse can share experiences with the client and the family, but it should not be in a way that the adolescent is embarrassed. Parents can share their experiences with the child, but they have to be open to this discussion or it can lead to an awkward experience for the adolescent. Reminding the parent of how the child is feeling and the possible feelings that can come from their interactions will bring the parent's attention to a delicate situation and is most appropriate. Simply stating these are expected findings does not address the joking manner of the parent.

The parent of a preschooler reports that the child seems to believe in magic. The parent voices concern that this "fantasy world" may become a problem. What response(s) by the nurse is indicated? Select all that apply. "This type of thought process allows your child to begin to observe the differences in the world." "This type of imagination is not normally seen until a child is school aged." "Fantasy play is most often seen in lonely children in an attempt to occupy themselves." "Your child is engaging in what we call magical thinking." "While imagination is normal, this type of fantasy world can cause problems for your child and should be discouraged."

"Your child is engaging in what we call magical thinking." "This type of thought process allows your child to begin to observe the differences in the world."

The mother of a 3-year-old tells the nurse that she is concerned that her child is not developing motor skills quickly enough. She states that, "My son can't skip and cannot stand on one foot for any length of time while playing." How should the nurse respond? "Maybe practicing these activities with him would help him improve these motor skills." "I wouldn't be too concerned since he seems fine during my assessment." "I am sure he will become more proficient in these activities soon." "Your child is not expected to be able to perform those activities at 3 years of age."

"Your child is not expected to be able to perform those activities at 3 years of age."

A parent brings a 6-year-old to the clinic and informs the nurse that the child is tired all the time, even though the child sleeps 7 to 8 hours each night. What is the best response by the nurse?

"Your child should be getting 11 to 12 hours of sleep per night with some quiet time after school." Explanation: Sleep needs for children change according to their ages. A 6- to 8-year-old child needs 12 hours of sleep per night. The 8- to 10-year-old child needs 10 to 12 hours of sleep per night. The 10- to 12-year-old child needs between 9 and 10 hours of sleep per night. Many younger children need a nap or to be provided with quiet time after school to recharge after a busy day in the classroom. Increasing the child's sleeping hours should be attempted before asking for medical intervention.

During a well-child visit, the mother of a preschooler tells the nurse that her daughter is "daddy's girl." She says, "It seems like I don't exist." Which response by the nurse would be most appropriate? "Did you do something to make your daughter angry with you?" "Why do you think she is doing this?" "This might be a problem because your daughter is obviously alienating you." "Your daughter is showing normal behavior for her age."

"Your daughter is showing normal behavior for her age."

The parents of a 7-year-old girl report concerns about her seemingly low self-esteem. The parents question how self-esteem is developed in a young girl. Which response by the nurse is best?

"Your daughter's self-esteem is influenced by feedback from people they view as authorities at this age." **Self-esteem is developed early in childhood. The feedback a child receives from those perceived in authority such as parents and educators impacts the child's sense of self-worth. As the child ages, the influence of peers and their treatment of the child begin to have an increasing influence on self-esteem.

Diaper Dermatitis: -What is it? - What would you document for assessment? - What is the best management of diaper dermatitis? - What education would the nurse provide?

- Inflammatory reaction of the skin in the diaper area - Ordinary diaper dermatitis does not usually result in a bumpy rash, but starts as a flat red rash in the convex skin creases - PREVENTION (barrier ointment) - change diapers frequently, avoid rubber pants!!!, avoid harsh soaps or fragranced wipes, allow infant to go diaperless if rash has already occurred, and blow dry the are on warm (NOT HOT) for 3-5 mins!!!

Seborrhea: - In the infant, what should be applied to the scalp and how?

- Mineral oil. Massage it well w/a washcloth and then shampoo 10-15 minutes later, using a brush to gently lift the crusts; do not forcibly remove the crusts.

Bacterial infections of the skin: Impetigo - Nonbullous - Bullous - What does the rash of impetigo look like?

- Nonbullous-follows skin trauma. Secondary bacterial infection. - Bullous-sporadic occurrence on intact skin from S. aureus. - honey colored crusting

Treatment for contact dermatitis:

- Wash lesions daily with mild soap and water - mildly debride crusted lesions - tepid baths!!! - Avoid hot baths or shower!!! - apply corticosteroid topicals but do not cover - weeping lesions may be wrapped lightly - Burow or domeboro solutions with dressing applied - OTC preparations such as calamine - Do not use topical antihistamines

Acne Vulgaris: Nursing Management

- avoid oil-based cosmetic products - Friction from hats and helmets could cause lesions - Dryness and peeling could result from treatment - Mild soap and water twice daily. -No picking. - Use sunscreen - May take 4-6 weeks to see results of meds - Isontretinoin causes fetal development defects - Watch for depression and may need counseling.

Bacterial Infections of the Skin: - What are the bacterial infection of the skin? - what are they often caused by?

- bullous and nonbullous impetigo, folliculitis, cellulitis, and staphylococcal scalded skin syndrome. - Staphylococcus aureus and group A beta-hemolytic streptococcus—which are normal flora on the skin.

Fungal Infections of the Skin: Tinea corporis - What is it? - What does it look like? - What should I know about medications?

- fungal infection on the arms or legs (ringworm) - Annular lesion with raised peripheral scaling and central clearing (looks like a ring) - topical antifungal cream is required for at least 4 weeks

Fungal Infections of the Skin: Tinea Pedis - What is it? - What does it look like?

- fungal infection on the feet (athletes foot) Dry the area between the toes good!! - Red, scaling rash on soles and between toes

Fungal Infections of the Skin: Tinea capitis - What is it? - What does it look like? - When does the hair grow back?

- fungal infection on the scalp, eyebrows, or eyelashes - patches of scaling in the scalp w/central hair loss - 3-12 months; Prevent infection

Fungal Infections of the Skin: Tinea versicolor - What is it? - What does it look like?

- fungal infection on the trunk and extremities - Hypopigmented scaly lesions; more noticeably in the summer

Bacterial infections of the skin: Folliculitis - What is it? - What medication is typically used?

- infection of the hair follicle, most often as a result from occlusion of the hair follicle. - topical mupirocin, occasionally a oral antibiotic is required!!!

Classification of burns: Partial thickness

- involve epidermis and portions of dermis; heal with minimal scarring in about 2 weeks - skin looks wet with significant pain

Classification of burns: Superficial

- involve only epidermal injury; heal without scarring in 4 to 5 days - skin looks reddened, dry, and slightly swollen

Classification of burns: Full thickness

- result in significant tissue damage and extend through epidermis, dermis, and hypodermis; extensive scarring results; significant time to heal needed; may also be termed "4th degree" - skin is very painful, numb in some areas, appear red, edematous, leathery, dry, or waxy!!!

Classification of burns: Deep partial thickness

- take longer to heal; may scar; result in changes in nail, hair, and sebaceous gland function; may require sugical interventions - look a lot like partial

Nursing Interventions for Children with Extensive Burns: preventing infection

- this is CRITICAL to success - if childs immunization status is unknown or if it has been longer than 5 years, administer tetanus shot

What type of burns are usually admitted to the unit?

-Electrical burns, including lightning injury -Chemical burns -Inhalation injury

Laboratory and Diagnostic Tests for Burns:

-Electrolytes and complete blood count -Eosinophils: elevated in children with allergies & atopic dermatitis -ESR-send to lab immediately -Culture of wound drainage-check sensitivities -Scanning for inhalation injury -Electrocardiographic monitoring for electrical injury -Potassium Hydroxide (KOH) prep -Patch or skin testing

Causes of Integumentary Disorders in Children

-Exposure to infectious microorganisms -Hypersensitivity reactions -Hormonal influences -Injuries

Signs and Symptoms of Erythema Multiforme?

-Fever -Malaise -Achiness (myalgia) -Rash (macules- flat reddened area -> papules-> plaques-> vesicles-> and target lesions) -Itchiness (pruritus) -Burning

Difference in Skin Between Children and Adults:

-Infant's epidermis is thinner and blood vessels are closer to the surface. -Infant loses heat more readily through skin surface. -Allows substances to be absorbed through skin quicker. -Infant's skin contains more water. -Epidermis is loosely bound to the dermis. -Friction may easily cause separation of layers, resulting in blistering or skin breakdown. -Infant's skin is less pigmented, therefore at risk for UV damage!!!

What other criteria will put you In the unit?

-Partial thickness burns greater than 10% of total body surface area -Burns that involve the face,hands and feet, genitalia, perineum, or major joints -Burn injury in children who have pre-existing conditions that might affect their care -Persons with burns and traumatic injuries -Persons who will require special social, emotional, or long-term rehabilitative care -Burned children in a hospital without qualified personnel or equipment for the care of children

Integumentary Disorders

-Range from mild and self-limited or chronic and managed consistently, to severe and even life-threatening (full-thickness burns) -Chronic or severe disorders can impact the child's physiologic or psychological status

Acne Vulgaris: 1. Age group? 2. location? 3. Risk factors? 4. Therapeutic management?

1. 12-16 years old 2. Face, chest, and back 3. preadolescent/adolescent, male gender, oily complexion, Cushing syndrome, other diseases that result in increased androgen production 4. cleanse skin twice daily.

Teaching Guidelines: Burn Prevention 1. Keep hot water temp lower that _____ 2. Bath water? 3. Cooking? 4. Hot liquids? 5. Fire drills?

1. 120 degrees F!!!! 2. test bath water 3. keep children away from open flames, stove, and keep pots turned inward 4. out of reach, avoid hot liquids while holding the child 5. practice fire drills, "stop, drop, and roll", and teach older children how to safely get out of the house

Nursing Interventions for Children with Extensive Burns: Promoting oxygenation and ventilation

1. AIRWAY!!! 2. Secure tracheal tube because as edema sets in, it becomes more diffictult to intubate 3. respiratory status warrents evaluation and reevalutation, as airway edema may not become evident until 2 days after burn 4. administer 100% O2 via nonrebreather mask or bag-valve-mask for every child with severe burns !!!! 5. May see a falsely high pulse oximetry reading due to high levels of carboxyhemoglobin as a result of smoke inhalation

Erythema Multiforme: 1. What is it? 2. How is this managed? 3. What is the most severe form of this?

1. Acute, self-limiting hypersensitivity reaction in response to virus, infection, drug, immunizations, food reaction. 2. supportive because it resolves on it's own. 3. Sevens-Johnson syndrome and toxic epidermal necrolysis

Contact Dermatitis: 1. What are the causes? 2. What are the complications? 3. Does it spread?

1. Causes: - Response to an antigenic substance exposure - Allergy to nickel or cobalt in clothing, hardware, or dyes - Exposure to highly allergenic plants: poison ivy, oak, and sumac—very itchy, may last 2-4 weeks—not contagious 2. Complications: - Secondary bacterial skin infection - Lichenification or hyperpigmentation 3. It does not spread person to person or to other parts of the body

Atopic Dermatitis: 1. What is it? 2. What is it caused by? 3. Explain the process: 4. Where is it most commonly seen in children >2 yrs? 5. Where is it most commonly seen in older children?

1. Chronic disorder characterized by extreme itching and inflamed, reddened, and swollen skin with relapse and remitting nature 2. Could be food, could be environmental 3. Very itchy> then the rash> scratching causes the rash to appear> Sweating makes rash worse. Humid and dry environment will make rash worse as well 4. face, scalp, wrists, extensor surfaces of arms/legs 5. flexor areas.

Seborrhea: 1. What is it? 2. Where can it appear? 3. How may it present in adolescents? 4. What is the therapeutic management?

1. Chronic inflammatory dermatitis (Skin or scalp) AKA "Cradle cap" 2. Eyebrows, behind ears, diaper area 3. Dandruff 4. corticosteroids or lotions, antidandruff shampoo

Psoriasis: 1. What is it? 2. How is it controlled? 3. What does the incidence depend on? 4. What does it look like? 5. Therapeutic management?

1. Chronic inflammatory skin disease with periods of remission and exacerbation 2. Control possible with conscientious therapy 3. Incidence depends on climate and genetics 4. silvery or yellow-like scale and sharply demarcated borders 5. exposure to sunlight, but take note not to allow the child to burn

Nursing Assessment for Urticaria: 1. hx? 2. Inspect 3. Assess?

1. Detailed history of new foods, medications, symptoms of recent infection, changes in environment, or unusual stress. 2. Inspect the skin for raised edematous hives on body or mucous membranes. 3. Assess airway and breathing as hypersensitivity may affect respiratory status.

Nursing Interventions for Children with Extensive Burns: Preventing hypothermia

1. Due to loss of protective dermis, risk for hypothermia. 2. Keep warm, warm IV fluids, monitor temp

Nursing Interventions for Children with Extensive Burns: Restoring and maintaining fluid volume

1. Fluid calculation base on BSA burned 2. Ringer lactate (crystalloid) in first 24 hours -detrose may be added for smaller children 3. Monitor strict I&O's 4. Daily weights @ same time each day 5. monitor electrolyte levels 6. Administer most of the fluid volume in the first 8 hours!!!

Nursing Management: 1. identify what? 2. Administer what? 3. When should the child be reevaluated? 4. What should be done if the reaction is severe? 5. What is given in an emergency situation When ABC's are compromised?

1. Identify and remove trigger; Discontinue abx 2. Antihistamine, Corticosteroids, Topical antipruritics 3. If it lasts up to 6 weeks 4. Child should wear a medical alert bracelet 5. subcutaneous epinephrine, then IV diphenhydramine and corticosteroids

Bacterial Infections of the Skin: Staphylococcal scalded skin syndrome 1. what does it result from? 2 How does it appear? 3. When is this most common? 4. What are the risks for getting CA-MRSA

1. Infection with S.aureus that produces a toxin which causes exfoliation 2. Abrupt onset which results in diffuse reddening of the skin and skin tenderness. 3. Most common in infancy and rare beyond 5 years of age CA-MRSA; also commonly occurs as a skin or soft tissue infection such as, cellulitis of abscess. 4. Turf burns, towel sharing, team sports, daycare, outdoor camps

Bacterial Infections of the Skin: Cellulitis 1. What is it? What does it usually proceed?

1. Localized infection and inflammation of skin and subcutaneous tissue(warmth of skin at skin disruption site!!); usually preceded by skin trauma

Nursing Interventions for Children with Extensive Burns: 1. Managing pain with ___ ____. 2. Treating ____ _____. 3. Providing burn _______.

1. Managing pain with atraumatic care 2. Treating infected burns 3. Providing burn rehabilitation

Nursing Interventions for Children with Extensive Burns: Cleansing the burn

1. Remove charred clothing to stop the burning 2. NO ICE!!! 3. Don't pop blisters 4. Debridement is sterile procedure 5. Pain management is of utmost importance

Urticaria: 1. What it is? 2. Onset? 3. duration? 4. What does histamine release lead to?

1. Type 1 hypersensitivity reaction (HIVES)!!! 2. Begins rapidly!!! 3. Disappears in a few days or may take 6-8 weeks 4. Vasodilation!!!

Acne: 1. What is it? 2. Is there treatment? 3. Where does it occur? 4. How is it resolved?

1. common skin condition occurring in childhood... Acne neonatorum-response to the presence of maternal androgens or to transient androgen production in the newborn 2. NO treatment 3. Cheeks, face, upper chest, back. 4. Acne will resolve on its own

What is stated in the iPLEDGE for isotretinoin?

1. must use 2 forms of contraceptives 2. must take a pregnancy test & obtain (-) result 3. cannot donate blood up to 1 month after treatment

Integumentary Descriptors: 1. Best lighting? 2. What type of rashes? 3. Linear rash? 4. Shape? 5. Morbilliform? 6. target lesions? 7 Note what about drainage?

1. natural daylight. 2. Macular, papular, pustular, vesicular 3. in a line (contact dermatitis.. such as poison ivey) 4. round, oval, annular (ring around a central clearing- such as wring worm) 5. a rosy maculopapular rash 6. Bull's eye 7. clear, purulent, honey-colored, etc.

Acne Neonatorum: 1. What is it? 2. tx? 3. teaching? 4. Will there be fever?

1. occurs as response to the presence of maternal hormones 2. No treatment, topical in severe cases to prevent scaring 3. do not pick or squeeze it, wash affected areas daily w/ clear water (avoid fragranced soaps or lotions) 4. NO fever

Atopic Dermatitis: 1. What subjective/objective data might the nurse document? 2. How could the nurse educate to promote skin hydration? 3. What should be included in education to prevent infection? 4. Lab test?

1. wiggling, scratching, dry scaly skin, vesicles, or papules, erythema or warmth, symptoms of allergic rhinitis, hypertrophy, and lichenification!!! 2. avoid hot water, fragranced products, bathe BID w/ warm water, slightly pat skin dry!!, apply prescribed ointment while skin is still moist from the shower, apply moisturizer multiple times a day!!!! 3. cut the child's fingernails and keep them clean, avoid tight clothing and heat, use 100% cotton sheets and pjs, give antihistamines 4. IgE will be elevated!!!

if a child is how mnay lbs or more they get the adult dose

100lbs

A 6- to 8-year-old child needs ___ hours of sleep per night.

12 **Many younger children need a nap or to be provided with quiet time after school to recharge after a busy day in the classroom. Increasing the child's sleeping hours should be attempted before asking for medical interventio

he number of hours of sleep required for growth and development decreases with age. Children between the ages of 6 and 8 years require approximately ____ hours of sleep per night.__________________________

12 (twelve)

Language skills continue to accelerate during the school-age years. Vocabulary expands to 8,000 to _______ words.

14000

A 13-year-old girl has grown rapidly in height over the past 2 years and is taller than most of the boys in her class. She wonders when she will stop growing. What should the nurse tell her as a general guideline for the ages at which most girls stop growing?

16 to 17 years old Explanation: Growth stops with closure of the epiphyseal lines of long bones which occurs at about 16 or 17 years of age in females and about 18 to 20 years of age in males.

tylenol after how many months of age

The nurse is conducting a well-child examination of a 4-year-old and is assessing the child's height. By how much should the nurse expect the child's height to have increased since last year's examination? 2.5 to 3 inches (6.35 to 7.62 cm) 1 to 2 inches (2.54 to 5.07 cm) 3.5 to 4 inches (8.89 to 10.16 cm) 0.5 to 1 inch (1.27 to 2.54 cm)

2.5 to 3 inches (6.35 to 7.62 cm)

The infant weighs 7 lbs. 4 oz. at birth. If the infant is following a normal pattern of growth, which of the following would be an expected weight for this child at the age of 12 months? a) 28 lbs. 4 oz. b) 25 lbs. c) 21 lbs. 12 oz. d) 14 lbs. 8 oz.

21 lbs. 12 oz.

The infant measures 21 ½ inches at birth. If the infant is following a normal pattern of growth, which of the following would be an expected height for this child at the age of six months? a) 30 ½ inches b) 27 ½ inches c) 29 inches d) 32 inches

27 ½ inches

The infant measured 20 inches at birth. If the infant is following a normal pattern of growth, which of the following ranges would be an expected height for this child at the age of 12 months? a) 36-38 inches b) 26-28 inches c) 30-32 inches d) 40-42 inches

30-32 inches

School-age children with an average body weight of 20 to 35 kg need approximately _____ calories per kilogram daily.

70 (seventy)

When weighing and measuring a child at her 1-year well-baby checkup, the nurse would expect to see that over the previous 6 months a baby who weighed 8 pounds and was 20 inches long at birth would have gained about a) 16 pounds and grown 4-6 inches b) 16 pounds and grown 2-3 inches c) 8 pounds and grown 4-6 inches d) 8 pounds and grown 2-3 inches

8 pounds and grown 4-6 inches

10. The nurse is caring for a child with widespread itching and has recommended bathing as a relief measure. After teaching the mother about this, which statement from the mother indicates a need for further instruction? A) "After bathing, I need to rub his skin everywhere to make sure he is completely dry." B) "I must make sure I use lukewarm water instead of hot water." C) "Oatmeal baths are helpful we can add Aveeno skin relief bath treatment." D)"We should leave his skin moist before applying medication or moisturizer."

17. The nurse is providing care to a child with folliculitis. Which of the following would the nurse expect to administer? A) Topical mupirocin B) Oral cephalosporin C) Intravenous oxacillin D) Topical Eucerin cream

The nurse contacts a child life specialist (CLS) to work with children on a pediatric ward. What is the primary goal of the CLS? A) Decrease anxiety and fear during hospitalization and painful procedures B) Keep children who are hospitalized distracted from pain C) Perform medical procedures using atraumatic principles D) Act as a liaison between the nurse and the child

The nurse is caring for a 14-year-old boy with an osteosarcoma. Which of the following communication techniques would be least effective for him? A) Letting him choose juice or soda to take pills B) Seeking the teenager's input on all decisions C) Discussing the benefits of chemotherapy with him D) Avoiding undue criticism of noncompliance

The nurse is implementing care for a hospitalized toddler. What communication technique would the nurse use with the child to reflect the child's developmental level? A) Allow the child extra time to complete thoughts. B) Communicate solely through play. C) Provide simple but honest and straightforward responses. D) Remain nonjudgmental to avoid alienation.

The nurse uses family-centered care to care for children in a pediatric office. Upon what concept is family-centered care based? A) The family is the constant in the child's life and the primary source of strength. B) The care provider is the constant in the child's life and the primary source of strength. C) The child must be prepared to be his or her own source of strength during times of crisis. D) The wishes of the family should direct the nursing care plan for the child.

A nurse observes a child engaged in parallel play in a nursery. What is an example of parallel play? Two boys playing cooperatively with stuffed animals, pretending that the toys are fighting each other A boy sitting beside a girl in the floor, each playing independently with a separate set of blocks A girl sitting by herself and alternating between playing with a doll for a time and then with a toy truck for a time A group of children playing hide and seek on the playground

A boy sitting beside a girl in the floor, each playing independently with a separate set of blocks All during the toddler period, children play beside children next to them, not with them. This side-by-side play (called parallel play) is not unfriendly but is a normal developmental sequence that occurs during the toddler period. The other answers are not examples of parallel play.

A hospitalized 7-year-old is recovering from a head injury. Occupational therapy has been ordered to assist the child in regaining eye/hand coordination. If the child cannot master this skill, what feelings may arise?

A feeling of inferiority Children who are unsuccessful in completing activities during the school-age phase, whether from physical, social, or cognitive disadvantages, develop a feeling of inferiority.

A nurse is caring for a hospitalized 7-year-old child whose family members have been unable to visit for 2 days. The nurse is preparing a diversional activity for the child. What activity would best be suited for a child in this age group?

A paint-by-numbers activity creating a picture Explanation: Between the ages of 6 and 8 years, children begin to enjoy participating in real-life activities, such as helping with gardening, housework, and other chores. They love making things, such as drawings, paintings, and craft projects. The child would need additional instruction to learn fractions, which may not be considered fun. A card game such as solitaire and a board game of monopoly may be too hard for the 7-year-old. In addition, the game of monopoly would require additional players.

The nurse is providing parental anticipatory guidance to promote healthy emotional development in a 12-month-old boy. Which statement best accomplishes this? Emotions of a 12-month-old are labile. He can move from calm to a temper tantrum rapidly. A regular routine and rituals will provide stability and security. A sense of control can be provided through offering limited choices. Aggressive behaviors such as hitting and biting are common in toddlers.

A regular routine and rituals will provide stability and security. Toddlers benefit most from routines and rituals that help them anticipate events and teach and reinforce expected behaviors. Knowing that a child can move from calm to temper tantrum very quickly, understanding the benefit of limited choices, and realizing that hitting and biting are common behaviors in toddlerhood provide information but not a guiding concept.

A 17-year-old female is meeting with the nurse for an annual well-visit and is asking the nurse questions about how to know when one is in love. The nurse should point out which factor to help decide if both individuals have reached a mutual agreement and are ready for an intimate relationship? A sense of trust and identity An understanding of socialization and of isolation An ability to be autonomous A willingness to take initiative

A sense of trust and identity

A sense of trust and identity Explanation: In order to be intimate or to share one's deepest feelings with another person, it is impossible unless both persons have established a sense of trust and a sense of identity. Being autonomous or taking initiative are not aspects that lead toward intimate relationships. Socialization and isolation are not relevant to the establishment of intimate relationships.

The nurse is helping the mother of a 5-month-old boy understand the importance of developmentally appropriate play. Which one of the toys best meets the needs of this child? a) A yellow rubber duck for the bath b) Brightly colored stacking toy c) Pots and pans from the kitchen cupboard d) A push-pull toy

A yellow rubber duck for the bath

After teaching a group of parents about language development in toddlers, what if stated by a member of the group indicates successful teaching? A)"When my 3-year-old asks 'why?' all the time, this is completely normal." B)"A 15-month-old should be able to point to his eyes when asked to do so." C)"At age 2 years, my son should be able to understand things like under or on." D)"An 18-month-old would most likely use words and gestures to communicate."

A) "When my 3-year-old asks 'why?' all the time, this is completely normal." Feedback: Language development occurs rapidly in a toddler. By age 3 years, the child asks "why?" Pointing to named body parts is characteristic of a 2-year-old. Understanding concepts such as on, under, or in is typical of a 3-year-old. A 1-year-old would communicate with words and gestures.

The nurse is interviewing a 3-year-old girl who tells the nurse: 'Want go potty.' The parents tell the nurse that their daughter often speaks in this type of broken speech. What would be the nurse's appropriate response to this concern? A)'This is a normal, common speech pattern in the 3-year-old and is called telegraphic speech.' B)'This is considered a developmental delay in the 3-year-old and we should consult a speech therapist.' C)'This is a condition known as echolalia and can be corrected if you work with your daughter on language skills.' D)'This is a condition known as stuttering and it is a normal pattern of speech development in the toddler.'

A) 'This is a normal, common speech pattern in the 3-year-old and is called telegraphic speech.' Feedback: Telegraphic speech is common in the 3-year-old. Telegraphic speech refers to speech that contains only the essential words to get the point across, much like a telegram. In telegraphic speech the nouns and verbs are present and are verbalized in the appropriate order. Echolalia (repetition of words and phrases without understanding) normally occurs in toddlers younger than 30 months of age. "Why" and "what" questions dominate the older toddler's language. Stuttering usually has its onset at between 2 and 4 years of age. It occurs more often in boys than in girls. About 75% of all cases of stuttering resolve within 1 to 2 years after they start.

The nurse is describing the maturation of various organ systems during toddlerhood to the parents. What would the nurse correctly include in this description? A)Myelinization of the brain and spinal cord is complete at about 24 months. B)Alveoli reach adult numbers by 3 years of age. C)Urine output in a toddler typically averages approximately 30 mL/hour. D)Toddlers typically have strong abdominal muscles by the age of 2.

A) Myelinization of the brain and spinal cord is complete at about 24 months.

The nurse is teaching the parents of an overweight 18-month-old girl about diet. Which intervention will be most effective for promoting proportionate growth? A)Remove high-calorie, low-nutrient foods from the diet. B)Ensure 30 minutes of unstructured activity per day. C)Avoid sharing your snacks and candy with the child. D)Reduce the amount of high-fat food the child eats.

A) Remove high-calorie, low-nutrient foods from the diet. Feedback: The most effective intervention will be to remove high-calorie, low-nutrient foods from the diet in order to reduce the number of calories and increase the nutritional value. Exercise is also important, but a child this age should have 30 minutes of structured physical activity plus several hours of unstructured physical activity per day. The parents should set an example for good eating habits. Dietary fat should not be restricted for an 18-month-old child because it is necessary for nervous system development.

The parents of a 1-year-old girl, both of whom have perfect teeth, are concerned about their child getting dental caries. Which is the best advice the nurse can provide? A)Tell the parents to limit the child's eating to meal and snack times. B)Urge the parents to take the child to a dentist for a check-up. C)Advise the parents to reduce carbohydrates in the child's diet. D)Advise the parents to use fluoride toothpaste.

A) Tell the parents to limit the child's eating to meal and snack times. Feedback: Telling the parents to limit eating to meal and snack times is the best advice for preventing dental caries. This reduces the amount of exposure the child's teeth have to food. Urging them to take the child to see a dentist is sound advice but doesn't suggest actions they can take now to prevent caries. Carbohydrates react with oral bacteria to cause caries, but they should not be reduced from the diet. Avoiding fluoridated toothpaste may help prevent fluorosis.

The nurse is watching toddlers at play. Which normal behavior would the nurse observe? A)Toddlers engage in parallel play. B)Toddlers engage in solitary play. C)Toddlers engage in cooperative play. D)Toddlers do not engage in play outside the home.

A) Toddlers engage in parallel play. Feedback: Toddlers typically play alongside another child (parallel play) rather than cooperatively. Infants engage in solitary play.

The most important safety precaution for parents to teach preschoolers is: A) not to ride in a car with strangers. B) not to begin formal dance classes. C) to chew bites of food three times. D) not to watch their father mow the lawn.

A) not to ride in a car with strangers. Preschoolers begin to spend more time away from parents than formerly as they begin preschool. That makes it a time to learn about people and traffic safety.

19. A group of students are preparing for a class exam on skin disorders. As part of their preparation, they are reviewing information about acne vulgaris and its association with increased sebum production. The students demonstrate understanding of the information when they identify which areas as having the highest sebaceous gland activity? Select all answers that apply. A) Face B) Upper chest C) Neck D) Back E) Shoulders

A, B, D

what is the nurses role in pharmacologic pain management?

Adhering to the rights of medication administration Knowledge about the drug's pharmacokinetics and pharmacodynamics Assessment is crucial and ongoing -Monitor physiologic parameters -level of consciousness -vital signs -oxygen saturation levels -urinary output -monitor for signs of adverse effects (respiratory depression) Assess the child's and parents' emotional status Teach the child and parent's about the drug

A nurse is explaining cognitive development in children to a client, with the help of Piaget's theory of cognitive development. What would be the best explanation by the nurse about the formal operations level of cognitive development? Children from ages 2 to 7 years investigate and explore the environment and look at things from their own point of view. After age 12 children can think in the abstract, including complex problem solving. From ages 7 to 11 years, children internalize actions and can perform them in the mind. Up to age 2, children learn by touching, tasting, and feeling. They learn to control body movement.

After age 12 children can think in the abstract, including complex problem solving.

what factors influence pain?

Age Gender Cognitive level Temperament Previous pain experiences Family and cultural background Situational factors -some kids think pain=having to get a shot but thats not the case

A 15-year-old is hospitalized for acute appendicitis. Which activities would the nurse include in the client's plan of care? Select all that apply. Include the parents when educating the client. Have the nurse control the patient's care as much as possible. Arrange care to provide for extra rest and sleep. Allow friends to visit during visiting hours. Keep the client in hospital gowns for sanitary reasons.

Allow friends to visit during visiting hours. Include the parents when educating the client. Arrange care to provide for extra rest and sleep.

A 15-year-old is hospitalized for acute appendicitis. Which activities would the nurse include in the client's plan of care? Select all that apply. Keep the client in hospital gowns for sanitary reasons. Include the parents when educating the client. Allow friends to visit during visiting hours. Arrange care to provide for extra rest and sleep. Have the nurse control the patient's care as much as possible.

Allow friends to visit during visiting hours. Include the parents when educating the client. Arrange care to provide for extra rest and sleep.

A chronically ill adolescent is readmitted to the hospital with an infected wound requiring long-term dressing changes. What is the best way the nurse can encourage independence for this client? Have the school provide homework. Have the adolescent go to the teen room every day. Allow the adolescent to choose the time for the dressing change. Teach the parents to perform dressing changes at home.

Allow the adolescent to choose the time for the dressing change.

A 3-year-old is hospitalized unexpectedly and is frightened about the experience. What action could the nurse take to minimize the anxiety the child is experiencing? Allow the child to handle the equipment before it is used on the child. Provide all of the child's care, including all ADLs. Tell the child that everything will be fine and not to worry. Insist that the parents stay with the child at all times.

Allow the child to handle the equipment before it is used on the child.

The nurse is caring for a 5-year-old who has been hospitalized after an episode of asthma. As the nurse prepares to teach the child how to use the nebulizer, which action should the nurse prioritize? Use a poster or brochure to illustrate to the child how the machine works. Show the child how to use the nebulizer and tell the child how much easier it is to breathe afterward. Allow the child to touch and play with the nebulizer for a few minutes before the treatment. Explain that the child will feel better after the treatment and allow the child to ask questions.

Allow the child to touch and play with the nebulizer for a few minutes before the treatment.

A parent is concerned about nutrition for her school-age child, voicing questions on how to encourage a healthy diet. The nurse would recommend which action? Select all that apply.

Allow the child to voice food dislikes and respect them. Limit fat intake to no more than 35% of total calories to help control weight.

parent is concerned about nutrition for her school-age child, voicing questions on how to encourage a healthy diet. The nurse would recommend which action? Select all that apply.

Allow the child to voice food dislikes and respect them. Limit fat intake to no more than 35% of total calories to help control weight. Explanation: Parents are encouraged to offer healthy foods to children, allow them to choose their foods and not encourage frequent snacking, especially with non-nutritious foods. Fat intake needs to be limited to less than 35% of the total daily calories to avoid obesity. Forcing a child to "clean his or her plate" is not a good idea either, since it forces the child to eat more than they often want to eat. Eating fast food more than twice a week is discouraged because fast food contributes to obesity.

Parents say they have been using measures to lessen the struggle of getting their preschooler to bed at night and to sleep. Which practice will the nurse suggest they discontinue?

Allowing the preschooler to fall asleep wherever and whenever the child is tired enough

The school nurse is assessing a 16-year-old girl who was removed from class because of disruptive behavior. She arrives in the nurse's office with dilated pupils and is talking rapidly. Which drug might she be using? Opiates Marijuana Barbiturates Amphetamines

Amphetamines

What is the correct amount of urine diapers a mature infant should have each day? a) An infant should have 3 to 5 wet diapers/day. b) An infant should have 6 to 8 wet diapers/day. c) An infant should have 1 to 2 wet diapers/day. d) An infant should have 9 to 10 wet diapers/day.

An infant should have 6 to 8 wet diapers/day.

medications used for pain management?

Analgesics -Nonopioid and opioids Adjuvant -Benzodiazepines -Anticonvulsants Anesthetics Preferred routes -Oral, rectal, intravenous, topical, or local nerve block routes -Epidural administration and moderate sedation also can be used

7.The nurse uses family-centered care to provide care for children in a pediatric office. Upon what concept is family-centered care based? A) The family is the constant in the child's life and the primary source of strength. B) The care provider is the constant in the child's life and the primary source of strength. C) The child must be prepared to be his or her own source of strength during times of crisis. D) The wishes of the family should direct the nursing care plan for the child.

Ans: A Feedback: Family-centered care involves a partnership between the child, family, and healthcare providers in planning, providing, and evaluating care. Family-centered care enhances parents' and caregivers' confidence in their own skills and also prepares children and young adults for assuming responsibility for their own healthcare needs. It is based on the concept that the family is the constant in the child's life and the primary source of strength and support for the child.

12.The nurse is caring for a 14-year-old boy with an osteosarcoma. Which communication technique would be least effective for him? A) Letting him choose juice or soda to take pills B) Seeking the teenager's input on all decisions C) Discussing the benefits of chemotherapy with him D) Avoiding undue criticism of noncompliance

Ans: A Feedback: Letting the child choose juice or soda to take pills is the least effective communication technique for an adolescent. It may provide some sense of control, but is not as effective as seeking his input on all care decisions, including him during discussions of the benefits of chemotherapy, and avoiding undue criticism of noncompliance.

Origin: Chapter 14, 3 The nurse is caring for a child who is recovering from an appendectomy. What is the appropriate term for the pain this child is experiencing? A) Nociceptive pain B) Neuropathic pain C) Chronic pain D) Superficial somatic pain

Ans: A Feedback: Nociceptive pain reflects pain due to noxious stimuli that damages normal tissues or has the potential to do so if the pain is prolonged. Nociceptive pain ranges from sharp or burning; to dull, aching, or cramping; to deep aching or sharp stabbing. Examples of conditions that result in nociceptive pain include chemical burns, sunburn, cuts, appendicitis, and bladder distention. Neuropathic pain is pain due to malfunctioning of the peripheral or central nervous system. Chronic pain is defined as pain that continues past the expected point of healing for injured tissue. Superficial somatic pain, often called cutaneous pain, involves stimulation of nociceptors in the skin, subcutaneous tissue, or mucous membranes.

Origin: Chapter 14, 18 For which child would nonopioid analgesics be recommended? A) A child with juvenile arthritis B) A child with end-stage cancer C) A child with a broken arm D) A child with severe postoperative pain

Ans: A Feedback: Nonopioid analgesics may be used to treat mild to moderate pain, often for conditions such as arthritis; joint, bone, and muscle pain; headache; dental pain; and menstrual pain. Opioid analgesics are typically used for moderate to severe pain as can occur with cancer, broken bones, and postoperative healing.

Origin: Chapter 14, 22 The nurse is preparing to administer a topical anesthetic for a 10-year-old girl with a chin laceration. The nurse would expect to apply what as ordered in preparation for sutures? A) TAC (tetracaine, epinephrine, cocaine) B) Iontophoretic lidocaine C) EMLA D) Vapocoolant spray

Ans: A Feedback: TAC (tetracaine, epinephrine, cocaine) is commonly used for lacerations that require suturing. The agent can be applied directly to the wound with a cotton ball or swab for 20 to 30 minutes until the area is numb. EMLA and iontophoretic lidocaine are applied to intact skin, not to open wounds or lacerations. A vapocoolant spray, which should not be applied over a wound, is only effective for 1 to 2 minutes.

4.The nurse contacts a child life specialist (CLS) to work with children on a pediatric ward. What is the primary goal of the CLS? A) Decrease anxiety and fear during hospitalization and painful procedure. B) Keep children who are hospitalized distracted from pain. C) Perform medical procedures using atraumatic principles. D) Act as a liaison between the nurse and the child.

Ans: A Feedback: The CLS is a specially trained individual who provides programs that prepare children for hospitalization, surgery, and other procedures that could be painful (Child Life Council, 2010a, 2010b). The goal of the CLS is to decrease the anxiety and fear while improving and encouraging understanding and cooperation of the child. The CLS may use distraction techniques and act as a liaison, but that is not the primary goal of the CLS role. The CLS does not perform medical procedures.

Origin: Chapter 14, 13 The nurse is assessing the pain of a postoperative newborn. The nurse measures the infant's facial expression, body movement, sleep, verbal or vocal ability, consolability, and response to movements and touch. Which behavioral assessment tool is being used by the nurse? A) Riley Infant Pain Scale B) Pain Observation Scale for Young Children C) CRIES Scale for Neonatal Postoperative Pain Assessment D) FLACC Behavioral Scale for Postoperative Pain in Young Children

Ans: A Feedback: The Riley Infant Pain Scale measures six parameters: facial expression, body movement, sleep, verbal or vocal ability, consolability, and response to movements and touch. The Pain Observation Scale for Young Children (POCIS) measures seven parameters: facial expression, cry, breathing, torso, arms and fingers, legs and toes, and state of arousal. The CRIES tool assesses five parameters: cry, oxygen required for saturation levels less than 95%, increased vital signs, facial expression, and sleeplessness. The FLACC tool measures five parameters: facial expression, legs, activity, cry, and consolability.

16.The nurse is enlisting the parents' assistance for therapeutic hugging prior to an otoscopic examination. What should the nurse emphasize to the parents? A) "You will need to keep his hands down and his head still." B) "If this does not work, we will have to apply restraints." C) "If you are not capable of this, let me know so I can get some assistance." D) "I may need you to leave the room if your son will not remain still."

Ans: A Feedback: The nurse needs to provide a specific explanation of the parents' role and what body parts to hold still in a safe manner. Implying that the parents may not be capable or may have to leave the room is inappropriate. Telling the parents that restraints may be required is not helpful, does not teach, and may be perceived as a threat.

Origin: Chapter 14, 25 The nurse is providing teaching to the parents of a newborn prior to a heelstick. The nurse is describing the procedure and recommending various methods for the parents to help comfort their baby. Which statement by the parents indicates a need for further teaching? A) "It's better if we are not in the room for this." B) "We can use kangaroo care before and after." C) "We hope you are using a very tiny needle." D) "We can offer him nonnutritive sucking to calm him."

Ans: A Feedback: Unless contraindicated, the parents should be encouraged to be present before, during, and after the procedure to provide comforting support to the child. Kangaroo care, small-gauge needles, and nonnutritive sucking are other methods to provide atraumatic care.

10.The nurse is implementing care for a hospitalized toddler. What communication technique would the nurse use with the child to reflect the child's developmental level? A) Allow the child extra time to complete thoughts. B) Communicate solely through play. C) Provide simple but honest and straightforward responses. D) Remain nonjudgmental to avoid alienation.

Ans: A Feedback: When working with toddlers and preschoolers, the nurse should allow them time to complete their thoughts. Though language acquisition at this age is exponential, it often takes longer for the young child to find the right words, particularly in response to a query. Infants communicate nonverbally and often through play. School-age children need simple but honest and straightforward responses, and nurses should be nonjudgmental with adolescents to avoid alienating them and to keep lines of communication open.

22. A nurse is providing care for a child hospitalized with a diagnosis of aplastic anemia. In planning the child's care, which intervention(s) will assist the child in adapting to being hospitalized? Select all that apply. A) Provide opportunities for the parents to participate in the child's care. B) Encourage the parents to bring personal items to make the child feel more at home. C) Make the child's room off limits to invasive procedures. D) Discuss the plan of care out of earshot of the child. E) Answer any questions the child may have in generalized terms.

Ans: A, B, C Feedback: Atraumatic care is important to a child's well-being during hospitalization. Examples of this include providing opportunities for the parents and the child to participate in care, encouraging parents to bring personal items, and maintaining the child's room as a safe place, off limits to invasive procedures. It is important to be honest with the child and include the child in all plan of care discussions.

23. A nurse is assisting the health care provider with suturing a laceration on a preschooler's leg. What distraction methods can the nurse perform to promote atraumatic care? Select all that apply. A) Ask the child to squeeze the nurse's hand. B) Sing a song and have the child sing along. C) Have the child blow bubbles. D) Allow the child to play with surgical instruments. E) Let the child suture a doll.

Ans: A, B, C Feedback: Distraction methods for preschoolers include asking the child to squeeze the nurse's hand, encouraging the child to count aloud, singing a song and having the child sing along, pointing out any pictures on the ceiling, having the child blow bubbles, and playing music appealing to the child. Suturing a doll or playing with surgical instruments would be activities better suited for school-age children.

1.The nurse is providing atraumatic care to children in a hospital setting. What are principles of this philosophy of care? Select all that apply. A) Avoid or reduce painful procedures. B) Avoid or reduce physical distress. C) Minimize parent-child interactions. D) Provide child-centered care. E) Minimize child control. F) Use core primary nursing.

Ans: A, B, F Feedback: When using atraumatic care, the nurse would avoid or reduce painful procedures, avoid or reduce physical distress, use core primary nursing, maximize parent-child interactions, provide family-centered care, and provide opportunities for control, such as participating in care, attempting to normalize daily schedule, and providing direct suggestions.

17.The nurse is preparing to perform a dressing change on a 13-year-old client who is being treated for burns he received 2 weeks ago. The client prefers not to take pain medication before the dressing change because it causes drowsiness. What nursing interventions would provide atraumatic care? Select all that apply. A) The nurse asks the client if he would like the television on during the dressing change. B) The nurse asks the client if a small group of nursing students can observe the dressing change. C) The nurse encourages the client to wear headphones to listen to music during the dressing change. D) The nurse encourages the parent to talk to the child about taking pain medication prior to the procedure. E) The nurse tells the client that the dressing change will not be performed unless pain medication is taken.

Ans: A, C Feedback: Minimizing stress prior to and during a procedure helps provide atraumatic care. Since the child chooses to not take pain medication, watching television or using headphones during the procedure provides distraction to the discomfort of the procedure. Students observing does not provide distraction. The child has chosen for the last 2 weeks to not receive pain medication, so having the parent talk to the child again does not provide atraumatic care. The nurse cannot force the child to take pain medication.

Origin: Chapter 14, 2 The nurse is managing children who have chronic diseases in a neighborhood clinic. What are some examples of chronic conditions? Select all that apply. A) Diabetes mellitus B) Myocardial infarction C) Rheumatoid arthritis D) Compound fracture E) Acute asthma F) Bronchopneumonia

Ans: A, C, E Feedback: Chronic pain is defined as pain that continues past the expected point of healing for injured tissue. Diabetes, arthritis, and asthma are examples of chronic pain. Acute pain is defined as pain that is associated with a rapid onset of varying intensity. It usually indicates tissue damage and resolves with healing of the injury. Examples include heart attack, fractures, and bronchopneumonia.

Origin: Chapter 14, 6 The nurse caring for infants in the neonatal intensive care unit (NICU) relies on the use of behavioral and physiologic indicators for determining pain. Which examples are behavioral indicators? Select all that apply. A) The infant grimaces. B) The infant's heart rate is elevated. C) The infant flails his arms and legs. D) The infant's respiratory rate is elevated. E) The infant is crying uncontrollably. F) The infant's oxygen saturation is low.

Ans: A, C, E Feedback: In preterm and term newborns, behavioral and physiologic indicators are used for determining pain. Behavioral indicators include facial expression, body movements, and crying. Physiologic indicators include changes in heart rate, respiratory rate, blood pressure, oxygen saturation levels, vagal tone, palmar sweating, and plasma cortisol or catecholamine levels.

Origin: Chapter 14, 10 When the nurse is assessing a child's pain, which is most important? A) Obtaining a pain rating from the child with each assessment B) Using the same tool to assess the child's pain each time C) Documenting the child's pain assessment D) Asking the parents about the child's pain tolerance

Ans: B Feedback: Although obtaining a pain rating, documenting the assessment, and asking the child's parents about the pain are important, the most important aspect of pain assessment is to use the same tool each time so that appropriate comparisons can be made and effective interventions can be planned and implemented. Consistency allows the most accurate assessment of the child's pain.

Origin: Chapter 14, 23 The nurse is caring for a child who reports chronic pain. What is the priority nursing assessment? A) How the pain impacts the child's and family's stress level B) The pain's history, onset, intensity, duration, and location C) The child's and parents' feeling of anxiety and depression D) The child's cognitive level and emotional response

Ans: B Feedback: Assessment of the child's pain is key; it is the priority assessment and is the only answer that focuses on the child's physiologic need. Assessment of how the pain impacts the child's and family's stress, feelings of anxiety, hopelessness, and depression, as well as the child's cognitive level and emotional response, are secondary after the pain is explored.

Origin: Chapter 14, 14 The nurse tells a joke to a 12-year-old to distract him from a painful procedure. What pain management technique is the nurse using? A) Relaxation B) Distraction C) Imagery D) Thought stopping

Ans: B Feedback: Distraction involves having the child focus on another stimulus, thereby attempting to shield him from pain. Humor has been demonstrated to be an effective distracting technique for pain management.

Origin: Chapter 14, 28 The nurse is explaining the effects of heat application for pain relief. Which effect would the nurse be likely to include? A) Decreased blood flow to the area B) Increased pressure on nociceptive fibers C) Possible release of endogenous opioids D) Altered capillary permeability

Ans: B Feedback: Heat causes an increase in blood flow. This alters capillary permeability, leading to a reduction in swelling and pressure on nociceptive fibers. Heat also may trigger the release of endogenous opioids, which mediate the pain response.

19.The nurse is caring for a child who is scheduled to begin chemotherapy. When planning education for the parents, what action by the nurse is most correct? A) Obtain a large classroom to allow the nurse to stand at the front and present information. B) Obtain a small conference room and arrange the chairs in a circle for both the nurse and family members to sit. C) Provide written information to the family and allow them to review it, with instructions to contact the nurse if there are additional questions. D) Provide a video of information to the family, with instructions to contact the nurse if there are additional questions.

Ans: B Feedback: Teaching is an important function of the nurse. When providing education, it is important to offer the information in an environment that is conducive to learning. A circular set of chairs will allow the nurse to face the parents during the exchange. A large class that has the nurse standing and the parents sitting does not provide the ability for a personal interaction needed for this session. Giving the parents information in writing should be done in conjunction with a face-to-face teaching session. Video information may be beneficial but does not replace the face-to-face teaching session.

21. A nurse is preparing to start an intravenous (IV) line in a child with severe pneumonia. The nervous child asks the nurse to wait until later to do the procedure. How should the nurse proceed? A) Inform the child that the procedure will have to happen immediately. B) Explain to the child why the IV is needed and find creative games to utilize while inserting the IV. C) Call the health care provider to see if the medication can be given in liquid form by mouth. D) Ask the parent to hold the child down so that the procedure can be completed.

Ans: B Feedback: When a procedure is necessary the nurse should use a firm, positive, and confident approach that provides the child with a sense of security. The child should be allowed to express feelings of anger, anxiety, fear or frustration but also know the procedure is necessary. In atraumatic care, the nurse should use a topical anesthetic at the IV site prior to the IV insertion to minimize pain. The parents should not be used as a restraint. This causes severe anxiety for the parent and the child. If an IV is prescribed to be placed, then most likely IV medications will be needed. Just because the child does not want the IV, the child should not be allowed to dictate care.

6.The child life specialist (CLS) is preparing a 6-year-old child for a magnetic resonance imaging (MRI) scan. Which statement reflects the use of atraumatic principles when explaining the procedure? A) "You will be taken to a magnetic resonance imaging machine for an x-ray of your liver." B) "You may hear some loud noises when you are lying in the machine, but they won't hurt you." C) "You have nothing to worry about; the MRI machine is safe and will not cause you any pain." D) "Let's just get you to the x-ray department for your test and you'll see how simple it is."

Ans: B Feedback: When using atraumatic principles, the CLS would explain any sensations, such as noises that will be experienced. The language should be simple and at the child's developmental age; using the technical term for the machine might frighten the child. Telling the child there is nothing to worry about does not allay the child's fears. Allowing the child to experience the machine without explaining the sensations does not follow atraumatic principles.

20.The nurse is caring for a teen who will be hospitalized for physical rehabilitation for an extended period of time after an auto accident. When working to promote a good working relationship with the teen, what action by the nurse will be most beneficial? A) Allow the teen to control the daily schedule. B) Keep your word with regard to promises and statements made to the teen. C) Allow the teen to make decisions about the plan of care. D) Include the teen in the weekly interdisciplinary care conferences

Ans: B Feedback: When working with teens, the establishment of trust and rapport is of the highest priority. Establishing trust can best be done by demonstrating consistency and keeping promises made to the teen. Control of the daily schedule may not be feasible. The teen can be allowed to have an impact on some elements of the plan of care but this does not have a greater importance than the establishment of trust. The teen may be able to attend care conferences, but this is not of the highest priority.

18.The nurse is admitting a 7-year-old child to the medical-surgical unit. The child answers questions with very short answers, makes little eye contact with the nurse, and looks to the parent to answer most questions. Which interventions would be appropriate during this admission assessment? Select all that apply. A) Tell the child that you are going to be their nurse so it would be best if they answered your questions. B) When asking questions, look at the child as well as the parent. C) Sit at the child's eye level during the admission questioning process. D) Stop asking questions for the present time and return later when the child feels more comfortable. E) Ask the child if they are always nervous around new people.

Ans: B, C Feedback: The goal is to establish rapport with the client and encourage communication. It is common for young children to be shy, so it is acceptable for the nurse to ask both the child and parent questions until the child feels comfortable talking with the nurse. Sitting at eye level is less intimidating and may help in establishing a trusting relationship. Telling the child that they need to answer the questions appears as condemning the child's behavior. Admission questions are important and can't be delayed until a later time. Asking the child if they are nervous around new people is intimidating and may further block communication.

The nurse is teaching the student nurse the physiology involved in pain transmission. Which statements accurately describes a physiologic event in the nervous system related to pain transmission? Select all that apply. A) Thermal stimulation may involve the release of mediators, such as histamine, prostaglandins, leukotrienes, or bradykinin. B) When nociceptors are activated by noxious stimuli, the stimuli are converted to electrical impulses that are relayed to the spinal cord and brain. C) Myelinated A-delta fibers are large fibers that conduct the impulse at very rapid rates; unmyelinated small C fibers transmit the impulse slowly. D) Once in the dorsal horn of the spinal cord, the nerve fibers divide and then cross to the opposite side and rise upward to the thalamus. E) The point at which the person first feels the highest intensity of the painful stimulus is termed the pain threshold. F) Peripheral sensitization allows the nerve fibers to react to a stimulus that is of lower intensity than would be needed to cause pain.

Ans: B, C, D, F Feedback: When nociceptors are activated by noxious stimuli, the stimuli are converted to electrical impulses that are relayed along the peripheral nerves to the spinal cord and brain. Myelinated A-delta fibers are large fibers that conduct the impulse at very rapid rates; unmyelinated small C fibers transmit the impulse slowly. Once in the dorsal horn of the spinal cord, the nerve fibers divide and then cross to the opposite side and rise upward to the thalamus. Peripheral sensitization allows the nerve fibers to react to a stimulus that is of lower intensity than would be needed to cause pain. Chemical stimulation may involve the release of mediators, such as histamine, prostaglandins, leukotrienes, or bradykinin. The point at which the person first feels the lowest intensity of the painful stimulus is termed the pain threshold.

8.The nurse knows that effective communication with children and their parents is critical to providing atraumatic quality nursing care. Which statement accurately describes the communication patterns of children? A) Communication patterns are similar from one child to the next. B) Children often use more words than adults to describe their fears. C) Children rely more on nonverbal communication and silence. D) Parents more often require affective communication rather than neutral communication.

Ans: C Feedback: Children often use fewer words than adults and may rely more on nonverbal communication and silence. Communication patterns can vary greatly from one child to the next. Some children are very talkative, while others are quiet. Parents more often require neutral communication (i.e., verbal communication that is related to assessing and solving problems), whereas children more often desire affective communication (establishment of rapport and trust, giving comfort).

Origin: Chapter 14, 5 The nurse is caring for a child who is experiencing pain related to chemotherapy treatment. What is a behavioral factor that might affect the child's pain experience? A) Knowledge of the therapy B) Fear about the outcome of therapy C) Participation in normal routine activities D) Ability to identify pain triggers

Ans: C Feedback: Participation in normal routine activities is a behavior factor. Knowledge of the therapy and ability to identify pain triggers are cognitive factors. Fear about the outcome of therapy is an emotional factor. Situational factors involve factors or elements that interact with the child and his or her current situation involving the experience of pain.

Origin: Chapter 14, 7 A nurse is providing teaching to the mother of an adolescent girl about how to manage menstrual pain nonpharmacologically. Which statements by the mother indicates a need for further teaching? A) "I need to help her learn techniques to distract her; card games, for example." B) "I need to be able to identify the subtle ways she shows pain." C) "I need to follow these instructions exactly for them to work properly." D) "I need to encourage her to practice and utilize these techniques."

Ans: C Feedback: The mother does not need to follow the instructions exactly; she needs to review the methods and modify them in a way that works best for her daughter. The other statements are correct.

3.The nurse is implementing interventions to prevent physical stressors for a 9-year-old child receiving chemotherapy in the hospital. How will the nurse provide atraumatic care for this child? A) Use restraint or "holding down" of the child during the procedure to prevent injury. B) Have the parent stand near and/or rub the child's feet during the procedure. C) Insert a saline lock if the child will require multiple doses of parenteral medications. D) Avoid using numbing techniques for multiple blood draws or IV insertion.

Ans: C Feedback: The nurse should insert a saline lock if the child will require multiple doses of parenteral medications. During painful or invasive procedures, the nurse should avoid traditional restraint or "holding down" of the child and use alternative positioning such as "therapeutic hugging." If therapeutic hugging is not an option, the nurse could have the parent stand near the child's head, not his feet to provide visual and verbal comfort. The nurse should also use numbing techniques for blood draws or IV insertion.

Origin: Chapter 14, 17 The nurse is teaching an 8-year-old child and his family how to manage cancer pain using nonpharmacologic methods. Which parent statement signifies successful child teaching? A) 'I will avoid using descriptive words like pinching, pulling, or heat.' B) 'I will not use positive reinforcement until the technique is perfected.' C) 'I will begin using the technique before he experiences pain.' D) 'I will be honest and tell him that the procedure will hurt a lot.'

Ans: C Feedback: The parents should begin using the technique chosen before the child experiences pain or when the child first indicates he is anxious about, or beginning to experience, pain. The parents should use descriptive terms like pushing, pulling, pinching, or heat and avoid overly descriptive or judgmental statements such as, "This will really hurt a lot" or "This will be terrible." They should offer praise, positive reinforcement, hugs, and support for using the technique even when it was not effective.

13.The nurse is educating a 16-year-old girl who has just been diagnosed with acute myelogenous leukemia. Which statement best demonstrates therapeutic communication? A) Discussing the treatment plan in detail for the next few weeks B) Using medical terms when describing the disease C) Assessing the adolescent's emotional status in private D) Talking about clothing and the stores where she shops

Ans: C Feedback: Therapeutic communication is goal directed and purposeful. Assessing the child's emotional status in private is goal directed and purposeful. Talking about clothing and shopping is not therapeutic communication unless its purpose is to find head coverings or wigs to mask hair loss and that information was not presented. Discussing the treatment plan for the next few weeks in detail is too much information for someone who has just been diagnosed. Using medical terms when describing the disease does not promote understanding.

5.The nurse is preparing a child and his family for a lumbar puncture. Which would be a primary intervention instituted to keep the child safe? A) Distraction methods B) Stimulation methods C) Therapeutic hugging D) Therapeutic touch

Ans: C Feedback: Therapeutic hugging (a holding position that promotes close physical contact between the child and a parent or caregiver) may be used for certain procedures or treatments where the child must remain still. Alternatively, distraction or stimulation (such as with a toy) can help to gain the child's cooperation, but therapeutic hugging would be used to keep the child safe during the procedure. Therapeutic touch is an energy therapy used to promote healing and decrease anxiety and stress and is not related to safety.

9.The nurse is teaching the student nurse how to communicate effectively with children. Which method would the nurse recommend? A) Position self above the child's level to denote authority. B) If possible, communicate with the child apart from the parent. C) Direct questions and explanations to the child. D) Use the medical terms for body parts and medical care.

Ans: C Feedback: To communicate effectively with children, the nurse should direct questions and explanations to the child; position self at the child's level; allow the child to remain near the parent if needed, so the child can remain comfortable and relaxed; and use the child's or family's terms for body parts and medical care when possible.

14.The nurse is performing a cultural assessment of an Asian family that has a child hospitalized for leukemia. What is the best technique for providing culturally competent care for this family? A) Research the culture and base care on findings. B) Ask other Asians to explain their culture. C) Just ask the family about their culture and listen. D) Hire an interpreter to explain the family culture.

Ans: C Feedback: Understanding and respecting the family's culture helps foster good communication and improves child and family education about health care. The best way to assess the family's cultural practices is to ask and then listen. Determine the language spoken at home and observe the use of eye contact and other physical contact. Demonstrate a caring, nonjudgmental attitude and sensitivity to the child's and family's cultural diversity. An interpreter should be hired for a family who does not speak English.

Origin: Chapter 14, 20 The nurse is administering pain medication for a child with continuous pain from internal injuries. Which method would be ordered to dispense the medication? A) Administer the medication PRN (as needed). B) Administer the mediation when pain has peaked. C) Administer the medication around the clock at timed intervals. D) Administer the medication when the child complains of pain.

Ans: C Feedback: With any medication administered for pain management, the timing of administration is vital. Timing depends on the type of pain. For continuous pain, the current recommendation is to administer analgesia around the clock at scheduled intervals to achieve the necessary effect. As-needed or PRN dosing is not recommended for continuous pain. This method can lead to inadequate pain relief because of the delay before the drug reaches its peak effectiveness. For pain that can be predicted or considered temporary, such as with a procedure, analgesia is administered so that the peak action of the drug matches the time of the painful event. It is not recommended to wait until the child complains of pain because therapeutic levels will be difficult to reach at this point.

2.The nurse is consulting with a child life specialist (CLS) to help minimize the stress of hospitalization for a child. Which services would the CLS provide? Select all that apply. A) Medical preparation for tests, surgeries, and other medical procedures B) Support before and after, but not during, medical procedures C) Activities to support normal growth and development D) Grief and bereavement support E) Emergency room interventions for children and families F) Only inpatient consultations with families

Ans: C, D, E Feedback: • The CLS would provide activities to support normal growth and development, grief and bereavement support, and emergency room interventions for children and families. The CLS would also provide nonmedical preparation for tests, surgeries, and other medical procedures; support during medical procedures; and outpatient consultation with families (American Academy of Pediatrics, Committee on Hospital Care and Child Life Council, 2014, reaffirmed 2018).

Origin: Chapter 14, 8 The nurse is counseling the parents of a 9-year-old boy who is receiving morphine for postoperative pain. Which statement from the nurse accurately reflects the pain experience in children? A) 'You can expect that your child will tell you when he is experiencing pain.' B) 'Your child will learn to adapt to the pain he is experiencing.' C) 'Your child will experience more adverse effects to narcotics than adults.' D) 'It is very rare that children become addicted to narcotics.'

Ans: D Feedback: Addiction to narcotics when used in children is very rare. Often children deny pain to avoid a painful situation or procedure, embarrassment, or loss of control. Repeated exposure to pain or painful procedures can result in an increase in behavioral manifestations. The risk of adverse effects of narcotic analgesics is the same for children as for adults.

Origin: Chapter 14, 4 The nurse is conducting an assessment of a high school track athlete. The client tells the nurse he is experiencing pain along his outer thigh. He describes it as tight, achy, and tender, particularly after he runs. The nurse understands that he is most likely experiencing what kind of pain? A) Cutaneous B) Neuropathic C) Visceral D) Deep somatic

Ans: D Feedback: Deep somatic pain typically involves the muscles, tendons, joints, fasciae, and bones. It can be localized or diffuse and is usually described as dull, aching, or cramping with tenderness. It can also be due to overuse injuries commonly experienced by athletes. Cutaneous pain usually involves the skin and is described as sharp or burning. Neuropathic pain is due to a malfunctioning of the peripheral nervous system and is described as burning or tingling. Visceral pain is pain that develops within organs.

11.The nurse is caring for a 4-year-old boy with Ewing sarcoma who is scheduled for a computed axial tomography (CAT) scan tomorrow. Which is the best example of therapeutic communication? A) Telling him he will get a shot when he wakes up tomorrow morning B) Telling him how cool he looks in his baseball cap and pajamas C) Using family-familiar words and soft words when possible D) Describing what it is like to get a CAT scan using words he understands

Ans: D Feedback: Describing what it is like to get a CAT scan using age-appropriate words is the best example of therapeutic communication. It is goal-directed, focused, and purposeful communication. Using family-familiar words and soft words is a good teaching technique. Telling him how cool he looks in his baseball cap and pajamas is not goal-directed communication. Telling the child he will get a shot when he wakes up could keep him awake all night.

Origin: Chapter 14, 26 The nurse is conducting a pain assessment of a 10-year-old boy who has been taking acetaminophen for chronic knee pain. The assessment indicates that the recommended dose is no longer providing adequate relief. What is the appropriate nursing action? A) Increase the dosage of the acetaminophen. B) Tell the child he is experiencing the ceiling effect. C) Use guided imagery to help his pain. D) Obtain an order for a different medication.

Ans: D Feedback: Increasing the dose of the acetaminophen will not help his pain because he has reached as high a dose of that medication that will work. This is known as the ceiling effect, but explaining that to him will not help his pain. Guided imagery is not the best therapy for his pain, so the physician needs to order a different medication to manage his pain.

15.The nurse is educating the parents of a 7-year-old girl who has just been diagnosed with epilepsy. Which teaching technique would be most appropriate? A) Assessing the parents' knowledge of the anticonvulsant medications B) Demonstrating proper seizure safety procedures C) Discussing the surgical procedure for epilepsy D) Giving the parents information in small amounts at a time

Ans: D Feedback: Parents, when given a life-altering diagnosis, need time to absorb information and to ask questions. Therefore, giving the parents information in small amounts at a time is best. The child has just been diagnosed with epilepsy, and surgical intervention is not used unless seizures persist in spite of medication therapy. Therefore, discussing surgery would be inappropriate at this time. Assessing the parents' knowledge of the anticonvulsant medications identifies a knowledge gap and need to learn, but it would be unreasonable to think that they would understand the medications when the diagnosis had just been made. Demonstrating proper seizure safety procedures is an effective way to present information to an adult.

Origin: Chapter 14, 29 Pentazocine is prescribed for a child with moderate pain. The nurse identifies this drug as an example of which type? A) Nonsteroidal anti-inflammatory drug (NSAID) B) Prostaglandin inhibitor C) Opioid D) Mixed opioid agonist-antagonist

Ans: D Feedback: Pentazocine is classified as a mixed opioid agonist-antagonist. Ibuprofen, ketorolac, and naproxen are examples of NSAIDs that inhibit prostaglandin synthesis. Morphine, codeine, and fentanyl are examples of opioids.

Origin: Chapter 14, 9 The nurse is using the acronym QUESTT to assess the pain of a child. Which is an accurate descriptor of this process? A) Question the child's parents. B) Understand the child's pain level. C) Establish a caring relationship with the child. D) Take the cause of pain into account when intervening.

Ans: D Feedback: The acronym QUESTT stands for the following: Question the child. Use a reliable and valid pain scale. Evaluate the child's behavior and physiologic changes to establish a baseline and determine the effectiveness of the intervention. The child's behavior and motor activity may include irritability and protection as well as withdrawal of the affected painful area. Secure the parent's involvement. Take the cause of pain into account when intervening. Take action.

Origin: Chapter 14, 11 Which tool would be the least appropriate scale for the nurse to use when assessing a 4-year-old child's pain? A) FACES pain rating scale B) Oucher pain rating scale C) Poker chip tool D) Numeric pain intensity scale

Ans: D Feedback: The numeric pain intensity scale can be used with children as young as 5 years of age, but the preferred minimum age for using this tool is 7 years. The FACES and Oucher pain rating scales and the poker chip tool are appropriate pain assessment tools for a 4-year-old.

Origin: Chapter 14, 24 The nurse is monitoring a child who has received epidural analgesia with morphine. The nurse is careful to monitor for which adverse effect of the medication? A) Epidural hematoma B) Arachnoiditis C) Spinal headache D) Respiratory depression

Ans: D Feedback: The nurse needs to monitor for signs of respiratory depression, a potential adverse effect of the opioid medication. Epidural hematoma, arachnoiditis, and spinal headache are potential adverse effects of the insertion of the epidural catheter.

Origin: Chapter 14, 15 The nurse is providing instructions to a mother on how to use thought stopping to help her child deal with anxiety and fear associated with frequent painful injections. Which statement indicates the mother understands the technique? A) "We will imagine that we are on the beach in Florida." B) "We can talk about our favorite funny movie and laugh." C) "She can let her body parts go limp, working from head to toe." D) "We'll repeat 'quick stick, feel better, go home soon' several times."

Ans: D Feedback: Thought stopping is a technique that involves the use of short, concise phrases of positive ideas. Doing so helps to promote the child's sense of control. Imagining a favorite beach in Florida is using imagery. Talking about a favorite funny movie involves humor. Letting body parts go limp is a relaxation technique.

24. A 10-year-old child with sickle-cell anemia is frequently in the pediatric center of a hospital. What intervention can the nurse provide that will allow the child the sense of control that meets the goals promotes atraumatic care? A) Advocate for minimal laboratory blood draws. B) Promote family-centered care. C) Provide appropriate pain management. D) Maintain the child's home routine related to activities of daily living.

Ans: D Feedback: To promote a sense of control that meets the goals of atraumatic care, the nurse would attempt to maintain the child's home routine related to activities of daily living. In the hospital, the nurse would use primary nursing. The nurse would encourage the child to have a security item present if desired. Other measures include involving the child and family in planning care from the moment of the first encounter, empowering them by providing knowledge, allowing them choices when available, and making the environment more inviting and less intimidating. The nurse could advocate for minimum blood draws, but with the child's disease this will likely not happen. The nurse can help the child with reassurance and topical pain medication for laboratory draws to prevent the discomfort of multiple needle sticks. These actions, however, do not offer the child a sense of control.

Origin: Chapter 14, 12 The nurse uses the FLACC behavioral scale to assess a 6-year-old's level of postoperative pain and obtains a score of 9. The nurse interprets this to indicate that the child is experiencing: A) little to no pain. B) mild pain. C) moderate pain. D) severe pain.

Ans: D Feedback: With the FLACC behavioral scale, five parameters are measured and scored as 0, 1, or 2. They are then totaled to achieve a maximum score of 10. The higher the score, the greater the pain. A score of 9 indicates severe pain.

The nurse is admitting a 10-year-old for surgery. What action should the nurse prioritize when caring for this child?

Answer questions regarding pain. Explanation: School-age children need privacy more than younger children do and may not want to have physical contact with adults; this wish should be respected. These attitudes should be recognized and handled in a way that ensures as much privacy as possible. Children's questions, including those about pain, should be answered truthfully. An opportunity to verbalize anxieties will help a child deal with them. Family caregivers may feel guilty about the child's need for hospitalization and, as a result, may overindulge the child. The child may regress in response to this, but this regression should not be encouraged.

The school nurse is monitoring a student athlete who experienced a concussion 2 weeks ago during a soccer game. The student reports having difficulty in a course in which the child previously performed well. Which action should the nurse's take first?

Ask the student to describe the issues he is having in the class Explanation: Talking with the teacher and performing a neurological assessment are actions that may be necessary, but the nurse must first determine if the student is following the recommended level of cognitive activity; this can be accomplished by asking the child to describe the issues he is having in class. Contacting the parents immediately would not be warranted until sufficient information is collected.

An adolescent with a new piercing comes to the health center at the school. The client reports feeling hot. Which action will the nurse complete first? Ask the client if any other piercings are present. Determine when the client started feeling hot. Inquire about the piercing technique used. Assess the client for signs of infection.

Assess the client for signs of infection.

A teenage boy tells the nurse that his parents embarrass him in front of his friends when they kiss him goodbye. The nurse is aware that this teenager is revisiting which stage of development identified by Erikson? Autonomy Industry Generativity Initiative

Autonomy

Autonomy Explanation: In revisiting the stage of autonomy, the adolescent is seeking out ways to express his or her individuality in an effective manner. The adolescent would avoid behaviors that would "shame" or ridicule him or her in front of his or her peers. The sense of industry is again encountered as the adolescent makes his or her choice to participate in different activities at school, in the community, at church, and in the workforce. Initiative is revisited as the adolescent develops his or her vision for what he or she might become. Generativity largely involves establishment of career and work.

15. Which of the following would the nurse include when teaching an adolescent about tinea pedis? A) "Keep your feet moist and open to the air as much as possible." B) "Dry the area between your toes really well." C) "Wear nylon or synthetic socks every day." D) "Go barefoot when you are in the locker room at school."

26. A nurse is preparing a presentation for a local parent group about burn prevention and care in children. Which of the following would the nurse be least likely to include in the presentation when describing how to care for a superficial burn? A) Using cool water over the burned area until the pain lessens B) Applying ice directly to the burned skin area C) Covering the burn with a clean, nonadhesive bandage D) Giving the child acetaminophen for pain relief

8. The nurse is caring for an infant with candidal diaper rash. Which topical agent would the nurse expect the physician to order? A) Corticosteroids B) Antifungals C) Antibiotics D) Retinoids

9. The nurse is caring for a 15-year-old boy who has sustained burn injuries. The nurse observes the burn developing a violaceous color with discharge and a foul odor. The nurse suspects which of the following infections? A) Burn wound cellulitis B) Invasive burn cellulitis C) Burn impetigo D) Staphylococcal scalded skin syndrome

The child life specialist (CLS) is preparing a 6-year-old child for a magnetic resonance imaging (MRI) scan. Which of the following statements reflects the use of atraumatic principles when explaining the procedure? A) "You will be taken to a magnetic resonance imaging machine for an x-ray of your liver." B) "You may hear some loud noises when you are lying in the machine, but they won't hurt you." C) "You have nothing to worry about; the MRI machine is safe and will not cause you any pain." D) "Let's just get you to the x-ray department for your test and you'll see how simple it is."

The nurse is explaining a discharge plan to the parents of an infant being discharged from the hospital. Which of the following characteristics regarding adult learning should the nurse incorporate into her plan? A) Adults are dependent learners. B) Adults are problem focused. C) Adults are future focused. D) Adults do not value past learning.

The nurse is incorporating nonverbal communication with verbal communication when explaining the treatment plan for a child with juvenile diabetes. Which of the following should the nurse do to communicate effectively with this family? A) Relax; maintain an open posture, with the arms crossed. B) Sit opposite the family and lean forward slightly. C) Use eye contact sparingly to avoid embarrassment. D) Speak a verbal yes or no; do not use head nods.

The nurse is teaching good sleep habits for toddlers to the mother of a 3-year-old boy. Which response indicates the mother understands sleep requirements for her son? A)"I'll put him to bed at 7 p.m., except Friday and Saturday." B)"He needs 13 hours of sleep per day including his nap." C)"I need to put the side down on the crib so he can get out." D)"His father can give him a horseback ride into his bed."

B) "He needs 13 hours of sleep per day including his nap." Feedback: The mother understands her child needs 12 hours of sleep and one nap per day. Routines, such as the same bedtime every night, promote good sleep. However, a horseback ride to bed may cause problems because it may not provide a calming transition from play to sleep. A bath and reading a book would be better. If the child can climb out of a crib, he needs to be in a youth bed or regular bed to avoid injury.

The parents of a 2-year-old girl are frustrated by the frequent confrontations they have with their child. Which is the best anticipatory guidance the nurse can offer to prevent confrontations? A)"Respond in a calm but firm manner." B)"You need to adhere to various routines." C)"Put her in time-out when she misbehaves." D)"It's important to toddler-proof your home."

B) "You need to adhere to various routines." Feedback: Making expectations known through everyday routines helps to avoid confrontations. This helps the child know what to expect and how to behave. It is the best guidance to give these parents. Calm response and time-out are effective ways to discipline, but do not help to prevent confrontations. Toddler-proofing the house doesn't eliminate all the opportunities for confrontation.

During a health history, the nurse explores the sleeping habits of a 3-year-old boy by interviewing his parents. Which statement from the parents reflects a recommended guideline for promoting healthy sleep in this age group? A)'Our son sleeps through the night, and we insist that he takes two naps a day.' B)'We keep a strict bedtime ritual for our son, which includes a bath and bedtime story.' C)'Our son still sleeps in a crib because we feel it is the safest place for him at night.' D)'Our son occasionally experiences night walking so we allow him to stay up later when this happens.'

B) 'We keep a strict bedtime ritual for our son, which includes a bath and bedtime story.' Feedback: Consistent bedtime rituals help the toddler prepare for sleep; the parent should be advised to choose a bedtime and stick to it as much as possible. The nightly routine might include a bath followed by reading a story. A typical toddler should sleep through the night and take one daytime nap. Most children discontinue daytime napping at around 3 years of age. When the crib becomes unsafe (that is, when the toddler becomes physically capable of climbing over the rails), then he or she must make the transition to a bed. Attention during night waking should be minimized so that the toddler receives no reward for being awake at night.

When instructing the parents of a toddler about appropriate nutrition, what would the nurse recommend? A)About 12 to 16 ounces of fruit juice per day B)Approximately 16 to 24 ounces of milk per day C)Fat intake of 30% to 40% of total calories D)An average of 10 to 12 grams of fiber per day

B) Approximately 16 to 24 ounces of milk per day Feedback: Milk intake should be limited to 16 to 24 ounces per day, with fruit juice limited to 4 to 6 ounces per day. A toddler's total fat intake should be 20% to 30% of total calories. The daily recommended fiber intake is 19 grams.

The nurse is presenting an in-service training to a group of pediatric nurses on the topic of play. After discussing various types of play, the following examples are given. Which is the best example of solitary independent play? A) Children are playing together in an activity without organization. B) Children are playing apart from others without being part of a group. C) Children are playing in an organized group with each other. D) Children are playing independently and are side-by-side.

B) Children are playing apart from others without being part of a group. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. Associative play occurs when children play together and are engaged in a similar activity but without organization, rules, or a leader, and each child does what she or he wishes. During cooperative play children play in an organized group with each other as in team sports. Parallel play occurs when the toddler plays alongside other children but not with them.

The nurse is teaching the parents of a 2-year-old toddler methods of dealing with their child's 'negativism.' Based on Erickson's theory of development, what would be an appropriate intervention for this child? A)Discourage solitary play; encourage playing with other children. B)Encourage the child to pick out his own clothes. C)Use 'time-outs' whenever the child says 'no' inappropriately. D)Encourage the child to take turns when playing games.

B) Encourage the child to pick out his own clothes. Feedback: Erikson defines the toddler period as a time of autonomy versus shame and doubt. It is a time of exerting independence. Allowing the child to choose his own clothes helps him to assert his independence. Negativism and always saying "no" is a normal part of healthy development and is occurring as a result of the toddler's attempt to assert his or her independence. It should not be punished with 'time-outs.' The toddler should be encouraged to play alone and with other children. Toddlers cannot take turns in games until age 3.

The nurse is helping parents prepare a healthy meal plan for their toddler. Which guidelines for promoting nutrition should be followed when planning meals? Select all that apply. A)The child younger than 2 years of age should have his or her fat intake restricted. B)Extending breastfeeding into toddlerhood is believed to be beneficial to the child. C)Weaning from the bottle should occur by 6 to 12 months of age. D)Adequate calcium intake and appropriate exercise lay the foundation for proper bone mineralization. E)The toddler requires an average intake of 500 mg calcium per day. F)Toddlers tend to have the highest daily iron intake of any age group.

B) Extending breastfeeding into toddlerhood is believed to be beneficial to the child. D)Adequate calcium intake and appropriate exercise lay the foundation for proper bone mineralization. E)The toddler requires an average intake of 500 mg calcium per day. Feedback: Extending breastfeeding into toddlerhood is believed to be beneficial to the child as it is known to help prevent obesity. Adequate calcium intake and appropriate exercise lay the foundation for proper bone mineralization. The toddler requires an average intake of 500 mg calcium per day. The child younger than 2 years of age should not have his or her fat intake restricted, but this does not mean that unhealthy foods such as sweets should be eaten liberally. Weaning from the bottle should occur by 12 to 15 months of age. Prolonged bottle-feeding is associated with the development of dental caries. It is important for toddlers to consume adequate amounts of iron since they tend to have the lowest daily iron intake of any age group.

The nurse is assessing a 2-year-old boy who has missed some developmental milestones. Which finding will point to the cause of motor skill delays? A)The mother is suffering from depression. B)The child is homeless and has no toys. C)The mother describes an inadequate diet. D)The child is unperturbed by a loud noise.

B) The child is homeless and has no toys. Feedback: Children develop through play, so a child without any toys may have trouble developing the motor skills appropriate to his age. Maternal depression is a risk factor for poor cognitive development. Inadequate diet will cause growth deficiencies. A child who does not respond to a loud noise probably has hearing loss, which will lead to a language deficit.

The nurse is observing a 24-month-old boy in a day care center. Which finding suggests delayed motor development? A)The child has trouble undressing himself. B)The child is unable to push a toy lawnmower. C)The child is unable to unscrew a jar lid. D)The child falls when he bends over.

B) The child is unable to push a toy lawnmower. Feedback: Children with normal motor development are able to push toys with wheels at 24 months of age. He won't be ready to undress himself, unscrew a jar lid, or bend over without falling until about 36 months of age.

18. A nurse is preparing a class for parents of infants about managing diaper dermatitis. Which of the following would the nurse include in the presentation? Select all answers that apply. A) Applying topical nystatin to the diaper area B) Using a blow dryer on warm to dry the diaper area C) Refraining from using rubber pants over diapers D) Using scented diaper wipes to clean the area E) Washing the diaper area with an antibacterial soap

B, C

A nurse is promoting the use of family-centered care in a local community clinic. Which of the following are advantages or disadvantages of this type of care provision? Select all answers that apply. A) Recovery times are longer. B) Anxiety is decreased. C) Communication is improved. D) Health care costs are increased. E) Pain management is enhanced. F) More health care resources are utilized.

BCD

indicators of pain in an infant?

Behavioral -Facial expressions, body movements, crying, increased irritability, refusal to move injured body part, interrupted sleep Physiologic -Changes in heart rate, respiratory rate, oxygen saturation levels, vagal tone, plantar or palmar sweating

The nurse is preparing a presentation for a local health fair depicting the differences in maturity between preadolescents. Which differing factor should the nurse prioritize in the presentation? Boys grow at a rapid, sporadic rate. Boys and girls grow at the same rate. Boys grow at a slower, steadier rate than do girls. Girls grow at a slower, steadier rate than do boys.

Boys grow at a slower, steadier rate than do girls.

The nurse is assessing a 3-year-old at a well-child visit and the child appears to be progressing well. Which activity will the nurse ask the child to attempt to appropriately assess the fine motor skills of this preschooler? Use scissors. Print a few letters. Button clothes. Tie shoelaces.

Button clothes.

11. After teaching a class about the differences in the skin of infants and adults, the nurse determines that additional teaching is necessary when the class states which of the following? A) "An infant's skin is thinner than an adult's, so substances placed on the skin are absorbed more readily." B) "The infant's epidermis is loosely connected to the dermis, increasing the risk for breakdown." C) "The infant has a lower risk for damage from ultraviolet radiation because the skin is more pigmented." D) "An infant has less subcutaneous fat, which places the infant at a higher risk for heat loss."

14. When developing the plan of care for a child with burns requiring fluid replacement therapy, which of the following would the nurse expect to include? A) Administration of colloid initially followed by a crystalloid B) Determination of fluid replacement based on the type of burn C) Administration of most of the volume during the first 8 hours D) Monitoring of hourly urine output to achieve less than 1 mL/kg/hour

23. A 3-year-old child has sustained significant severe burns and is ordered to receive 100% oxygen. Which of the following would the nurse use to administer the oxygen? A) Nasal cannula B) Venturi mask C) Nonrebreather mask D) Oxygen hood

25. A 4-year-old is brought to the emergency department with a burn. Which of the following would alert the nurse to the possibility of child abuse? A) Burn assessment correlates with mother's report of contact with a portable heater. B) Parents state that the injury occurred approximately 15 to 20 minutes ago. C) Clear delineations are noted between burned and nonburned skin areas. D) The burn area appears asymmetric and nonuniform.

3. The nurse is providing care for a 14-year-old girl with severe acne. The girl expresses sadness and distress about her appearance. Which response by the nurse would be most appropriate? A) "Are you using your medicine every day?" B) "Your condition will most likely improve in a year or two." C) "Many people feel this way I know someone who can help." D) "If you have any scarring you can undergo dermabrasion."

5. A nurse is caring for a 5-year-old in Buck traction. When conducting a skin examination for signs of pressure ulcers, the nurse pays particular attention to which area? A) Sacral area B) Hip area C) Occiput D) Upper arm

The nurse is educating a 16-year-old girl who has just been diagnosed with acute myelogenous leukemia. Which of the following statements best demonstrates therapeutic communication? A) Discussing the treatment plan in detail for the next few weeks B) Using medical terms when describing the disease C) Assessing the adolescent's emotional status in private D) Talking about clothing and the stores where she shops

The nurse is implementing interventions to prevent physical stressors for a 9-year-old child receiving chemotherapy in the hospital. Which of the following is an example of using atraumatic care for this child? A) Use restraint or "holding down" of the child during the procedure to prevent injury. B) Have the parent stand near and/or rub the child's feet during the procedure. C) Insert a saline lock if the child will require multiple doses of parenteral medications. D) Avoid using numbing techniques for multiple blood draws or IV insertion.

The nurse is preparing a child and his family for a lumbar puncture. Which of the following would be a primary intervention instituted by the CLS to keep the child safe? A) Distraction methods B) Stimulation methods C) Therapeutic hugging D) Therapeutic touch

The nurse is teaching the student nurse how to communicate effectively with children. Which one of the following methods would the nurse recommend? A) Position self above the child's level to denote authority. B) If possible, communicate with the child apart from the parent. C) Direct questions and explanations to the child. D) Use the medical terms for body parts and medical care.

The nurse knows that effective communication with children and their parents is critical to providing atraumatic quality nursing care. Which of the following statements accurately describes the communication patterns of children? A) Communication patterns are similar from one child to the next. B) Children often use more words than adults to describe their fears. C) Children rely more on nonverbal communication and silence. D) Parents more often require affective communication rather than neutral communication.

The mother of a 4-year-old girl reports her daughter has episodes of wetting her pants. The nurse questions the mother about the frequency. The nurse determines these episodes occur about once every 1 to 2 weeks. Which response by the nurse is indicated? A) "Discipline should be applied after these times." B) "The frequency of these wetting episodes may be consistent with a low-grade urinary tract infection." C) "At this age it is helpful to remind children to go to the bathroom." D) "Consider restricting your daughter's fluid intake."

C) "At this age it is helpful to remind children to go to the bathroom." Preschool-aged children may become occupied with activities around them and not remember to void. Reminding them to void is helpful. Discipline should not be applied to infrequent episodes of incontinence. There is no indication the child has an infection.

The nurse is teaching parents interventions appropriate to the emotional development of their toddlers. What is a recommended intervention for this age group? A)Remove children's security blankets at this stage to help them assert their autonomy. B)Distract toddlers from exploring their own body parts, particularly their genitals. C)Do not blame toddlers for aggressive behavior; instead, point out the results of their behavior. D)Offer toddlers many choices to foster control over their environment.

C) Do not blame toddlers for aggressive behavior; instead, point out the results of their behavior. Feedback: Toddlers should not be blamed for their aggressive behavior; adults can assist the toddler in building empathy by pointing out when someone is hurt and explaining what happened. Adults should allow toddlers to rely upon a security item to self-soothe as this is a function of autonomy and is viewed as a sign of a nurturing environment, rather than one of neglect. Toddlers may question parents about the difference between male and female body parts and may begin to explore their own genitals. This is normal behavior in this age group. Offering limited choices is one way of allowing toddlers some control over their environment and helping them to establish a sense of mastery.

The nurse is assessing a 3-year-old boy's development during a well-child visit. Which response by the child indicates the need for further assessment? A)He says a swear word when he hurts himself playing. B)He says "pew" when his sister has soiled her diaper. C)He laughs when his brother cries getting vaccinated. D)He constantly asks "why?" whenever he is told a fact.

C) He laughs when his brother cries getting vaccinated. Feedback: Laughing when his brother cries when being vaccinated indicates that the child hasn't yet developed a sense of empathy or that there may be psychosocial issues, such as sibling rivalry, that should be assessed. The child may repeat a word even if it is out of context. This is called echolalia. Older toddlers have a well-developed sense of smell and will comment if they don't like a smell. The incessant "why" is very common to toddlers' speech.

The nurse is caring for a preschool-aged child who needs a CT scan. Which action would the nurse use to best prepare the child for this diagnostic test? A) Tell the child that the CT scan is a picture of the dark parts inside the body. B) Explain that the child must behave because the technician is busy. C) Help the child to pretend that the CT scan machine is a camera. D) Tell the child to follow directions to avoid being hurt.

C) Help the child pretend that the CT scan machine is a camera. Because preschoolers' imagination is so active, this leads to several fears such as fear of the dark and mutilation. The nurse needs to help the child understand that the CT scanner is like a camera to take pictures of the body parts. Threatening the child to follow directions or becoming hurt plays into the child's fear of mutilation. Telling the child to behave creates a fear of punishment. Telling the child that the CT scan is a picture of the body's dark parts plays into the child's fear of the dark.

The pediatric nurse is planning quiet activities for hospitalized 18-month-old. What would be an appropriate activity for this age group? A)Painting by number B)Putting shapes into appropriate holes C)Stacking blocks D)Using crayons to color in a coloring book

C) Stacking blocks Feedback: At 18 months the child can stack four blocks. The 24-month-old can paint (but not by number), scribble, and color, and put round pegs into holes.

The nurse is providing guidance after observing a mother interact with her negative 2-year-old boy. For which interaction will the nurse advise the mother that she is handling the negativism properly? A)Telling the child to stop tearing pages from magazines B)Asking the child if he would please quit throwing toys C)Telling the child firmly that we don't scream in the office D)Saying, "Please come over here and sit in this chair. OK?"

C) Telling the child firmly that we don't scream in the office Feedback: Telling the child firmly that we don't scream in the office gets the point across to the child that his behavior is unacceptable while role modeling appropriate communication. Telling the child to stop tearing up magazines does not give him direction for appropriate behavior. Asking the child if he would quit throwing toys gives him an opportunity to say "no," and is the same as asking "OK?" at the end of a direction.

The nurse is testing the sensory development of a toddler brought to the clinic for a well visit. What might alert the nurse to a potential problem with the child's sensory development? A)The toddler places the nurse's stethoscope in his mouth. B)The toddler's vision tests at 20/50 in both eyes. C)The toddler does not respond to commands whispered in his ear. D)The toddler's taste discrimination is not at adult levels yet.

C) The toddler does not respond to commands whispered in his ear. Feedback: Hearing should be at the adult level, as infants are ordinarily born with hearing intact. Therefore, the toddler should hear commands whispered in his ear. Toddlers examine new items by feeling them, looking at them, shaking them to hear what sound they make, smelling them, and placing them in their mouths. Toddler vision continues to progress and should be 20/50 to 20/40 in both eyes. Though taste discrimination is not completely developed, toddlers may exhibit preferences for certain flavors of foods.

The nurse is performing a physical assessment of a 3-year-old girl. What finding would be a concern for the nurse? A)The toddler gained 4 pounds in weight since last year. B)The toddler gained 3 inches in height since last year. C)The toddler's anterior fontanel is not fully closed. D)The circumference of the child's head increased 1 inch since last year.

C) The toddler's anterior fontanel is not fully closed. Feedback: The anterior fontanel should be closed by the time the child is 18-months old. The average toddler weight gain is 3 to 5 pounds per year. Length/height increases by an average of 3 inches per year. Head circumference increases about 1 inch from when the child is between 1 and 2 years of age, then increases an average of a half-inch per year until age 5.

The nurse is consulting with a child life specialist (CLS) to help minimize the stress of hospitalization for a child. Which of the following services would the CLS provide? Select all answers that apply. A) Medical preparation for tests, surgeries, and other medical procedures B) Support before and after, but not during, medical procedures C) Activities to support normal growth and development D) Grief and bereavement support E) Emergency room interventions for children and families F) Only inpatient consultations with families

CDE

The nurse is providing anticipatory guidance for violence prevention to a group of parents with adolescents. Which parental action should the nurse include as the most effective in preventing suicide? Monitoring video games, TV shows, and music Becoming acquainted with the teen's friends Watching for aggressive behavior or racist remarks Checking for signs of depression or lack of friends

Checking for signs of depression or lack of friends

why do we start lower in children and titrate up?

Children metabolize drugs more rapidly than adults and shower greater variability in drug elimination and side effects. Children may require higher doses to achieve the same effect. Start lower and titrate up. Doses are based on weight in Kg. Never more than adult dose.

TAKE NOTE:

Chocolate, skim milk and French fries do not cause acne. Wash hands to avoid spreading oils to face.

A nurse is assigned to care for a 7-year-old child. The child wants to show the nurse a collection of baseball cards. The nurse understands that the collection of objects is common in this age group and is known as what type of thinking?

Classification An important change in thinking during the school-age period is classification. This is the ability to divide things in different sets and identify their relationships to each other. Children in this age group love to collect sports cards, insects, rocks, stamps, coins, etc. These collections may be only a short-term interest, but they are of utmost importance to the child when he or she is collecting them. Decentration occurs in the concrete operational stage from ages 7 to 12 years. It is the ability to consider multiple aspects of a situation. The preoperational stage occurs between ages 2 and 7 years. During this time thinking is at a symbolic level. One part of the preoperational stage is egocentrism. In this stage, the child has the inability to see things from another's point of view.

Clients who are showing pubertal changes Explanation: The nurse should know that boys who are undergoing pubertal changes are more likely to experience nocturnal emissions. The first sign of pubertal changes and sex maturation is testosterone secretion. As this increased so does the penis and scrotum enlargement. This is a time when nocturnal emissions occur. In late adolescence, which lasts from age 18 to 20, the transition into adulthood is completed. The nurse should also know that boys in the age group of age 12 to 20 experience various chemical and physical changes taking place within their body. A strong, muscular appearance does not indicate the presence of nocturnal emissions.

What action by a parent would be least likely to foster development of self-confidence in a school-age child?

Comparing the child to an older sibling regarding academic achievements

The nurse is caring for a hospitalized 10-year-old client. What nursing action is most appropriate?

Consistently reinforce the child's self-worth Explanation: Helping school-aged clients experience satisfaction in projects, social activities, family life, and school helps them gain a sense of industry. Reinforcing self-worth provides this satisfaction. The child should not be discouraged from participating in their care. The child's mistakes may need corrected to learn; however, the child has to be allowed to make mistakes in a safe environment to promote learning. Pointing these mistakes out needs to be done with care. Competition between clients will not facilitate growth and development or psychosocial development.

An 8-year-old boy who says he wants to be a doctor when he grows up pleads with the nurse to let him put on his own band-aid after receiving an injection. The nurse agrees and watches as the boy very carefully lines the band-aid up with the mark left by the injection and applies it to his skin. Then he asks, "Did I do it right?" and waits eagerly for the nurse's feedback. The nurse recognizes in this situation the boy's attempt to master the primary developmental step of school age. What is that step?

Correct response: Industry Explanation: During the early school years, children attempt to master their new developmental step: learning a sense of industry or accomplishment. Accommodation is the ability to adapt thought processes to fit what is perceived, such as understanding there can be more than one reason for other people's actions. Conservation is the ability to appreciate that a change in shape does not necessarily mean a change in size. Perfectionism is the desire to do something perfectly. The boy's desire to apply the band-aid "the right way" is a hallmark of the development of industry. The other answers are not as pertinent.

The nurse is preparing a list of abilities of 10-month-olds to use in teaching a parenting group. Which ability should appear at this age? a) Sits from standing position b) Uses two or three words with meaning c) Cruises around furniture d) Feeds self with spoon (but spills)

Cruises around furniture

The nurse is performing an assessment on a 12-year-old boy. Which finding is consistent with the child's age? Curling pubic hair No pubic hair Coarse pubic hair Sparse pubic hair

Curling pubic hair

16. A child is diagnosed with atopic dermatitis. Which laboratory test would the nurse expect the child to undergo to provide additional evidence for this condition? A) Erythrocyte sedimentation rate B) Potassium hydroxide prep C) Wound culture D) Serum immunoglobulin E level

24. As part of a clinical conference with a group of nursing students, the instructor is describing the burn classification. The instructor determines that the teaching has been successful when the group identifies which of the following as characteristic of full thickness burns? A) Skin that is reddened, dry, and slightly swollen B) Skin appearing wet with significant pain C) Skin with blistering and swelling D) Skin that is leathery and dry with some numbness

6. A 6-year-old boy has been admitted to the hospital with burns. The nurse notes carbonaceous sputum. Which of the following would be the priority? A) Determining the burn depth B) Eliciting a description of the burn C) Estimating burn extent D) Ensuring a patent airway

7. A nurse is caring for a 14-year-old girl who received an electrical burn. The nurse would anticipate preparing the girl for which diagnostic tests as ordered? A) Pulse oximetry B) Fiberoptic bronchoscopy C) Xenon ventilation-perfusion scanning D) Electrocardiographic monitoring

The nurse is caring for a 4-year-old boy with Ewing sarcoma who is scheduled for a computed axial tomography (CAT) scan tomorrow. Which of the following is the best example of therapeutic communication? A) Telling him he will get a shot when he wakes up tomorrow morning B) Telling him how cool he looks in his baseball cap and pajamas C) Using family-familiar words and soft words when possible D) Describing what it is like to get a CAT scan using words he understands

The nurse is using verbal skills to explain the nursing care plan to parents of a 10-year-old child with cancer. Which of the following describes a guideline the nurse should follow to provide appropriate verbal communication? A) Use closed-ended questions that do not restrict the child's or parent's answers. B) Allow the focus to change without redirecting the conversation. C) Restate the child's and parents comments in your own words. D) Paraphrase the child's or parent's feelings to demonstrate empathy.

The nurse is developing a teaching plan for toddler safety to present at a parenting seminar. Which safety intervention should the nurse address? A)Encourage parents to enroll toddlers in swimming classes to avoid the need for constant supervision around water. B)Advise parents to keep pot handles on stoves turned outward to avoid accidental burns. C)Encourage parents to smoke only in designated rooms in the house or outside the house. D)Advise parents to use a forward-facing car seat with harness straps and a clip, placed in the backseat of the car.

D) Advise parents to use a forward-facing car seat with harness straps and a clip, placed in the backseat of the car. Feedback: Safety is of prime concern throughout the toddler period. The safest place for the toddler to ride is in the back seat of the car. Parents should use the appropriate size and style of car seat for the child's weight and age as required by the state. At a minimum, all children over 20 pounds and up to 40 pounds should be in a forward-facing car seat with harness straps and a clip. Parents who want to enroll a toddler in a swimming class should be aware that a water safety skills class would be most appropriate. However, even toddlers who have completed a swimming program still need constant supervision in the water. Pot handles on stoves should be turned inward to avoid accidental burn. Nurses should counsel parents to stop smoking (optimal), but if they continue smoking never to smoke inside the home or car with children present.

The nurse is providing anticipatory guidance to the parents of an 18-month-old girl. Which guidance will be most helpful for toilet teaching? A)Telling them either one may demonstrate toilet use B)Assuring them that bladder control occurs first C)Telling them that curiosity is a sure sign of readiness D)Advising them to use praise, not scolding

D) Advising them to use praise, not scolding Feedback: The most helpful guidance for toilet teaching is to urge the parents to use only praise, but never to scold, throughout the process. It is best for the same-sex parent to demonstrate toilet use. Bowel control will occur first. It may take additional months for nighttime bladder control to be achieved. Curiosity is a sign of readiness for toilet teaching, but by no means a sure sign.

Parents say they have been using measures to lessen the struggle of getting their preschooler to bed at night and to sleep. Which practice will the nurse suggest they discontinue? A) Planning for the child to get 12 hours of sleep daily B) Eliminating caffeine sources beginning late afternoon C) Providing a nightlight D) Allowing the preschooler to fall asleep wherever and whenever the child is tired enough E) Taking the TV set out of the child's room

D) Allowing the preschooler to fall asleep wherever and whenever the child is tired enough Consistent bedtimes and places for sleep promote good sleep habits. Caffeine (soft drinks) interferes with sleep. A nightlight can reduce fear of the dark common in preschoolers. Removing the TV from the child's room prevents viewing and screen light from keeping her awake. Twelve hours of sleep daily is an average amount for preschoolers.

The nurse is assessing a 3-year-old child. Which assessment finding would the nurse identify as abnormal? A) Builds a tower of 10 cubes. B) Unscrews a bolt on a toy. C) Pedals tricycle without assistance. D) Falls when bending over to touch toes.

D) Falls when bending over to touch toes. Bending over easily without falling is a normal expected gross motor skill in a 3-year-old. Building a tower of nine or ten cubes, pedaling a tricycle without assistance and unscrewing lids, bolts or nuts are also expected gross and fine motor skills for this age.

The nurse is teaching the parents of a 2-year-old girl how to deal with common toddler situations. Which is the best advice? A)Discipline the child for regressive behavior. B)Scold the child for public thumb sucking. C)Tell the older sibling to not act like a baby. D)Have the child help clean up a bowel accident.

D) Have the child help clean up a bowel accident. Feedback: Having the child help clean up a bowel accident is the best advice. Toddlers should never be punished for bowel or bladder "accidents," but gently reminded about toileting. Regressive behavior is best ignored, while appropriate behavior should be praised. Telling the older sibling to not act like a baby is a negative approach. It would be better to have the child be mother's helper. Calmly telling the child that thumb sucking is something that is done at home is better than scolding the child.

A 4-year-old is hospitalized with a urinary tract infection. Based on what you know of her cognitive development, which approach would be best to prepare her for a radiograph? A) Explain that she must behave because the technician is busy. B) Tell her a radiograph is a picture of the dark inside her body. C) Tell her she must follow directions or she will be hurt. D) Help her pretend the x-ray machine is a camera.

D) Help her pretend the x-ray machine is a camera. Most preschoolers express fear of the dark and mutilation. Their active imaginations make it possible to turn almost any procedure into a game.

The nurse is caring for a toddler who is in Piaget's sensorimotor stage of cognitive development. Which task would the nurse expect the toddler to be able to perform? A)Completing puzzles with four pieces B)Winding up a mechanical toy C)Playing make-believe with dolls D)Knowing which are his or her toys

D) Knowing which are his or her toys Feedback: The toddler in Piaget's sensorimotor stage of cognitive development (18 to 24 months) understands requests, is capable of following simple directions, and has a sense of ownership (knowing which toys are his). The other tasks are accomplished by the child in the preoperational stage (2 to 7 years).

The nurse is designing a nursing care plan for a toddler with lymphoma, who is hospitalized for treatment. What is a priority intervention that the nurse should include in this child's nursing plan? A)Limiting visitors to scheduled visiting hours B)Planning physical therapy for the child C)Introducing the toddler to other toddlers in the unit D)Monitoring the toddler for developmental delays

D) Monitoring the toddler for developmental delays Feedback: When the toddler is hospitalized, growth and development may be altered. The toddler's primary task is establishing autonomy, and the toddler's focus is mobility and language development. The nurse caring for the hospitalized toddler must use knowledge of normal growth and development to be successful in interactions with the toddler, promote continued development, and recognize delays. Parents should be encouraged to stay with the toddler to avoid separation anxiety. Planning activities and socialization of the toddler is important, but the priority intervention is monitoring for, and addressing, developmental delays that may occur in the hospital.

Nursing students are reviewing information about the cognitive development of preschoolers. The students demonstrate understanding of the information when they identify that a 3-year-old is in what stage as identified by Piaget? A) Primary circular reaction B) Tertiary circular reaction C) Coordination of secondary schema D) Preoperational thought

D) Preoperational thought A 3-year-old is in the preoperational stage according to Piaget. Primary circular reaction is seen in infants of 3 months. Coordination of secondary schema is seen in infants at age 10 months. Tertiary circular reaction is seen in toddlers between 12 and 15 months.

The nurse emphasizes that a toddler younger than the age of 18 months should never be spanked primarily for which reason? A)Spanking in a child this age predisposes the child to a pro-violence attitude. B)The child will become resentful and angry, leading to more outbursts. C)Spanking demonstrates a poor model for problem-solving skills. D)There is an increased risk for physical injury in this age group.

D) There is an increased risk for physical injury in this age group. Spanking should never be used with toddlers younger than 18 months of age because there is an increased possibility of physical injury. Although spanking or other forms of corporal punishment lead to a pro-violence attitude, create resentment and anger in the child, and are a poor model for learning effective problem-solving skills, the risk of physical injury in this age group is paramount.

The nurse is choosing foods for a toddler's diet that are high in vitamin A. What foods could be added to the menu? Select all that apply. A)Applesauce B)Avocados C)Broccoli D)Sweet potatoes E)Spinach F)Carrots

D)Sweet potatoes E)Spinach F)Carrots Feedback: Foods that are high in vitamin A include apricots, cantaloupe, carrots, mangos, spinach and dark greens, and sweet potatoes. Applesauce is high in fiber, and avocados and broccoli are high in folate.

The mother of a 2-year-old tells the nurse she is constantly scolding him for having wet pants. She says her son was trained at 12 months, but since he started to walk, he wets all the time. Which nursing diagnosis would be most applicable? Deficient parental knowledge related to inappropriate method for toilet training Ineffective coping related to lack of self-control of 2-year-old Total urinary incontinence related to delayed toilet training Excess fluid volume related to inability to control urination

Deficient parental knowledge related to inappropriate method for toilet training It is probable that a child toilet trained at 12 months was not truly trained; his mother was trained to remind him or place him on a toilet frequently during the day. When the child begins to play independently, the training is no longer effective.

A nurse is conducting an assessment of a 16-year-old's cognitive development. The nurse determines that the adolescent's cognitive development is within acceptable parameters for the adolescent's age based on which assessment finding? Select all that apply. Uses scientific methods to solve verbal problems. Exhibits limited abstract thought processes Able to develop career plans Shows a beginning interest and concern with societal and political issues. Demonstrates thinking that the adolescent is invincible.

Demonstrates thinking that the adolescent is invincible. Uses scientific methods to solve verbal problems. Shows a beginning interest and concern with societal and political issues.

Infant development is best described by which of the following statements? a) Development proceeds cephalocaudally. b) Development is not sequential but predictable. c) Development varies greatly from infant to infant. d) Development proceeds from fine to gross.

Development proceeds cephalocaudally.

Nursing students reviewing information about discipline demonstrate a need for additional education when they identify what information as correct? Discipline helps children know what is expected. Discipline involves setting rules. When discipline breaks down, the consequence is punishment. Discipline and punishment are interchangeable.

Discipline and punishment are interchangeable. Discipline and punishment are not interchangeable. Discipline refers to setting rules or road signs so children know what is expected of them. Punishment is a consequence that results from a breakdown in discipline, from a child's disregard of rules that were learned.

While observing a group of 9-year-old children at school, the nurse is concerned that one of the children is not cognitively developing according the Piaget's stage of concrete-operational thought processes. With which activity is the nurse concerned?

Does not understand the phrase "slow as molasses" when used by the teacher **Piaget's stage of cognitive development for the 7- to 11-year-old is the period of concrete-operational thoughts. In developing concrete operations, the child is able to assimilate and coordinate information about his or her world from different dimensions. Abstract thinking, such as understanding the meaning of the phrase "slow as molasses" is expected at this stage of cognitive development.

The nurse is observing a group of 5-year-olds playing in the playroom. Which developmental milestones does the nurse identify as newly acquired skills since turning 5 years old? Select all that apply. Drawing a 6-part man Standing on one foot Lacing one's shoes Jumping Drawing a cross

Drawing a 6-part man Lacing one's shoes

what factors affect the choice of pharmacologic intervntions for pain?

Drug being administered (IM/SQ) The child's status (can they keep oral med down) The type, intensity, and location of the pain Any factors that may be influencing the child's pain

classifications of pain?

Duration Acute or chronic (pain that persists for 3 months or longer than the expected period of healing) Etiology Nociceptive (damage to body tissue) or neuropathic (nervous pain) Source/location Somatic (skin, muscles, ligaments) or visceral (organ pain)

During the preschool years, female children may develop a strong attachment to their fathers. What is this attachment called? Oedipus complex Freudian complex Sexual identification complex Electra complex

Electra complex

A nurse is admitting a 16-year-old male to the floor for an appendectomy. How can the nurse prepare this client for hospitalization? Select all that apply.

Encourage him to keep his cell phone nearby to communicate with his friends. Interview the adolescent separately from the parent to allow expression of information that he may not be comfortable sharing in front of the parent. Provide privacy when client is changing into the hospital gown or going to the bathroom.

An 8-year-old boy's foster mother is concerned about three recent cavities found in his permanent teeth and reports the child eats a nutritional diet, doesn't eat junk food, and the town water supply is fluoridated. Which suggestion should the nurse prioritize to this mother in regard to the child's dental health?

Ensure that the child brushes his teeth after each meal and snacks. Explanation: Proper dental hygiene includes a routine inspection and conscientious brushing after meals. A well-balanced diet with plenty of calcium and phosphorus and minimal sugar is important to healthy teeth. Foods containing sugar should be eaten only at mealtimes and should be followed immediately by proper brushing. The school-aged child should visit the dentist at least twice a year for a cleaning and application of fluoride.

A nurse is presenting a class on discipline for a group of parents of toddlers. What information would be important for the nurse to teach this group? Select all that apply. Toddlers cannot learn self-control until at least 3 to 4 years of age. Even at this young age, children need boundaries. If a child does something wrong, the parent must address the behavior immediately so the child understands what they did wrong. Consistency in the rules is important so the child understands what is expected. If a child hits or bites another child, the parents should scold them, saying such things as "You are very naughty for biting Rachel."

Even at this young age, children need boundaries. If a child does something wrong, the parent must address the behavior immediately so the child understands what they did wrong. Consistency in the rules is important so the child understands what is expected. Discipline for toddlers must have consistency and correct timing. Parents need to come to a consensus on how to discipline their child and do so consistently and in a unified fashion. Also, the toddler needs to receive negative feedback for negative behavior as soon as the infraction occurs so the child understands what they did wrong. Parents should never label the child as bad, just their behavior. Every child needs boundaries—it is just that every family's boundaries may vary. Discipline begins early in life and toddlers can learn self-control.

The nurse is assessing a teenage client and notes his lower front teeth are slightly crossed over. The nurse points out to his caregiver that he should see an orthodontist about this to prevent which potential situation? Leaving even slightly crooked teeth will lead to more cavities later in life. This could have a lasting effect on his future to include everything from dating to hiring. Even slight malocclusions make chewing and jaw function less efficient. Uncorrected malocclusions lead to infection and ultimately tooth loss.

Even slight malocclusions make chewing and jaw function less efficient.

Even slight malocclusions make chewing and jaw function less efficient. Explanation: Dental malocclusion (improper alignment of the teeth) is a common condition that affects the way the teeth and jaws function. Correction of the malocclusion with dental braces improves chewing ability and appearance. Crooked teeth do not lead to more cavities, nor do they lead to infection and tooth loss. While appearance and acceptance in society is important to the adolescent, that is not the most important reason for orthodontic care for the adolescent.

The nurse is performing a health surveillance visit with a 12-year-old boy. Which characteristic suggests the boy has entered adolescence?

Experiences frequent mood changes Explanation: If the boy has just entered adolescence, he is likely to exhibit frequent mood changes. A growing interest in attracting girls' attention and understanding that actions have consequences are typical of the middle stage of adolescence. Feeling secure with his body image does not occur until late adolescence.

The nurse is talking to the mother of a 19-month-old girl about setting limits and supervising activities. In which situation will the nurse recommend letting the child do as she pleases? Choosing her own foods Exploring her body Playing on the picnic table Deciding her bedtime schedule

Exploring her body It is normal for toddlers to explore their genitals when they are undressed. The parent should allow this and not punish the child. Choosing food and deciding bedtimes need to be done by an adult. Likewise, safety dictates that the picnic table is not a safe play area.

different pediatric pain assessment tools?

FACES pain rating scale (ages 3+-7/8, emoticon-like faces) Oucher pain rating scale (ages 3+, actual photos of children, must know number values) Poker chip tool ( ages 3+, uses 1 to 4 poker chips to describe pain) Visual analog and numeric scales (ages 5+, scales of 0-10) Adolescent pediatric pain tool (ages 8 to 15, measures pain location, intensity, and quality)

The nurse is assessing a 3-year-old child. Which assessment finding would the nurse identify as abnormal? Pedals tricycle without assistance. Unscrews a bolt on a toy. Falls when bending over to touch toes. Builds a tower of 10 cubes.

Falls when bending over to touch toes.

Active play has decreased in recent years as television viewing and computer games have increased. This trend has resulted in health risks such as early onset of arthritis, mental dysfunction, and decreased blood pressure.

False

In reference to physical growth, the differences between girls and boys are more apparent at the end of the preschool years and may become extreme and a source of emotional problems.

False

With regard to growth and development of the school-aged child, the term industry defines ways to develop nutritious meal plans.

False

A toddler's "no" can best be eliminated by asking a question instead of making a statement. False True

False A toddler's "no" can best be eliminated by limiting the number of questions asked of the child. Making a statement instead of asking a question this way can avoid a great many negative responses.

What foods could a parent provide that would be the most beneficial to support healthy dentition for a school-aged child?

Fish, spinach salad and a glass of milk Explanation: A well-balanced diet rich in calcium and phosphorus fosters healthy teeth. Minimal sugar, a diet of whole grain breads, and fish and cheeses are all good sources of calcium and/or phosphorus. Sugary soda drinks and juices, pretzels and bagels, beef and sherbet do not provide substantial amounts of calcium or phosphorus.

The nurse is talking to a 13-year-old boy about choosing friends. Which function do peer groups provide that can have a negative result?

Following role models Explanation: Peers serve as role models for social behaviors, so their impact on an adolescent can be negative if the group is using drugs, or the group leader is in trouble. Sharing problems with peers helps the adolescent work through conflicts with parents. The desire to be part of the group teaches the child to negotiate differences and develop loyalties.

A toddler's mother reports that her child will only eat peanut butter and jelly sandwiches for several days in a row. The child will then refuse to eat them for several weeks. Which term would the nurse use to document this behavior? Echolalia Egocentrism Physiologic anorexia Food jag

Food jag During a food jag, the toddler may prefer only one particular food for several days, then not want it for weeks. Physiologic anorexia describes the fact that toddlers do not require as much food intake for their size as they did in infancy. Echolalia is repetition of words and phrases. Egocentrism describes the focus on self that is present in toddlers.

A 17-year-old adolescent chats excitedly with the nurse about plans for college and a career. The adolescent states having checked out every college in the region and determined which one is the best fit and would give the adolescent the best career options. The nurse recognizes which developmental aspect in this client?

Formal operational thought Explanation: The final stage of cognitive development, the stage of formal operational thought, begins at age 12 or 13 years and grows in depth over the adolescent years, though it may not be complete until about age 25. This step involves the ability to think in abstract terms and use the scientific method (deductive reasoning) to arrive at conclusions. With the ability to use scientific reasoning, adolescents can plan their future. They can create a hypothesis (What if I go to college? What if I do not?) and think through the probable consequences (In the long run, I will earn more money; I could begin earning money immediately). This scenario does not pertain to socialization, role identification, or sensorimotor development.

What is a true statement regarding developmental milestones of the 30-month-old? a) Triples birth weight b) Anterior fontanel closes c) Head circumference equals chest circumference d) Full set of primary teeth

Full set of primary teeth

A mother suspects that her 11-year-old son is experimenting with deliriants with his friends. Which symptoms would the nurse advise the mother to look for that would validate her concerns?

Giddiness and coughing Explanation: Inhalation of substances can cause numerous symptoms, including giddiness and coughing. The child will not experience diarrhea, hyperactivity or develop bad breath from experimenting with inhalants.

Which measure would you suggest an infant's parents use to relieve teething discomfort? a) Provide her with a fluid diet for 2 days. b) Ask her pediatrician for a sedative for her. c) Give her a cold teething ring to chew. d) Offer her Aspergum to chew.

Give her a cold teething ring to chew.

What teaching points would a nurse provide for families of school-aged children to help prevent substance abuse? Select all that apply.

Give the child "what if" examples to situations they may face. Set firm rules regarding alcohol and other drug usage and discuss consequences associated with breaking the rules. Encourage decision-making and discuss family values.

The nurse is teaching a mother of a 1-year old girl about weaning her from the bottle and breast. Which recommendation should be part of the nurse's plan? a) Wean from breast by 18 months of age at the latest. b) Wean from the bottle at 15 months of age. c) Switch the child to a no-spill sippy cup. d) Give the child an iron-fortified cereal.

Give the child an iron-fortified cereal.

The nurse is observing a 3-year-old boy in a day care center. Which behavior might suggest an emotional problem? Has persistent separation anxiety Goes from calm to tantrum suddenly Sucks his thumb periodically Is unable to share toys with others

Has persistent separation anxiety Separation anxiety should have disappeared or be subsiding by 3 years of age. The fact that it is persistent suggests there might an emotional problem. Emotional lability, self-soothing by thumb sucking, or the inability to share are common for this age.

A 15-year-old adolescent shows a pattern of gaining weight, not a large amount but a little more each visit. The adolescent is not active in any sports and eats out frequently with parents. What is the best way for the nurse to assess the adolescent's eating pattern? Have the adolescent keep a food diary for 1 week. Have the adolescent guess the calorie intake in a 24-hour period. Ask the adolescent to recall what was eaten in the last 3 days. Ask the adolescent to show the nurse what a healthy portion looks like.

Have the adolescent keep a food diary for 1 week.

Have the adolescent keep a food diary for 1 week. Explanation: Having the adolescent keep a food diary over 1 week allows the nurse as well as the client to examine what the client eats and when the client is eating it. Keeping a food journal allows a discussion of the choices made and the substitutes that the client could possibly make. The times that the client eats may also lead to weight gain. Asking for recall of 3 days' intake would be difficult, and most information would be inaccurate due to forgetting some item of food intake or when the food was eaten. Most people have no idea how many calories are in a food item unless they are specifically counting calories for dieting or health reasons. An adolescent would have a difficult time demonstrating a healthy portion size unless it has been demonstrated first.

The parents of a 16-year-old male are worried about recent changes in his behavior, ignoring his schoolwork and sports, and spending almost all of his free time interacting with his girlfriend. Which suggestion should the nurse point out would best address this situation? He has chosen a girl who is overly dependent on him. They should talk to him about making sure he meets his own needs, including doing the schoolwork he enjoys, in any relationship. He has developed his own identity by now; being able to establish close relationships with girls is important preparation for all of his adult relationships. They should honor his need to be with, or talk to, his girlfriend as long as he has completed his schoolwork for the day. He is not developmentally mature enough to make healthy choices about the ways in which he spends his time, so it would be helpful if they would make a schedule for him that includes about a half-hour per day to talk with his girlfriend. He is not developmentally mature enough to have an intimate relationship with one girl; they should encourage him to spend time with groups of friends rather than time alone with his girlfriend.

He has developed his own identity by now; being able to establish close relationships with girls is important preparation for all of his adult relationships. They should honor his need to be with, or talk to, his girlfriend as long as he has completed his schoolwork for the day.

Which intervention would probably be most effective in preventing an adolescent from attempting suicide with an overdose again? Helping to learn better problem solving Helping to locate a close friend at school Assessing financial situation Teaching the parents to keep medicine in a locked cabinet

Helping to learn better problem solving

Which intervention would probably be most effective in preventing an adolescent from attempting suicide with an overdose again?

Helping to learn better problem solving Explanation: Suicide is a solution when there does not appear to be any other solution. It is the leading cause of death in 10- to 24-year olds. Some of the risk factors for suicide include a history of a previous suicide attempt, substance use disorder, depression, poor school performance, and family disorganization. Helping an adolescent learn better problem solving can help prevent a second attempt. Keeping medications locked may be a good safety practice but it does not solve the adolescent's depression and the underlying reason the adolescent feels the need to commit suicide. The financial level is not indicative of a need to commit suicide. Suicide can occur in all socioeconomic levels. The adolescent who is alone and has no close friends at school is at higher risk for suicide. Helping the adolescent find a friend would be a positive action but it is not as important as helping the teen to make better choices and have better problem-solving skills.

The school nurse is assessing the nutritional status of an overweight 12-year-old girl. What question is appropriate for the nurse to ask?

How often does everyone in your family eat together? *Asking how often the family eats together is an appropriate question for the girl. All the others should be directed to the parents.

I get 7 hours of sleep every night so I don't know why I am so tired." Explanation: The average number of hours of sleep that teens require per night is 8.5 to 9.5 due to rapid growth that occurs during these years. Following a curfew and limiting distractions at bedtime can help provide the student with adequate hours of sleep each night.

The nurse is assessing a 4-year-old child. The child tells the nurse about her friend, Nancy, who lives in her room at home. The mother tells the nurse that Nancy is not a real person. The nurse would use which term when documenting this assessment finding? Animism Imaginary friend Magical thinking Preoperational thought

Imaginary friend

The school nurse is developing a school wellness program to promote healthy eating habits and regular physical activity. What is the most important element to emphasize to maximize compliance, healthy habits, and long-term change? Eliminate sweetened, carbonated beverages in the cafeteria. Incorporate activity in parts of the daily schedule. Include both parents and children in the wellness program. Serve fruits and vegetables in the cafeteria.

Include both parents and children in the wellness program.

The nurse is educating the mother of a 6-month-old boy about the symptoms for teething. Which symptom would the nurse identify? a) Increased biting and sucking b) Running a mild fever or vomiting c) Frequent loose stools d) Choosing soft foods over hard foods

Increased biting and sucking

pain management guide for children?

Individualize interventions based on the amount of pain experienced and the child's characteristics, such as developmental level, temperament, previous pain experience, and coping strategies Use nonpharmacologic and pharmacologic approaches to ease or eliminate the pain Teach the child and family about pain-relief interventions and techniques and discuss with the child and family expectations of pain management

A mother brings her 2-year-old child to the pediatrician's office, voicing concerns about her toddler's growth over the last year. According to the child's records, the toddler has gained 6 pounds (2.7 kg ) and grown 2.5 in (6.25 cm) since his last visit a year ago. How should the nurse respond to this mother's concerns? Tell the mother that she needs to return to the pediatrician's office in 3 months to re-weigh the child and measure his height for any changes. Inform the mother that her toddler's growth is within normal limits and there is nothing to be worried about. Tell her that her child's growth is less than is expected and gather a nutritional history on the child. Ask the mother if there are other small people in her family.

Inform the mother that her toddler's growth is within normal limits and there is nothing to be worried about. Normally, a toddler's growth is 5 to 10 pounds per year and about 3 inches in height. This child falls within the recommended parameters of growth and the mother has nothing to be worried about.

The nurse is talking with parents of a depressed 16-year-old boy. Which question is of the mostimportance? Does he exercise? Is there a gun in your home? Have his sleeping and eating habits changed? How is his personal hygiene?

Is there a gun in your home?

The nurse is talking with parents of a depressed 16-year-old boy. Which question is of the mostimportance?

Is there a gun in your home? Explanation: He may be at risk for suicide. Firearm-related suicides have been responsible for a large number of the suicide deaths in 15- to 19-year-olds nationwide. All the other questions assess for depression and do not protect against suicide.Is there a gun in your home?

The nurse is meeting with a group of caregivers of adolescents. Which example should the nurse point out is most effective for the caregiver to support the adolescent? Let them choose their hairstyle, even though it may not look the best for them. Our house rules are stricter than their friends but everyone follows the same rules in our home. Leave pamphlets about topics such as drugs and alcohol in their room so they can read them. Discourage spending too much time with school friends since we know they can be a negative influence.

Let them choose their hairstyle, even though it may not look the best for them.

The nurse is meeting with a group of caregivers of adolescents. Which example should the nurse point out is most effective for the caregiver to support the adolescent?

Let them choose their hairstyle, even though it may not look the best for them. Explanation: The adolescent whose family caregivers make it difficult to conform are adding another stress to an already emotion-laden period. By allowing the adolescent to follow trends and fads in clothing choices, hairstyles, and music, the caregiver decreases the stress for the child. Information about drugs and alcohol is important to share, but these topics would be better discussed with the child. It is important the adolescent spend time with peers.

A group of students is reviewing material about ways parents can help to foster a child's self-esteem. The students demonstrate a need for additional studying when they identify which method as promoting self-esteem? Acting as a coach rather than a cheerleader Showing respect and support to the child Using positive reinforcement while limiting criticism Limiting the choices and decisions that the child makes

Limiting the choices and decisions that the child makes To promote self-esteem, parents should praise the child's achievements, show respect and support to the child, allow the child to make decisions, listen to the child, and spend time with the child. The parents need to be a coach to the child rather than just a cheerleader who merely praises accomplishments.

The nurse is providing helpful feeding tips to the mother of a 2-week-old boy. Which recommendations will best help the child feed effectively? a) Encourage the infant to latch on properly b) Maintain a feed-on-demand approach c) Apply warm compresses to the breast d) Maintain adequate diet and fluid intake

Maintain a feed-on-demand approach

The family reports to the nurse that their adolescent always wants to argue, will not participate in family functions, and has poor school grades. What recommendation should the nurse make for an adolescent client who presents with these symptoms? Supervise homework sessions. Have the child visit the school counselor. Encourage participation in sports. Make an appointment with the health care provider.

Make an appointment with the health care provider.

What anticipatory guidance can the nurse provide the girl who has noted the development of breast buds?

Menarche should follow in about 2 years. Explanation: Menarche usually follows within 2 years of the first signs of breast development. Peak height velocity (PVH) in girls occurs 6 to 12 months following menarche. It does not follow immediately. Breast development progresses through several stages and will not be complete until late puberty. Adult height is not reached at the time of menarche but about 6 to 12 months following menarche.

The parents of a 16-year-old are fearful that their child may be using illegal drugs. They report to the nurse that they have noticed recently that their child seems much more focused when doing homework or chores, is losing weight, displays a high level of energy, and becomes agitated easily. The nurse is aware that the teen is displaying symptoms of which type of drug use? Opiate Inhalant CNS Depressant Methamphetamine

Methamphetamine

Methamphetamine Explanation: Euphoria, increased energy and alertness, agitation, weight loss, insomnia, tachycardia, and hypertension are symptoms of methamphetamine use. Stimulants have similar effects as alcohol but the high only lasts a few minutes and includes slurred speech, lack of coordination, euphoria, and dizziness. Opiates produce feelings of relaxation and euphoria. CNS depressants cause euphoria followed by depression or hostility, impaired judgment, decreased inhibitions, slurred speech, and incoordination.

The nurse is teaching the mother of a 2-month-old girl about the social and emotional developments that will occur in the next 8 weeks. Which behavior is most likely to occur? a) Crying when the mother is out of sight b) Becoming clingy around strangers c) Mimicking mother's facial expressions d) Participating in a game of peek-a-boo

Mimicking mother's facial expressions

required interventions when a child is receiving moderate (conscious sedation)

Moderate sedation is a medically controlled state of depressed consciousness Ensuring that emergency equipment is readily available Maintaining a patent airway Monitoring the child's level of consciousness and responsiveness Assessing the child's vital signs (especially pulse rate, heart rate, blood pressure, and respiratory rate) Monitoring oxygen saturation levels

A 3-month-old still has a Moro reflex. Which statement is most true of this reflex? a) A Moro reflex present at 3 months of age requires referral for a neurologic exam. b) Most 3-month-olds still have a Moro reflex. c) It is not important how long the reflex persists, only that it is present at birth. d) A Moro reflex normally lasts until 9 months.

Most 3-month-olds still have a Moro reflex.

A nurse is reading a journal article about adolescents and major causes of injuries in this age group. The nurse demonstrates understanding of this information by identifying which situation as the major cause of adolescent injuries? Drowning Motor vehicle crashes Suicide Violence

Motor vehicle crashes

The school nurse is preparing health promotion presentations regarding unintentional injuries for a high school health fair. On which topic should the nurse place as the priority when preparing the presentation?

Motor vehicle safety Explanation: All options should be included in the presentation, but motor vehicle safety has the highest priority because motor vehicle accidents are the leading cause of injury and death followed by poisoning, which includes prescription drug overdose.

Once temper tantrums have started, which intervention is appropriate? Engage the child's behavior. Move objects out of the way or move the child to prevent injury. Speak to the child during the tantrum. Have a long talk with the child regarding the tantrum.

Move objects out of the way or move the child to prevent injury. Appropriate interventions include moving objects out of the way or moving the child to prevent injury from occurring during the temper tantrum. The caregiver should not speak to the child and should avoid eye contact until the child has calmed down. The child's behavior should not be engaged. Do not talk excessively about the tantrum because this can negatively impact the child's self-esteem.

never give a child with a fever what?

Never give a child with a fever Aspirin! Can cause Reye's Syndrome (sudden brain damage and liver toxicity)

myths about children and pain

Newborns don't feel pain Exposure to pain at an early age has little or no effect later Infants and small children have little memory of pain Intensity of the child's reaction to pain indicates intensity of pain A child who is sleeping or playing is not in pain Children are truthful when asked if they are in pain Children learn to adapt to pain and painful procedures Children experience more adverse effects of narcotic analgesics than adults do Children are more prone to addiction to narcotic analgesics

The nurse is assessing the oral cavity of a 4-month-old infant. Which finding is consistent with a child of this age? a) 1 upper tooth b) No teeth c) 1 to 3 natal teeth d) 1 to 2 lower teeth

No teeth

Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in late adolescence? Lengthening of the penis Breast enlargement Reddening of the scrotum Nocturnal emissions

Nocturnal emissions

Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in late adolescence?

Nocturnal emissions Explanation: This involuntary ejaculation during the night can be disturbing to the adolescent male who has little or no understanding of what is happening in his body. Lengthening of the penis begins to occur in early adolescence as does reddening of the scrotum. Breast enlargement occurs in some males in middle adolescence and resolves in late adolescence.

biophysical interventions for pain management?

Nonnutritive sucking with sucrose (infants or toddlers) Heat and cold applications Massage and pressure

health history data related to pain assessment?

OLDCARTS Location, quality, severity, and onset of the pain, as well as the circumstances in which the child experiences the pain. Conditions, if any, that preceded the onset of pain and conditions that followed the onset of pain Any measures that increase or decrease the pain Any associated symptoms, such as weight loss, fever, vomiting, or diarrhea, that may indicate a current illness Any recent trauma, including any interventions that were used in an attempt to relieve the pain

While evaluating the development of 10-month-old boy, a nurse hides the boy's stuffed animal behind her back. The boy crawls around the examination table to look behind the nurse's back for the stuffed animal. Which developmental phenomena has this infant demonstrated? a) Binocular vision b) Object permanence c) Depth perception d) Hand regard

Object permanence

A 15-year-old girl is in the hospital for surgery and is confined to bed. The nurse can tell that the client is nervous about being in the hospital. She tells the nurse that she feels "gross" and "on display" in her hospital gown. What should the nurse do to encourage a sense of autonomy and dignity related to the girl's body image? Offer to assist the girl in washing her hair and let her pick the shampoo. Allow the girl to wear her own clothes, despite hospital policy. Assist the girl with using the bed pan to urinate. Brush the girl's hair for her.

Offer to assist the girl in washing her hair and let her pick the shampoo.

Offer to assist the girl in washing her hair and let her pick the shampoo. Explanation: When caring for hospitalized adolescents, providing time for self-care, such as shampooing hair, is important to include in an adolescent's nursing care plan. Offering to assist the client in washing her hair and letting her pick the shampoo both encourages a sense of autonomy to the client and offers her dignity related to her body image. Brushing the girl's hair for her and assisting her with using the bed pan for urination do not encourage a sense of autonomy. If it is the hospital's policy to require clients to be dressed in a hospital gown while admitted, the nurse should not allow the girl to wear her own clothes.

The nurse is providing teaching about good nondairy sources of calcium for preschoolers. Which of these fruits contains the most calcium? Orange Peach Apple Banana

Orange

Place the steps for using time-out as a disciplinary measure for a 4-year-old in proper order. 1Warn the child there will be a time-out if the behavior does not stop. 2Parent knows the misbehavior was intentional. 3Move the preschool-age child to a boring spot. 4Set a timer for no more than 4 minutes. 5If the child gets up, return the child to the time-out location and restart the time.

Parent knows the misbehavior was intentional. Warn the child there will be a time-out if the behavior does not stop. Move the preschool-age child to a boring spot. Set a timer for no more than 4 minutes. If the child gets up, return the child to the time-out location and restart the time.

A preschool-age child tells the nurse about an imaginary friend. The parents are concerned because the child refuses to do anything without the friend's help. Which nursing diagnosis is most applicable for the family? Parental anxiety related to lack of understanding of childhood development Social isolation related to unwillingness to relate except through imaginary friend Disturbed thought processes related to deep-set psychological need Compromised family coping related to abnormal behavior of child

Parental anxiety related to lack of understanding of childhood development

A nurse is caring for a hospitalized 10-year-old child. What would be an appropriate activity for this child to meet the developmental tasks of this age group?

Participating in a craft project Explanation: During this stage, the child is interested in how things are made and run. The child learns to manipulate concrete objects. The child likes engaging in meaningful projects and seeing them through to completion. Playing jack-in-the-box and blocks are for much younger children. If anything, the child would be texting back and forth with friends, not writing a letter.

What activities would a nurse recommend to the families of school-aged children to promote attainment of Erikson's developmental stage of industry vs. inferiority? Select all that apply.

Participating on the school soccer team Praising the child for their academic efforts Allowing the child to assist her teacher in straightening up the classroom

What activities would a nurse recommend to the families of school-aged children to promote attainment of Erikson's developmental stage of industry vs. inferiority? Select all that apply.

Participating on the school soccer team Praising the child for their academic efforts Allowing the child to assist her teacher in straightening up the classroom Explanation: School-age children need support in order to achieve attainment of the developmental stage of industry vs. inferiority; parents can play a large role in the child accomplishing this. Encouraging participation in group sports, allowing children to assist their teacher and praising their academic efforts, even though they may not have made the best grade, are all ways to help the child accomplish this task. Expressing doubts about the child's abilities or defending them when they are not successful in accomplishing a skill only increases the chance the child will develop a sense of inferiority.

The mother of a 15-year-old boy expresses sadness to the nurse that her son is "much more connected to his friends than his family." What understanding would benefit this parent? Select all that apply. Adolescents need parental support and guidance as they move toward greater peer involvement. Parents should wait until the adolescent introduces them to their peers. Peers are needed for emotional security while stepping away from family. Peers provide opportunity to learn and practice social roles. Peers can be positive or negative influences.

Peers are needed for emotional security while stepping away from family. Peers provide opportunity to learn and practice social roles. Peers can be positive or negative influences. Adolescents need parental support and guidance as they move toward greater peer involvement.

Permit peers to visit during open visitation hours Explanation: In each stage of development, a significant person or group exerts a lasting influence on the ongoing development of the child. An adolescent striving for self-identity and increased independence spends more time with peers than with family. It is important for the hospitalized adolescent to still be able to visit with peers. Video games may be enjoyed by the adolescent and limit boredom; however, this action would not facilitate psychosocial development. Allowing the client to touch equipment to explain medical concepts and procedures are methods used to teach toddlers and preschoolers. Providing handouts and brochures are not effective methods to explain medical concepts; the nurse would verbally explain using models, pictures, and diagrams. Handouts and brochures can be used as supplements to teaching.

While caring for a 16-year-old client expected to be hospitalized for several months, the nurse will perform which action to assist the client in meeting the current stage of psychosocial development? Provide video games for the client to play. Allow the client to touch equipment before procedures. Permit peers to visit during open visitation hours. Explain medical concepts by providing handouts and brochures.

Permit peers to visit during open visitation hours.

A nurse realizes safety teaching has been successful when the parents identify which action to help prevent the leading cause of death in preschoolers? Washing hands after using the bathroom Placing the child in an approved car seat Using gates at the top of the stairs Putting latches on lower cabinets

Placing the child in an approved car seat

The nurse is presenting an in-service on the types of playing that children may engage in. The nurse determines the session is successful when the attending nurses correctly choose which example as representing cooperative play? Playing in an organized group with each other. Playing together in an activity without organization. Playing independently and are side-by-side. Playing apart from others without being part of a group.

Playing in an organized group with each other.

pediatric physiologic and behavioral pain assessment tools?

Premature Infant Pain Profile Neonatal Infant Pain Scale Riley Infant Pain Scale Pain Observation Scale for Young Children CRIES Scale for Neonatal Postoperative Pain Assessment FLACC Behavioral Scale for Postoperative pain in Young Children

A parent tells a nurse that the child has recently established some friendships for the first time. In which age group do you expect this child to be? Preschool Toddler Adolescence School age

Preschool

The nurse is promoting a healthy diet to the mother of a 6-month-old girl. What action would have the most effect on the infant's neurologic development? a) Adding fruit juice daily b) Establishing an adequate level of dietary iron intake c) Requiring more solid foods in the diet d) Promoting continuation of breastfeeding

Promoting continuation of breastfeeding

A female client tells the nurse about noticing an increase in weight and fat deposits during the past year. The nurse reviews the client's chart and recognizes that the client is most likely going through puberty. Which nursing action is most appropriate at this time? Provide reassurance that these are normal changes. Encourage increased exercise to control weight gain. Share what foods can be eaten on a low-fat diet to prevent fat deposits. Review dietary measures to assist in controlling weight gain.

Provide reassurance that these are normal changes.

Provide reassurance that these are normal changes. Explanation: Increased fat deposits and weight and height changes are normal as girls begin hormonal changes of puberty. During adolescence, girls are very sensitive about their appearance and experience a constant need for reassurance. Puberty is a period when children are very self-conscious about their overall appearance. Reassurance needs to be provided that increased fat deposits and weight and height changes are normal. Dietary management is indicated if a true weight problem is present, but healthy eating should be encouraged rather than dieting. Adolescents should be encouraged to participate in appropriate exercise programs. Dieting issues such as anorexia and bulimia can threaten the health of adolescents.

key principles of pain assessment (QUESTT)

Question the child Use a reliable and valid pain scale Evaluate the child's behavior and physiologic changes to establish a baseline and determine the effectiveness of the intervention Secure the parent's involvement Take the cause of pain into account when intervening Take action

The nurse is working with a group of 8-year-olds who are learning about the concept of conservation of numbers. Which activity will help teach this concept to these school-aged children?

Rearranging a group of coins first into a circle, then a triangle and then a square Explanation: In understanding the concept of conservation of numbers, the child understands that the number of objects does not change even though they may be rearranged. Conservation of weight can be accomplished by weighing different objects. Conversation of mass is demonstrated by forming vases out of clay.

Parents of a toddler describe how they handled their child's temper tantrum in a shopping mall. What action of the parents indicates need for additional teaching? Made sure the child was rested and not hungry before going to the mall Tried to refocus the child's attention as tantrum behavioral cues appeared Reasoned with the child to stop the behavior Remained relatively calm even though embarrassed

Reasoned with the child to stop the behavior The child having a tantrum is out of control, making reasoning impossible. Calmly bear hugging the child provides control, especially in a public place. The other actions are helpful in preventing a tantrum.

The mother of a 15-year-old boy confides in the nurse that she is concerned because her son is about to turn 16 and is pressuring her and her husband to buy him a motorcycle. Her husband is okay with the idea, but she is concerned about his safety. What information should the nurse mention to the mother regarding motorcycle safety? Select all that apply.

Require the son to wear a helmet. Require the son to wear long pants. Require the son to wear full body covering. Require the son to learn all relevant safety rules. Explanation: Equally dangerous as cars for adolescents are motorcycles, motorbikes, and motor scooters, which are appealing because of their low cost and convenience in parking. Both drivers and riders should wear safety helmets to prevent head injury; long pants to prevent leg burns from exhaust pipes; and full body covering to prevent abrasions in case of an accident. Advise adolescents who choose these forms of transportation to be as familiar with safety rules as automobile drivers and to wait until they are emotionally mature enough to use sound driving judgment. In the interest of an adolescent's safety and that of others, parents need to have the courage to insist on emotional maturity rather than age as the qualification for obtaining a driver's license. Motorcycles do not have seat belts.

A nurse is preparing discharge teaching for a client being discharged with her newborn baby. What is the highest priority item that must be included in the teaching plan? a) Restrain the baby in a car seat. b) Lock all cabinets that contain cleaning supplies. c) Keep all pots and pans in lower cabinets. d) Give warm bottles of formula to the baby.

Restrain the baby in a car seat.

The nurse is providing education to a teen mother about her 20-month-old daughter's growth. The teen says her daughter seems to have such a big head. What information should the nurse include in the response? Teach the mother that this larger head than body appearance will be this way until the child is about 6 years old. Share that the heads of children at this age are large in proportion to the rest of their body. Some children have large heads but that does not signal a problem. Explain that the child looks normal.

Share that the heads of children at this age are large in proportion to the rest of their body. Head circumference increases about 1 inch between 1 and 2 years of age, then increases an average of a half-inch per year until age 5. The anterior fontanel should be closed by the time the child is 18 months old. Head size becomes more proportional to the rest of the body near the age of 3 years.

A 17-year-old male adolescent on the high school swim team tells the nurse that during swim season he cuts the carbohydrates in his diet to 30% to help his swim times. What responses by the nurse are appropriate? Select all that apply.

Since you are so active, your carbohydrate intake should comprise 45% to 65% of your daily diet." "Can you tell me the reason you feel the need to cut your carbohydrates when your activity level is high?"

Which developmental milestone would the nurse expect an 11-month-old infant to have achieved? a) Building a tower of four cubes b) Sitting independently c) Turning a doorknob d) Walking independently

Sitting independently

Which milestone would you expect an infant to accomplish by 8 months of age? a) Pulling self to a standing position b) Being able to sit from a standing position c) Creeping on all fours d) Sitting without support

Sitting without support

What suggestions regarding the evaluation of a childcare center would the nurse share with a preschooler's mother? Research local newspapers to see if there are any complaints against the center. The longer the center has been in operation, the better it is. Specific program goals to be accomplished should be available. A ratio of 10 children to 1 teacher is adequate.

Specific program goals to be accomplished should be available.

What suggestions regarding the evaluation of a childcare center would the nurse share with a preschooler's mother? The longer the center has been in operation, the better it is. Specific program goals to be accomplished should be available. A ratio of 10 children to 1 teacher is adequate. Research local newspapers to see if there are any complaints against the center.

Specific program goals to be accomplished should be available.

Which action would provide an indication that an adolescent's parents understand their child's need for increased independence? Saying, "We will always be here for her whenever our child needs us." Stating they are encouraging their child in the search for an after-school job Verbalizing, "We try to do everything we can to make things easier for her." Reporting they understand that their child's chief need is for increased privacy

Stating they are encouraging their child in the search for an after-school job

A stay-at-home father wants to purchase commercial toddler meals because his 16-month-old girl recently choked on table food. Which food items will the nurse suggest not be given to this child? Select all that apply. Sticky foods like peanut butter alone, gummy candies, and marshmallows Hard foods such as nuts, raw carrots, and popcorn Round foods such as hot dogs, whole grapes, and cherry tomatoes Fruits such as peaches, pears, and kiwi Vegetables such as corn, green beans, and peas

Sticky foods like peanut butter alone, gummy candies, and marshmallows Hard foods such as nuts, raw carrots, and popcorn Round foods such as hot dogs, whole grapes, and cherry tomatoes To offer soft round foods safely, cut hot dogs in uneven pieces and cut grapes and cherry tomatoes into quarters. This prevents food impacting in an airway. Avoid the hard and sticky foods due to aspiration and airway occlusion risks. The cooked vegetables listed are safe as are the soft fruits.

Put the following developmental milestones related to an infant's hearing in correct chronological order: 1 Stop activity in response to spoken word 2 Locate sounds made above 3 Locate & turn toward sound in any direction 4 Turn head to locate sound 5 Recognize name when spoken 6 Locate sounds downward and to side

Stop activity in response to spoken word Turn head to locate sound Locate sounds downward and to side Locate sounds made above Recognize name when spoken Locate & turn toward sound in any direction

The school nurse is preparing a presentation for a group of teachers about teen suicide. When discussing risk factors for this occurrence which should be included? Select all that apply.

Substance use disorder History of mental illness Homosexuality

A 16-year-old client has been hospitalized 100 miles from home for 1 week to repair a fractured patella suffered in a skateboarding accident. She was cheerful and chatty when she first arrived, but the nurse notes in recent days she has become increasingly quiet and seems lonely. Which nursing intervention should the nurse prioritize for this client? Suggest that she read books and magazines from the hospital bookmobile. Ask her caregivers to bring her siblings and friends to visit. Call the hospital's mental health unit to see if she can get some counseling. Take her to the teen lounge so she can meet other teens, use a phone, and check her email.

Take her to the teen lounge so she can meet other teens, use a phone, and check her email.

Take her to the teen lounge so she can meet other teens, use a phone, and check her email. Explanation: Adolescents need access to their peers so they can keep up social contacts. Access to a phone, computer, and email will help the teen stay connected. Recreation areas are important. In settings specifically designed for adolescents, recreation rooms can provide an area where teens can gather to do schoolwork, play games and cards, and socialize. Because she is 100 miles from home, a visit from friends might be difficult.

The nurse is caring for several clients on the pediatric unit. When interacting with the preschool-age child, which action does the nurse predict will occur? Increased attention span and can be interested in an activity for a long length of time Grows and develops skills more rapidly than at any other time in their life Insists doing something and the next moment reverts to being dependent Takes in new information at a rapid rate and asks "why" and "how"

Takes in new information at a rapid rate and asks "why" and "how"

What activity would best foster the developmental task of an adolescent who uses a wheelchair to ambulate? Talking to another adolescent who has a similar situation Watching television on the set in the adolescent's room Having a teacher bring school work to the adolescent Allowing the adolescent to decide when to bathe

Talking to another adolescent who has a similar situation

An 18-year-old adolescent reveals the presence of nipple ring and is looking to get a tattoo in the next few months. What is the most important thing that the nurse can teach the adolescent at this time?

Tattooing carries risks such as infection, disease, and nerve damage. Explanation: The nurse needs to emphasize that tattoos and body piercing can be painful, and carry risks of complications such as infection, blood-borne diseases, keloids and granulomas, allergic reactions, excessive bleeding, nerve damage, or damage to the piercing site. Complications are more likely if a person tattoos oneself or has the tattoo done by a friend. The nurse needs to encourage the adolescent to seek the expertise of a trained technician, doctor, or nurse to have the piercing, tattooing, or branding done. There are developed safety rules for those who do piercing and

The nurse is preparing to participate in a community discussion on the needs of the adolescents in the local school. The nurse should point out which goal is the primary concern for these young individuals as the committee makes plans? They want to successfully complete activities. Each child is learning to do things on his or her own. Teens are busy developing their own personal identity. They understand and respond to discipline.

Teens are busy developing their own personal identity.

Teens are busy developing their own personal identity. Explanation: According to Erikson, the central task of adolescence is to develop unique personality and identity. The developmental task for the school-age child is to develop a sense of industry, and completing activities builds that feeling of confidence. Erikson's psychosocial developmental task for toddlers is to achieve autonomy (independence) and do things on their own. Learning to speak and to understand and respond to discipline are not developmental tasks, according to Erikson.

That must be hard for you to manage. Perhaps we can explore some strategies with her to establish more predictable sleep patterns." Explanation: It is common for adolescents to adopt habits of going to bed late and awakening late, especially on weekends. Despite the fact that this is common, it is not ideal; the nurse should explore strategies for changing the adolescent's behavior in a collaborative and inclusive manner. Simply communicating that it is unacceptable is unlikely to bring about change.

What is the best explanation of Erikson's theory of psychosocial development during adolescence? The adolescent faces many different decisions during the teen years concerning the future and the adult world. The adolescent develops many skills during the teen years that help them make educational and career choices. Cognitive development is cumulative; that is, what is learned is based on what has been known before. The adolescent thinks in the abstract and develops skills to participate in complex problem solving.

The adolescent faces many different decisions during the teen years concerning the future and the adult world.

hat is the best explanation of Erikson's theory of psychosocial development during adolescence?

The adolescent faces many different decisions during the teen years concerning the future and the adult world. Explanation: The main point of Erikson's theory on which the nurse should focus is that the adolescent faces many different decisions during the teen years concerning the future and the adult world. Piaget states that cognitive development is cumulative; that is, what is learned is based on what has been known before. It is true that the adolescent develops many skills during the teen years, which help adolescents make educational and career choices, and that the adolescent thinks in the abstract and develops skills to participate in complex problem solving. These aspects, however, are not central to Erikson's theory.

The nurse is assessing the psychosocial development of an adolescent. The nurse determines that the client is in the middle post-conventional phase with which observation?

The adolescent tells the nurse, "I'm starting to think that some of my friends care a lot more about what other people think of them than what I do." Explanation: According to Kohlberg, the middle post-conventional phase is characterized by the adolescent developing their own set of morals by evaluating individual morals in relation to peer, family, and societal morals. This is demonstrated when the adolescent stated. "I'm starting to think that some of my friends care a lot more about what other people think of them than what I do." The early post-conventional phase is characterized by asking broad, usually unanswerable questions about life such as the question about God. During the late post-conventional phase the adolescent internalizes their own morals and values, and continue to compare own morals and values to those of society. During this phase the adolescent also evaluates morals of others. The statements regarding the rich in society and work ethic demonstrate this late phase.

The nurse is admitting a 15-year-old adolescent to the hospital pediatric unit. What does the nurse recognize as a priority for this adolescent? The adolescent should be given freedom to participate in unit activities as desired. The adolescent's need for privacy should be respected. The adolescent should be encouraged to call friends often. The adolescent's need for parental support should be discussed.

The adolescent's need for privacy should be respected.

Parents of an 11-year-old child are bewildered that their child was caught stealing. The nurse bestsupports the parent by explaining which?

The child had a strong desire to have the item with little other way of obtaining it. Explanation: The nurse must consider the age of the child and compare with stages in moral development. The nurse would point out that the desire to have an item may have overcome the child's sense of right and wrong.

In discussing their 2-year-old's behavior with the nurse, which of the parents' statements suggests the child may be ready for toilet teaching? The child frequently repeats words parents just said. The child often removes her shoes and socks. The child hides behind her bedroom door when defecating. The toddler walks with a wide, swaying gait.

The child hides behind her bedroom door when defecating. Hiding while defecating indicates awareness of this need. Repeating words promotes language development but doesn't indicate readiness for toilet teaching. Walking with a wide, swaying gait is early walking behavior. Steady walking and running signals toileting readiness. Removal of shoes and socks is easily done. Greater fine motor clothing removal skill is needed for toileting.

A 4-year-old child is drawing with crayons. Which creation by the child would most be reflective of the anticipated skill level of this age? The child is able to proficiently draw several letters of the alphabet. The child draws a person with 6 body parts. The child is able to draw shapes such as circles and squares. The child draws random lines on the paper and reports it is a person.

The child is able to draw shapes such as circles and squares.

44s Report this Question A 10 year-old child on the oncology unit has attended mass every Sunday in the hospital chapel during every stay in the facility. What does the nurse suspect is the most likely reason for this attendance?

The child is comforted by participating in the rituals associated with their religion Explanation: While any of these scenarios could be true in some circumstances, the most common reason most children attend services while being hospitalized is that they find comfort in participating in their religious practice rituals.

The nurse is assessing the psychosocial development of a 10-year-old child. What observations would lead the nurse to determine that the child is not achieving the developmental task of Erikson's industry versus inferiority? Select all that apply.

The child tries out for various teams at school but does not make any of them The child is an average soccer player and the parents enforce 1 to 2 hours of practice per day Explanation: During the task of industry versus inferiority, the child is developing his or her sense of self-worth by becoming involved in multiple activities at home, at school, and in the community. It is important to nurture and encourage the child in areas the child enjoys in order to increase self-worth and self-esteem. Setting expectations too high can cause the child to feel inferior and incompetent.

The nurse is assessing development of a 4-month-old boy during a well-child visit. Which observation needs further investigation? a) The infant makes babbling sounds, coos, and smiles. b) The infant shows interest in looking at near or high-contrast objects. c) The infant responds to his mother when he sees her but not at other times when she is near. d) The infant turns his head in the direction of a squeak toy.

The infant responds to his mother when he sees her but not at other times when she is near.

The nurse is reviewing topics to be discussed with caregivers related to caring for infants. Which of the following statements would be the most appropriate statement for the nurse to make to this group of caregivers? a) The infant should be dressed more warmly than older children and caregivers b) The infant sleeps 10-12 hours at night and take 2-3 naps during the day c) The infant should wear hard-soled shoes in order to protect their feet from injury d) The infant should be sound asleep before being put into the crib for sleeping

The infant sleeps 10-12 hours at night and take 2-3 naps during the day

Using knowledge of normal growth and development, which of the following would be expected when observing a 12-week-old infant? a) The infant smiles at significant others b) The infant bears weight on legs when held in standing position c) The infant grasps objects and brings them to the mouth d) The infant is able to sit up and can roll over

The infant smiles at significant others

A nurse, who is also a mother of a 2-year-old child, attends a party at a friend's house and notes some safety concerns that she would like to share with the other mother privately. Which observations during the party would be considered a safety concern that should be addressed privately when appropriate? Select all that apply. The safety gate/fence surrounding the pool area is secure and a little hard, even for parents, to unlatch. Only toddlers with helmets on are allowed to ride the tricycle. The parent is busy entertaining guests and did not notice the toddler running out in the neighborhood street to get a toy. The nurse/mother notes that the toddler's car seat is located in the passenger front seat. The parents allow the toddler to climb up on the counter and watch as food is stirred on the stove.

The parent is busy entertaining guests and did not notice the toddler running out in the neighborhood street to get a toy. The nurse/mother notes that the toddler's car seat is located in the passenger front seat. The parents allow the toddler to climb up on the counter and watch as food is stirred on the stove. Toddlers' motor ability jumps ahead of their judgment. To prevent serious injury, the nurse should teach parents to be alert as to what their toddler is doing at all times (like climbing on a countertop next to a stove). Toddlers have no judgment concerning moving cars so they walk across streets with no regard for oncoming cars. Toddlers need to ride in a car seat with a five-point restraint placed in the back seat (not the front seat) so the child is not struck by the passenger seat airbag. Toddlers need to wear a helmet as soon as they begin riding a tricycle. Because they cannot swim well, parents need to check whether backyard pools—another area prone to unintended injury—are securely fenced.

The physician has made a notation in the medical record of a 17-year-old that the teen is not demonstrating successful completion of Erikson's stages of development. What behavior would be consistent with this assessment? The teen is anxious to move away from his parent's home. The teen is uncertain and frequently unable to make decisions. The teen is sexually promiscuous. The teen is distrustful of others.

The teen is uncertain and frequently unable to make decisions.

The nurse is assessing the sleeping practices of the parents of a 4-month-old girl who wakes repeatedly during the night. Which parent comment might reveal a cause for the night waking? a) If she is safe, they lie her down and leave. b) They put her to bed when she falls asleep. c) They sing to her before she goes to sleep. d) The child has a regular, scheduled bedtime.

They put her to bed when she falls asleep.

A toddler's father is concerned because his son refuses to share. What is your best response concerning this? Behavior modification techniques can change the child's behavior. His son is probably reacting to some family crisis. Play time with other children should be cut back until he learns to share. This is normal toddler behavior; sharing is learned later.

This is normal toddler behavior; sharing is learned later. Sharing is not usually learned until the preschool period; toddlers play parallel to each other.

The father of a 15-year-old daughter is concerned she is not getting adequate nutrition to play high school basketball. Her games are on Friday nights. Which suggestion should the nurse point out will best suit the needs of this adolescent? Three daily meals that include choices from each of the food groups; Friday's lunch eaten around 2 p.m. with a small amount of fat and a somewhat larger than usual portion of complex carbohydrates. Boiled eggs with bacon or ham and a glass of orange juice for breakfast on Thursday and Friday mornings along with some sliced turkey and a salad at noon on Friday. Three daily meals that include choices from each of the food groups with an additional serving of fruit and several extra glasses of water on Friday. Pasta with a small amount of meat sauce and two slices of bread for dinner on Wednesday and Thursday evenings and again at 2 p.m. on Friday.

Three daily meals that include choices from each of the food groups; Friday's lunch eaten around 2 p.m. with a small amount of fat and a somewhat larger than usual portion of complex carbohydrates.

The pediatric nurse is discussing the daily activities of a 4-year-old with the caregiver to assess growth and development status. The nurse would document that the child has reached the initiative stage of development if the caregiver indicates the child participates in which activity? Tries to sweep up spilled cereal but cries when can't do well Gets upset when a babysitter is in charge, but will do what is asked by the babysitter Refuses to hold anyone's hand while crossing the street Broke a dish but blamed it on some friend the caregivers don't know

Tries to sweep up spilled cereal but cries when can't do well

Sonograms demonstrate thumb sucking as early as in utero. a) False b) True

True

The best way for a parent to handle a temper tantrum by a toddler is to calmly express disapproval and then ignore it. False True

True Probably the best approach is for parents to tell a child simply they disapprove of the tantrum and then ignore it. They might say, "I'll be in the bedroom. When you're done kicking, you come into the bedroom, too." Children who are left alone in a kitchen this way will usually not continue a tantrum but will stop after 1 or 2 minutes and rejoin their parents. Parents should then accept the child warmly and proceed as if the tantrum had not occurred. This same approach works well for nurses caring for hospitalized toddlers.

The nurse at a family health clinic is teaching a group of parents about normal infant development. What patterns of communication should the nurse tell parents to expect from an infant at age 1? a) Uses speech-like rhythm when talking with an adult b) Understands "no" and other simple commands c) Squeals and makes pleasure sound d) Uses multisyllabic babbling

Understands "no" and other simple commands

The nurse is explaining safety precautions for toddlers to the mother of a normal 30-month-old boy. Which activity might the nurse suggest may be done without supervision? Undressing himself Playing in the basement Eating a mid-afternoon snack Turning on the bath water

Undressing himself The child would be capable of safely dressing or undressing himself with some success. Turning on the bath water, playing in the basement, or eating a mid-afteroon snack could present significant risk for injury if not supervised.

A nurse is developing a teaching plan for parents of preschoolers about how to address the issue of strangers and safety. Which would the nurse expect to include in the teaching? Select all that apply. Urge your children to report others who are bullying. Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable. Teach your children to say "no" to anyone whose touching makes them feel uncomfortable. Wait until children are old enough to tell them how to call for help in an emergency. Urge children never to talk to or accept a ride from a stranger.

Urge children never to talk to or accept a ride from a stranger. Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable. Urge your children to report others who are bullying. Teach your children to say "no" to anyone whose touching makes them feel uncomfortable.

The nurse is caring for the family with a 2-month-old boy with colic. The mother reports feeling very stressed by the baby's constant crying. Which intervention would provide the most help in the short term? a) Educating the parents about when colic stops b) Assessing the parents' care and feeding skills c) Urging the baby's mother to take time for herself away from the child d) Watching how the parents respond to the child

Urging the baby's mother to take time for herself away from the child

The nurse is examining an 8-month-old girl for appropriate development during a regular check-up. Which observation points to a developmental risk? a) Uses only the left hand to grasp b) Crawls with stomach down c) Picks up small objects using entire hand d) Cannot pull self to standing

Uses only the left hand to grasp

Parents and their 35-month-old child have returned to the clinic for a follow-up appointment. Which of the findings may signal a speech delay? Asks "why" often Uses two-word sentences or phrases Half of speech understood by outsider Talks about a past event

Uses two-word sentences or phrases A child nearly 3 years of age should speak in three- to four-word sentences. The other findings indicate normal expressive language for the age.

The school nurse is preparing to conduct routine health screenings of the elementary school students. Which screening will the nurse prioritize for students ages 6 to 8? You Selected:

Vision and hearing Explanation: Vision and hearing screening are often conducted by the school nurse, who then alerts the caregivers if there is a need for further evaluation from the primary care provider. Most states have immunization requirements that must be met when the child enters school. Signs of scoliosis are usually evaluated at about the age of 10 to 11 years. There are no specific tests which the school nurse would use to evaluate nutrition; however, the nurse would be monitoring all students who come to the nurse's office for potential nutritional situations as deemed appropriate.

With summer approaching, the nurse discusses sun safety with a group of teen girls. Which suggestion is most likely to be followed? Wear sunglasses. Wear a hat when in the sun. Do not attempt to get a tan. Limit sun exposure between 10:00 AM and 2:00 PM.

Wear sunglasses.

The nurse will monitor which adolescent client most closely for the risk of suicide? a homosexual client who is failing two high school courses and refusing prescribed medication a homosexual client requesting the nurse have the client's necklace and whose parents divorced last month a heterosexual client diagnosed with multiple personality disorder requesting no visitors a heterosexual client with a history of cocaine use whose best friend moved hours away last week

a homosexual client requesting the nurse have the client's necklace and whose parents divorced last month

A 15-year-old adolescent is seen at a health care facility for facial acne. When counseling the teen, the nurse would teach that the basic cause of acne is:

activation of androgen hormones. Explanation: Acne occurs in adolescence as the result of hormone influence. With increased androgen production the sebaceous glands become more active. With increased testosterone production (in both boys and girls) increased sebum is produced. These increased hormone productions lead to the development of acne. Showering will certainly lead to cleaner skin and the removal of oils but the lack of showering does not cause acne. Diet and thyroid hormones do not play a role in the development of acne.

The best way for parents to aid a toddler in achieving his developmental task would be to: allow him to make simple decisions. urge him to dress himself completely alone. help him learn to count. give him small household chores to do.

allow him to make simple decisions. Making decisions is primary practice toward achieving independence.

The way you would advise a toddler's mother to handle temper tantrums would be to: appear to ignore them. promise him a special activity if he will stop. distract him with a toy when he begins holding his breath. mimic his behavior by also holding her breath.

appear to ignore them. Rewarding temper tantrums can teach children that they are an effective method of interaction. Ignoring tantrums teaches the child that they are ineffective.

The mother of an infant asks you when to begin tooth brushing with her son. Your best response would be a) as soon as the first tooth erupts. b) as soon as he begins to eat fruit. c) when weaning is complete. d) by 12 months of age.

as soon as the first tooth erupts.

A 4-year-old girl has begun stuttering. Which practice by the parents will the nurse discourage? looking at the child while she is speaking asking the girl to slow down and to think before she talks enunciating clearly and slowing down parental speech giving the child opportunity to speak and finish her ideas

asking the girl to slow down and to think before she talks

School ____________, defined as frequent absences or academic disengagement, occurs in approximately 5% of school-age children.

avoidance

common adverse events associated with use of opioid medications?

constipation (with chronic use) pruritus (not an allergic reaction, IV morphine can cause itchiness, they arent allergic) N/V

how do we tell if baby is in pain?

crying heavily tense arms not relaxed body

The nurse is assessing the pain of a 3-year-old child. Which of the following pain assessment scales would be most appropriate? a. Visual analog scale b. Visual numeric scale c. Word-graphic rating scale d. FACES pain rating scale

d. FACES pain rating scale. The FACES pain rating scale would be most appropriate for a 3-year-old. Rationale: The FACES pain rating scale is a self-report tool that can be used by children as young as 3 or 4 years of age. The word-graphic rating scale is useful for children between 4 and 17 years old. The visual analog scale can be used with children 7 years or older. The numeric scale can be used with children 8 years or older.

The adolescent comes to the clinic seeking information about sexuality concerns. The clinic nurse assures the adolescent that confidentiality and privacy will be maintained unless a life-threatening situation occurs. Maintaining confidentiality demonstrates which nursing goal? Select all that apply. inappropriate response because adolescents are minors compliance with existing laws concern from parents who pay the office visit bill development of a trusting relationship an environment where adolescents can be truthful

development of a trusting relationship compliance with existing laws an environment where adolescents can be truthful

Define Scaling

dry, flaking skin

FLACC?

facial expression legs activity cry consolable

Define macule

flat, reddened area on the skin

Parents of a 3½-year-old indicate they spend time with grandparents who live near a lake. The nurse will emphasize: enrolling the child in swimming lessons. using and renewing sunscreen regularly. adults learning infant/child cardiopulmonary resuscitation (CPR). having the child wear a personal flotation device whenever near or on the water.

having the child wear a personal flotation device whenever near or on the water.

According to Erikson, the adolescent develops his or her own sense of being an independent person with individual thoughts and goals. This stage is referred to as: intimacy vs. isolation. identity vs. role confusion. industry vs. inferiority. autonomy vs. doubt and shame.

identity vs. role confusion.

According to Erikson, the adolescent develops his or her own sense of being an independent person with individual thoughts and goals. This stage is referred to as:

identity vs. role confusion. Adolescents must develop their own personal identity—a sense of being independent people with unique ideals and goals. This is the period Erikson calls identity versus role confusion. Erikson believes during this time the adolescent goes back through all previous developmental periods to achieve this identity. The stage of autonomy versus shame and doubt occurs between 18 months and 3 years. Industry versus inferiority occurs between 5 to 12 years. Intimacy versus isolation occurs in adulthood between the ages of 19 to 40 years.

When planning how to respond to a 3-year-old child about telling stories ("tall tales"), the nurse would base the statement on the fact that: a 3-year-old knows the word two but not the concept of two. imagination in a 3-year-old is at its peak. preschoolers have a limited vocabulary. a preschooler is in an insecure period.

imagination in a 3-year-old is at its peak.

A staff nurse is talking about Piaget's theory with a nursing student. Infants are in the sensorimotor stage of cognitive development during which object permanence is mastered. An example of an infant displaying this ability is: a) pushing a spoon from her high chair tray to the floor. b) looking for a toy in her crib at the last place she saw it. c) shaking a rattle to enjoy the sound. d) smiling at herself in the mirror.

looking for a toy in her crib at the last place she saw it.

A school-aged child develops school phobia. When counseling her mother, the nurse would advise her that the accepted action is to:

make her child attend school every day. Explanation: School phobia may result from both a parent not wanting a child to attend school and a child not wanting to leave a parent. Th nurse's role is to help them work together while keeping the child in school to resolve the issue.

The most important safety precaution for parents to teach preschoolers is: not to ride in a car with strangers. not to watch their father mow the lawn. not to begin formal dance classes. to chew bites of food three times.

not to ride in a car with strangers.

when do we use pca pump

postop pain cystic fibrosis

The school-age years are a time of continued maturation of physical, social, and ___________________ development.

psychological

The nurse pulls the 5-month-old to sitting position from supine and notes head lag. The nurse's response is to: a) conclude the earlier assessments carried out fatigued the infant. b) refer the infant for developmental and/or neurologic evaluation. c) consider this a normal response for the age. d) suggest more awake tummy time for the child.

refer the infant for developmental and/or neurologic evaluation.

The best way for an infant's father to help his child complete the developmental task of the first year is to a) talk to her at a special time each day. b) respond to her consistently. c) expose her to many caregivers to help her learn variability. d) keep her stimulated with many toys.

respond to her consistently.

Why should we discourage parents from using any type of baby powder?

risk of aspiration- inhalation can cause pneumonitis

A 2-year-old holds his breath until he passes out when he wants something his mother does not want him to have. You would base your evaluation of whether these temper tantrums are a form of seizure on the basis that: seizures rarely occur in toddlers. with seizures, cyanosis rarely develops. seizures are not provoked; temper tantrums are. seizures typically occur with fever; temper tantrums do not.

seizures are not provoked; temper tantrums are. Temper tantrums occur because children are angry or frustrated; seizures occur without respect to provocation.

The nurse conducting a 6-month well-baby check-up assesses for the presence/absence of the asymmetric tonic neck reflex. At this age the reflex: a) is a protective reflex and retained for life. b) should be pronounced and easy to elicit. c) should have disappeared. d) is expected to appear within 1 month.

should have disappeared.

A nurse is providing an anticipatory guidance class on safety for parents of preschool-age children. Which interventions are important for the nurse to address during the class? Select all that apply. gun safety swimming lessons stranger awareness drug awareness bicycle safety

swimming lessons stranger awareness bicycle safety

Who is an ECG usually ordered for?

the child who suffered from an electrical burn- it can identify arrhythmias, which can be noted up tp 72 hours after a burn injury!!!

The father of an 11-year-old boy is worried that the child spends too much time watching TV. What information should the nurse share with this father? Select all that apply.

~The American Academy of Pediatrics recommends 2 hours or less of TV daily. ~Establish guidelines on when a child can watch TV. ~Watch programs together and discuss subject matter with the child. Explanation: The American Academy of Pediatrics recommendation is correct. The parents should establish guidelines on when the child can watch TV, such as after chores are completed. Using TV as a reward elevates its importance and may not decrease viewing time. Certain TV programs and video games have merit, yet both represent screen time with little activity difference between the two. The parents should watch TV with the child and use the opportunity to discuss the subject matter with the child.

The nurse is teaching the mother of a 5-month-old boy who is concerned about thumb sucking. What should be included in the teaching plan? Select all that apply. a) Telling the mother this behavior usually decreases by 6 to 9 months of age b) Informing the mother that thumb sucking occurs more often during periods of stress c) Advising the mother this behavior is a form of self-comfort d) Assuring the mother this behavior won't cause malocclusion

• Advising the mother this behavior is a form of self-comfort • Assuring the mother this behavior won't cause malocclusion • Informing the mother that thumb sucking occurs more often during periods of stress • Telling the mother this behavior usually decreases by 6 to 9 months of age

Which statements regarding infant safety are accurate? Select all that apply. a) Bottle should only be propped for infants 8 months or older b) Crib and playpen bars should be no more than 2 3/8 inches apart c) Only small pillows should be used in cribs d) A safe temperature for hot water heaters in households with infants is 120 degrees e) Car seats should be placed in back seats

• Crib and playpen bars should be no more than 2 3/8 inches apart • Car seats should be placed in back seats • A safe temperature for hot water heaters in households with infants is 120 degrees

The infant in the exam room has these signs and symptoms. Which will the nurse attribute to teething? Select all that apply. a) Fever and diarrhea b) Refusing to eat c) Irritability and awakening from sleep d) Drooling and biting e) Increased sucking on hands

• Refusing to eat • Irritability and awakening from sleep • Drooling and biting • Increased sucking on hands

12.The nurse is preparing a class for a group of adolescents about reducing the risk of skin cancer. Which of the following would the nurse include? A) Using a sunscreen with para-aminobenzoic acid (PABA) with an SPF of at least 10 B) Applying sunscreen at least 1 hour before going outside in the sun C) Avoiding sun exposure between the hours of 10 a.m. and 2 p.m. D) Using artificial UV tanning beds instead of sun exposure

Which of the following would you include when teaching the parents of an infant about colic? a) Their child will need future follow-up for a "nervous" bowel. b) Formula intake should be doubled to keep her from losing weight. c) Colic symptoms will probably fade at 3 months of age. d) Symptoms will decrease if she is laid on her back after feedings.

Colic symptoms will probably fade at 3 months of age.

The nurse is providing anticipatory guidance regarding the respiratory development of a 4-week-old girl for her mother. Which action is accurate? a) Informing the mother that the respiratory system reaches maturity similar to the adult's by 12 months of age. b) Advising the mother that the infant's usual respiratory rate should slow to about 20 breaths per minute by age 6 months c) Explaining to the mother the risk for infection is high due to the lack of antibodies d) Telling the mother that abdominal breathing disappears by 9 month of age

Explaining to the mother the risk for infection is high due to the lack of antibodies

Mark is a 2-month-old that has inconsolable crying, is gassy, and constantly draws his legs up. It has been determined that Mark has colic. What is the best intervention to treat colic? a) He needs to try a different formula to assess for sensitivity. b) He is hungry so his mom should feed him more. c) His parents should sing and play music to comfort him. d) His mom should have a regular diet.

He needs to try a different formula to assess for sensitivity.

The nurse is examining a 6-month-old girl who was born 8 weeks early. Which finding is cause for concern? a) The child measures 21 in (53 cm) in length. b) Head size has increased 5 in (12 cm) since birth. c) The child weighs 10 lb 2 oz (4.6 kg). d) The child exhibits palmar grasp reflex.

Head size has increased 5 in (12 cm) since birth.

A parent who is feeding his child formula prepared at home using evaporated milk is concerned about whether the child is receiving all necessary nutrients. Which of the following would be important for this parent to add to his child's diet to supplement the formula? a) Calcium b) Vitamins D c) Iron d) Vitamin E

Iron

The mother of a 3-month-old is concerned because her daughter does not yet sit by herself. Which of the following statements best reflects average sitting ability? a) Most babies do not sit steadily until 8 months; she is normal. b) Most babies sit steadily at 3 months; she is slightly delayed. c) Sitting ability and the age of first tooth eruption are correlated. d) Most babies sit steadily at 4 months; she is normal.

Most babies do not sit steadily until 8 months; she is normal.

The nurse is caring for a 5-week-old infant who is spitting up "all the time." This is the mother's first child. What should be the priority nursing intervention? a) Describe the capacity of a 5-week-old infant's stomach. b) Offer assurance that spitting up is normal. c) Observe the mother while she feeds and burps her infant. d) Recommend the mother offer smaller and more frequent feedings.

Observe the mother while she feeds and burps her infant.

A 12-month-old seen at a walk-in clinic weighed 8 pounds 4 ounces (3.75 kg) at birth. Weight now is 20 pounds 8 ounces (9.3 kg). The nurse determines: a) The weight assessment is blatantly inaccurate. b) The child weighs more than expected for age. c) The child weighs the expected amount for age. d) The child weighs less than expected for age.

The child weighs less than expected for age.

The mother of a 1-month-old infant voices concern about her baby's respirations. She states they are rapid and irregular. Which information should the nurse provide? a) The normal respiratory rate for an infant at this age is between 20 and 30 breaths per minute. b) The respirations of a 1-month-old infant are normally irregular and periodically pause. c) An infant at this age should have regular respirations. d) The irregularity of the infant's respirations are concerning; I will notify the physician.

The respirations of a 1-month-old infant are normally irregular and periodically pause.

At birth the newborn's head and chest circumference were measured. The nurse knows that the head should be about: a) ½ inch smaller than the chest b) Equal in size to the chest c) 2 inches larger than the chest d) 1 inch larger than the chest

1 inch larger than the chest

A 6-month-old arrives for a well-baby visit with a case of diaper rash. The baby's mother tells the nurse she is not concerned and believes this to be normal. She reports that she changes the baby's diaper when he wakes up and before she puts him in his crib for naps or bedtime. It would be important to teach this mother that she should start checking his diaper to see if it needs changing every a) 2-4 hours b) 1/2 hour c) 5 hours d) 1-1 1/2 hours

2-4 hours

The nurse is examining a 10-month-old boy who was born 10 weeks early. Which of the following findings is cause for concern? A) The child has doubled his birthweight. B) The child exhibits plantar grasp reflex. C) The child's head circumference is 19.5 inches. D) No primary teeth have erupted yet.

Ans: C Feedback: The child's head size is large for his adjusted age (7.5 months), which would be cause for concern. Birth weight doubles by about 6 months of age. Plantar grasp reflex does not disappear until 9 months adjusted age. Primary teeth may not erupt until 8 months adjusted age.

The nurse enters her patient's room to find the new mom crying softly. The nurse asks what is wrong. The mom says, "I had my heart set on breast-feeding and now my baby has a cleft lip. My dreams of breast-feeding him are destroyed." What should the nurse tell her patient about breast-feeding an infant with this diagnosis? a) " You can still attempt breast-feeding; let me call a lactation consultant for you." b) "I am so sorry your infant has that problem, maybe next time." c) "I am so sorry, looks like bottle-feeding for you." d) "Sometimes dreams do not come true."

" You can still attempt breast-feeding; let me call a lactation consultant for you."

A teen mom asks the discharge nurse if it is okay to sleep in bed with the baby. She says her mom always did it with her siblings and it seemed okay. The nurse should respond how? a) "Bed sharing has positive effects on babies, let me get you information." b) "Bed sharing is okay, just make sure the infant is between two people." c) "Sure, you can do whatever you want, it is your baby." d) "Sure, you can, make sure you use a soft mattress for support."

"Bed sharing has positive effects on babies, let me get you information."

The caregiver of an infant tells the nurse that her dentist told her not to let the child go to bed with a bottle of milk. The caregiver states she doesn't understand the reason for this since her baby seems to enjoy the bottle. The most appropriate response to this caregiver would be: a) "Giving a bottle of milk when the infant goes to bed can lead to obesity." b) "Giving your baby a pacifier at bedtime will satisfy the need to suck." c) "Bottles given at bedtime can cause erosion of the enamel on the teeth." d) "You could give your baby a bottle of water at bedtime occasionally."

"Bottles given at bedtime can cause erosion of the enamel on the teeth."

Martha asks the nurse if her 2-month-old could have baby bananas yet. The nurse would respond and educate Martha on the nutrition stages of infants by which of these responses? a) "Sure, if you feel she is ready to have bananas." b) "In one month you can try bananas if you think she is ready." c) "In two months you can try bananas if you think she is ready." d) "When did you feed your other child bananas?

"In two months you can try bananas if you think she is ready."

Debbie asks her nurse what she thinks about giving her baby a pacifier. Debbie is struggling with this issue and is very teary-eyed about making a decision. How should the nurse respond to Debbie? a) "I always gave my kids a pacifier." b) "You should never give babies pacifiers." c) "It is a personal decision, let me give you a pamphlet from the AAP." d) "You should do whatever you want."

"It is a personal decision, let me give you a pamphlet from the AAP."

Patty calls the hospital nursing hotline and asks, "My 8-week-old daughter cries 8 hours a day, and she is hard to console, is that normal?" What should the nurse's response be to this mother? a) "Yes, maybe she is just tired." b) "Yes, infants cry all the time at that age." c) "No, call your doctor." d) "Let me ask you some more questions to see if there are symptoms of colic."

"Let me ask you some more questions to see if there are symptoms of colic."

The nurse goes in to check on Lilly and how breast-feeding is going with her new son. The nurse observes the infant is on her lap with the blanket unwrapped, and Lilly is washing his face, and gently stroking the baby. Lily has had trouble breast-feeding the last few times. What is the appropriate response from her nurse? a) "Lilly, you are doing a wonderful job attempting to waken the baby." b) "Lilly, you will never get him to eat all unwrapped like that." c) "Lilly, maybe you should watch the breast-feeding video again." d) "Lilly, that is not how you get him to eat."

"Lilly, you are doing a wonderful job attempting to waken the baby."

The nurse comes into infant Lucy's room on the pediatric floor. She is going to try and feed her for the first time since her surgery. How does the nurse know what infant state Lucy is in by what Mom says and that it is okay to try and feed Lucy? a) "Lucy has been crying every time someone picks her up." b) "Lucy is so quiet today, that is not like her." c) "Lucy is still sleeping, I guess she is worn out." d) "Lucy has been a chatterbox and smiles just like her brother."

"Lucy has been a chatterbox and smiles just like her brother."

The mother of 1-week-old boy voices concerns about her baby's weight loss since birth. At birth the baby weighed 7 lb (3.2 kg); the baby currently weighs 6 lb 1 oz (2.8 kg). Which response by the nurse is most appropriate? a) "All babies lose a substantial amount of weight after birth." b) "Your baby has lost a bit more than the normal amount." c) "Your baby has lost too much weight and may need to be hospitalized." d) "Your baby's weight loss is well within the expected range."

"Your baby has lost a bit more than the normal amount."

A frustrated mother comes to a 9-month well-baby checkup complaining to you that her son is refusing all of the solid food she gives him. When talking with this mother, the nurse discovers that she has struggled all her life with a weight problem. She attributes this problem to being forced to eat all of the food she was served as a child, even when she was full. Because she doesn't want to cause the same problem in her child, she tells the nurse that each time her son pushes food away with his tongue she believes that he doesn't want it. Which of the following statements would be most appropriate for the nurse to say to this mother? a) "The baby might not be ready for solid food, so wait a month or so and try again." b) "Because your baby is a fussy eater, have more than one food available at each feeding so he can choose a food he likes." c) "The baby might be allergic to the particular foods you offered, so try different kinds of food." d) "The baby needs to learn how to move the food to the back of the mouth for swallowing, so catch the food and offer it again until the baby learns this."

"The baby needs to learn how to move the food to the back of the mouth for swallowing, so catch the food and offer it again until the baby learns this."

Nurse Betty is documenting her postpartum mother and baby. She must document the relationship between the mother and infant. Which observation would demonstrate attachment? a) "The mom is talking to the infant while breast-feeding the infant." b) "The infant remains in the nursery most of the day." c) "The father is always holding the infant." d) "The infant is in the crib every time Betty goes into the room."

"The mom is talking to the infant while breast-feeding the infant."

Bob and Nancy have financial issues and ask the nurse if a borrowed crib would be okay to use for their new twin boys. Which response should the nurse use in educating the parents? a) "No, you cannot use a borrowed crib." b) "You can use the crib, but there are guidelines to follow." c) "You should just buy a new crib to be on the safe side." d) "You can use any crib that you want."

"You can use the crib, but there are guidelines to follow."

The nurse enters her patient's room and finds the infant on a pillow with a bottle propped up while mom is dressing. What reaction should the nurse make? a) "Are you almost ready to be discharged?" b) "Look how cute she is." c) "Is she almost done feeding?" d) "You should always hold your baby for feedings instead of propping the bottles."

"You should always hold your baby for feedings instead of propping the bottles."

The nurse is teaching a new mother about the drastic growth and developmental changes her infant will experience in the first year of life. Which of the following describes a developmental milestone occurring in infancy? A) By 6 months of age the infant's brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth. B) Most infants triple their birthweight by 4 to 6 months of age and quadruple their birthweight by the time they are 1 year old. C) The head circumference increases rapidly during the first 6 months: the average increase is about 1 inch per month. D) The heart triples in size over the first year of life; the average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old.

Ans: A Feedback: By 6 months of age the infant's brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth. Most infants double their birthweight by 4 to 6 months of age and triple their birthweight by the time they are 1 year old. The head circumference increases rapidly during the first 6 months: the average increase is about 0.6 inch (1.5 cm) per month. The heart doubles in size over the first year of life. As the cardiovascular system matures, the average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old.

A new mother expresses concern to the nurse that her baby is crying and grunting when passing stool. What is the nurse's best response to this observation? A) "This is normal behavior for infants unless the stool passed is hard and dry." B) "This is normal behavior for infants due to the immaturity of the gastrointestinal system." C) "This indicates a blockage in the intestine and must be reported to the physician." D) "This is normal behavior for infants unless the stool passed is black or green."

Ans: A Feedback: Due to the immaturity of the gastrointestinal system, newborns and young infants often grunt, strain, or cry while attempting to have a bowel movement. This is not of concern unless the stool is hard and dry. Stool color and texture may change depending on the foods that the infant is ingesting. Iron supplements may cause the stool to appear black or very dark green.

The nurse in a community clinic is caring for a 6-month-old boy and his mother. Which of the following is the priority intervention to promote adequate growth? A) Monitoring the child's weight and height B) Encouraging a more frequent feeding schedule C) Assessing the child's current feeding pattern D) Recommending higher-calorie solid foods

Ans: A Feedback: Monitoring the child's weight and height is the priority intervention to promote adequate growth. Encouraging a more frequent feeding schedule, assessing the child's current feeding pattern, and recommending higher-calorie solid foods are interventions when the nursing diagnosis is that nutrition level does not meet body requirements.

The nurse is caring for a 7-month-old girl during a well-child visit. Which of the following interventions is most appropriate for this child? A) Discussing the type of sippy cup to use B) Advising about increased caloric needs C) Explaining how to prepare table meats D) Describing the tongue extrusion reflex

Ans: A Feedback: The cup may be introduced at 6 to 8 months of age. Old-fashioned sippy cups are preferred compared to the new style. The nurse would not advise about increased caloric needs as caloric needs drop at this age. Transition to table meat will not take place until age 10 to 12 months. Tongue extrusion reflex has disappeared at age 4 to 6 months.

The nurse is providing anticipatory guidance to the mother of a 9-month-old girl during a well-baby visit. Which of the following topics would be most appropriate? A) Advising how to create a toddler-safe home B) Warning about small objects left on the floor C) Cautioning about putting the baby in a walker D) Telling about safety procedures during baths

Ans: A Feedback: The most appropriate topic for this mother would be advising her on how to create a toddler-safe home. The child will very soon be pulling herself up to standing and cruising the house. This will give her access to areas yet unexplored. Warning about small objects left on the floor, telling about safety procedures during baths, and cautioning about using baby walkers would no longer be anticipatory guidance as the child has passed these stages.

The parent of a 6-month old infant asks the nurse for advice about his son's thumb sucking. What would be the nurse's best response to this parent? A) "Thumb sucking is a healthy self-comforting activity." B) "Thumb sucking leads to the need for orthodontic braces." C) "Caregivers should pay special attention to the thumb sucking to stop it." D) "Thumb sucking should be replaced with the use of a pacifier."

Ans: A Feedback: Thumb sucking is a healthy self-comforting activity. Infants who suck their thumbs or pacifiers often are better able to soothe themselves than those who do not. Studies have not shown that sucking either thumbs or pacifiers leads to the need for orthodontic braces unless the sucking continues well beyond the early school-age period. The infant who has become attached to thumb sucking should not have additional attention drawn to the issue, as that may prolong thumb sucking. Pacifiers should not be used to replace thumb sucking as this habit will also need to be discouraged as the child grows.

Which reflex, if found in a 4-month-old infant, would cause the nurse to be concerned? A) Plantar grasp B) Step C) Babinski D) Neck righting

Ans: B Feedback: Appropriate appearance and disappearance of primitive reflexes, along with the development of protective reflexes, indicates a healthy neurologic system. The step reflex is a primitive reflex that appears at birth and disappears at 4 to 8 weeks of age. The plantar grasp reflex is a primitive reflex that appears at birth and disappears at about the age of 9 months. The Babinski reflex is a primitive reflex that appears at birth and disappears around the age of 12 months. The neck righting reflex is a protective reflex that appears around the age of 4 to 6 months and persists.

The nurse is educating a first-time mother who has a 1-week-old boy. Which of the following is the most accurate anticipatory guidance? A) Describing the effect of neonatal teeth on breastfeeding B) Explaining that the stomach holds less than 1 ounce C) Informing that fontanels will close by 6 months D) Telling that the step reflex persists until the child walks

Ans: B Feedback: Explaining that the child's stomach holds less than 1 ounce gives the mother a reason for frequent, small feedings and is the most helpful and accurate anticipatory guidance. Telling that the step reflex persists until the child walks and informing that fontanels will close by 6 months are inaccurate. The step reflex disappears at about 2 months and fontanels close between 12 and 18 months. Neonatal teeth are highly unusual and need no explanation unless they occur.

The nurse is providing anticipatory guidance to a mother of a 5-month-old boy about introducing solid foods. Which statement by the mother indicates that effective teaching has occurred? A) "I'll start with baby oatmeal cereal mixed with low-fat milk." B) "The cereal should be a fairly thin consistency at first." C) "I can puree the meat that we are eating to give to my baby." D) "Once he gets used to the cereal, then we'll try giving him a cup."

Ans: B Feedback: Iron-fortified rice cereal mixed with a small amount of formula or breast milk to a fairly thin consistency is typically the first solid food used. As the infant gets older, a thicker consistency is appropriate. Strained, pureed, or mashed meats may be introduced at 10 to 12 months of age. A cup is typically introduced at 6 to 8 months of age regardless of what or how much solid food is being consumed.

At which age would the nurse expect to find the beginning of object permanence? A) 1 month B) 4 months C) 8 months D) 12 months

Ans: B Feedback: Object permanence begins to develop between 4 and 7 months of age and is solidified by approximately age 8 months. By age 12 months, the infant knows he or she is separate from the parent or caregiver.

A new mother shows the nurse that her baby grasps her finger when she touches the baby's palm. How might the nurse respond to this information? A) "This is a primitive reflex known as the plantar grasp." B) "This is a primitive reflex known as the palmar grasp." C) "This is a protective reflex known as rooting." D) "This is a protective reflex known as the Moro reflex."

Ans: B Feedback: Primitive reflexes are subcortical and involve a whole-body response. Selected primitive reflexes present at birth include Moro, root, suck, asymmetric tonic neck, plantar and palmar grasp, step, and Babinski. During the palmar grasp, the infant reflexively grasps when the palm is touched. The plantar grasp occurs when the infant reflexively grasps with the bottom of the foot when pressure is applied to the plantar surface. The root reflex occurs when the infant's cheek is stroked and the infant turns to that side, searching with mouth. The Moro reflex is displayed when with sudden extension of the head, the arms abduct and move upward and the hands form a "C."

The nurse is counseling the mother of a newborn who is concerned about her baby's constant crying. What teaching would be appropriate for this mother? A) Carrying the baby may increase the length of crying. B) Reducing stimulation may decrease the length of crying. C) Using vibration, white noise, or swaddling may increase crying. D) Using a swing or car ride may increase the incidence of crying episodes.

Ans: B Feedback: Prolonged crying leads to increased stress among caregivers. Reducing stimulation may decrease the length of crying, and carrying the infant more may be helpful. Some infants respond to the motion of an infant swing or a car ride. Vibration, white noise, or swaddling may also help to decrease fussing in some infants. Parents should try one intervention at a time, taking care not to stimulate the infant excessively in the process of searching for solutions.

The nurse is caring for a 4-week-old girl and her mother. Which of the following is the most appropriate subject for anticipatory guidance? A) Promoting the digestibility of breast milk B) Telling how and when to introduce rice cereal C) Describing root reflex and latching on D) Advising how to choose a good formula

Ans: B Feedback: Telling the mother how to introduce rice cereal is the most appropriate subject for anticipatory guidance. Since this mother is already breast- or bottle-feeding her baby, educating her about these subjects would not inform her about what to expect in the next phase of development.

The nurse is assessing a 4-month-old boy during a scheduled visit. Which of the following findings might suggest a developmental problem? A) The child does not coo or gurgle. B) The child does not babble or laugh. C) The child never squeals or yells. D) The child does not say dada or mama.

Ans: B Feedback: The fact that the child does not babble or laugh might suggest a developmental problem. At 4 to 5 months of age most children are making simple vowel sounds, laughing aloud, doing raspberries, and vocalizing in response to voices. The child should have developed past cooing or gurgling, but is too young to squeal, yell, or say dada or mama.

The nurse is teaching a new mother about the development of sensory skills in her newborn. Which of the following would alert the mother to a sensory deficit in her child? A) The newborn's eyes wander and occasionally are crossed. B) The newborn does not respond to a loud noise. C) The newborn's eyes focus on near objects. D) The newborn becomes more alert with stroking when drowsy.

Ans: B Feedback: Though hearing should be fully developed at birth, the other senses continue to develop as the infant matures. The newborn should respond to noises. Sight, smell, taste, and touch all continue to develop after birth. The newborn's eyes wander and occasionally cross, and the newborn is nearsighted, preferring to view objects at a distance of 8 to 15 inches. Holding, stroking, rocking, and cuddling calm infants when they are upset and make them more alert when they are drowsy.

The nurse is teaching a new mother the proper techniques for breastfeeding her newborn. Which of the following is a recommended guideline that should be implemented? A) Wash the hands and breasts thoroughly prior to breastfeeding. B) Stroke the nipple against the baby's chin to stimulate wide opening of the baby's mouth. C) Bring the baby's wide-open mouth to the breast to form a seal around all of the nipple and areola. D) When finished the mother can break the suction by firmly pulling the baby's mouth away from the nipple.

Ans: C Feedback: Before each breastfeeding session, mothers should wash their hands, but it is not necessary to wash the breast in most cases. The mother should then stroke the nipple against the baby's cheek to stimulate opening of the mouth and bring the baby's wide-open mouth to the breast to form a seal around all of the nipple and areola When the infant is finished feeding, the mother can break the suction by inserting her finger into the baby's mouth.

The nurse is helping a new mother prepare for breastfeeding her infant. During which of the following newborn states of consciousness would the nurse recommended attempting the feeding? A) Light sleep B) Drowsiness C) Quiet alert state D) Active alert state

Ans: C Feedback: A normal newborn will ordinarily move through six states of consciousness: (1) deep sleep: the infant lies quietly without movement; (2) light sleep: the infant may move a little while sleeping and may startle to noises; (3) drowsiness: eyes may close; the infant may be dozing; (4) quiet alert state: the infant's eyes are open wide and the body is calm; (5) active alert state: the infant's face and body move actively; and (6) crying: the infant cries or screams and the body moves in a disorganized fashion. The quiet alert state is the optimal state in which to breastfeed an infant.

The nurse measures the head circumference of a 6-month-old infant. Which measurement would the nurse interpret as most appropriate? A) 33 cm B) 35 cm C) 43.5 cm D) 47 cm

Ans: C Feedback: Head circumference increases rapidly during the first 6 months. In a 6-month-old it is typically 42 to 44.5 cm (16.5 to 17.5 in); at birth it is usually 33 to 35 cm (13 to 14 in); and at 1 year of age it is usually 45 to 47.5 cm (17.7 to 18.7 in).

The nurse is assessing a 12-month-old boy with an English-speaking father and a Spanish-speaking mother. The boy does not say mama or dada yet. Which of the following is the priority intervention? A) Performing a developmental evaluation of the child B) Encouraging the parents to speak English to the child C) Asking the mother if the child uses Spanish words D) Referring the child to a developmental specialist

Ans: C Feedback: Infants in bilingual families may use some words from each language. Therefore, the priority intervention in this situation would be to ask the mother if the child uses Spanish words. There is not enough evidence to warrant performing a developmental evaluation or referring the child to a developmental specialist. Encouraging the parents to speak English to the child is unnecessary if the child is progressing with Spanish first.

The nurse is performing a health assessment of a 3-month-old Black American boy. For what condition should this infant be monitored based on his race? A) Jaundice B) Iron deficiency C) Lactose intolerance D) Gastroesophageal reflux disease (GERD)

Ans: C Feedback: Many dietary practices are affected by culture, both in the types of food eaten and in the approach to progression of infant feeding. Some ethnic groups tend to be lactose intolerant (particularly blacks, Native Americans, and Asians); therefore, alternative sources of calcium must be offered. Jaundice, iron deficiency, and GERD are not seen at a significantly higher rate in African American infants.

The nurse is providing anticipatory guidance to a mother to help promote healthy sleep for her 3-week old baby. Which of the following recommended guidelines might be included in the teaching plan? A) Place the baby on a soft mattress with a firm flat pillow for the head. B) Place the head of the bed near the window to provide fresh air, weather permitting. C) Place the baby on his or her back when sleeping. D) If the baby sleeps through the night, wake him or her up for the night feeding.

Ans: C Feedback: Sudden infant death syndrome (SIDS) has been associated with prone positioning of newborns and infants, so the infant should be placed to sleep on the back. The baby should sleep on a firm mattress without pillows or comforters. The baby's bed should be placed away from air conditioner vents, open windows, and open heaters. By 4 months of age night waking may occur, but the infant should be capable of sleeping through the night and does not require a night feeding.

A 6-month-old girl weighs 14.7 pounds during a scheduled check-up. Her birth weight was 8 pounds. Which of the following is the priority nursing intervention? A) Talking about solid food consumption B) Discouraging daily fruit juice intake C) Increasing the number of breastfeedings D) Discussing the child's feeding patterns

Ans: D Feedback: Assessing the current feeding pattern and daily intake is the priority intervention. Talking about solid food consumption may not be appropriate for this child yet. Discouraging daily fruit juice intake or increasing the number of breastfeedings may not be necessary until the situation is assessed.

The nurse is promoting a healthy diet to guide a mother when feeding her 2-week-old girl. Which of the following is the most effective anticipatory guidance? A) Encouraging breastfeeding until the sixth month B) Advocating iron supplements with bottle-feeding C) Advising fluid intake per feeding of 5 or 6 ounces D) Discouraging the addition of fruit juice to the diet

Ans: D Feedback: Discouraging the addition of fruit juice to the child's diet is the most effective anticipatory guidance. Fruit juice can displace important nutrients from breast milk or formula. Encouraging breastfeeding until the sixth month is only halfway to the Healthy People goal of breastfeeding for the first year. Advising fluid intake per feeding of 5 or 6 ounces is too much for this neonate, but is typical for an infant 4 to 6 months of age. Advocating iron supplements with bottle-feeding is unnecessary so long as the formula is fortified with iron.

A mother is concerned about her infant's spitting up. Which suggestion would be most appropriate? A) "Put the infant in an infant seat after eating." B) "Limit burping to once during a feeding." C) "Feed the same amount but space out the feedings." D) "Keep the baby sitting up for about 30 minutes afterward."

Ans: D Feedback: Keeping the baby upright for 30 minutes after the feeding, burping the baby at least two or three times during feedings, and feeding smaller amounts on a more frequent basis may help to decrease spitting up. Positioning the infant in an infant seat compresses the stomach and is not recommended.

The neonatal nurse assesses newborns for iron-deficiency anemia. Which of the following newborns is at highest risk for this disorder? A) A postterm newborn B) A term newborn with jaundice C) A newborn born to a diabetic mother D) A premature newborn

Ans: D Feedback: Maternal iron stores are transferred to the fetus throughout the last trimester of pregnancy. Infants born prematurely miss all or at least a portion of this iron store transfer, placing them at increased risk for iron-deficiency anemia compared with term infants. An infant having jaundice, having been born to a mother with diabetes, or have been born postterm does not significantly place the infant at risk for iron-deficiency anemia.

The nurse is providing discharge teaching regarding formula preparation for a new mother. Which of the following guidelines would the nurse include in the teaching plan? A) Always wash bottles and nipples in hot soapy water and rinse well; do not wash them in the dishwasher. B) Store tightly covered ready-to-feed formula can after opening in refrigerator for up to 24 hours. C) Warm bottle of formula by placing bottle in a container of hot water, or microwaving formula. D) Do not add cereal to the formula in the bottle or sweeten the formula with honey.

Ans: D Feedback: Proper formula preparation includes the following: wash nipples and bottles in hot soapy water and rinse well or run nipples and bottles through the dishwasher; store tightly covered ready-to-feed formula can after opening in refrigerator for up to 48 hours; after mixing concentrate or powdered formula, store tightly covered in refrigerator for up to 48 hours; do not reheat and reuse partially used bottles; throw away the unused portion after each feeding; do not add cereal to the formula in the bottle; do not sweeten formula with honey; warm formula by placing bottle in a container of hot water; and do not microwave formula.

A new mother asks for advice from the nurse about bathing her infant. Which of the following should the nurse tell her? a) Be sure to wash the infant's face, hands, and diaper area daily b) Be sure to brush the scalp with a soft toothbrush during the bath to prevent seborrhea c) Be sure to oil the scalp with mineral oil and leave it on overnight before bathing the infant the next day d) Be sure to give the baby a complete bath every day

Be sure to wash the infant's face, hands, and diaper area daily

An infant is breastfed. When assessing her stools, which of the following data would be typical? a) Breastfed infants are less likely to be constipated than bottle-fed infants. b) Breastfed infants usually have fewer stools than bottle-fed infants. c) Stools of breastfed infants are usually harder than those of bottle-fed infants. d) Stools of breastfed infants tend to have a strong odor.

Breastfed infants are less likely to be constipated than bottle-fed infants.

A new mother, when asked by a nurse, explains that her 4-month-old infant has been nursing regularly every 3 to 4 hours but seems satisfied. However, the mother recently introduced solid food in the form of unbuttered popcorn to the baby as a supplement, to "get her used to eating solid food." She felt that the popcorn would be safe because it is soft on the baby's gums. Which of the following should be the primary nursing diagnosis in this situation? a) Readiness for enhanced nutrition, related to the age of the infant b) Imbalanced nutrition, more than body requirements, related to introduction of a high-calorie food c) Imbalanced nutrition, less than body requirements, related to introduction of a low nutritive food d) Risk for aspiration related to feeding the infant an inappropriate food

Risk for aspiration related to feeding the infant an inappropriate food

A nurse places a toy car in front of a 6-month-old girl. She swats at it, and the car flies across the examination table and lands on the floor. She squeals with surprise and delight. When the nurse puts the toy car in front of her again, she immediately swats it again and laughs as it rolls across the table and falls to the floor again. What has the girl just demonstrated? a) Binocular vision b) Primary circular reaction c) Secondary circular reaction d) Object permanence

Secondary circular reaction third month of life, a child enters a cognitive stage identified by Piaget as primary circular reaction. During this time, the infant explores objects by grasping them with the hands or by mouthing them. Infants appear to be unaware of what actions they can cause or what actions occur independently, however. At about 6 months of age infants pass into a stage Piaget called secondary circular reaction. Now when infants reach for an object, hit it, and watch it move, they realize it was their hand that initiated the motion, and so they hit it again. By 10 months, infants discover object permanence. Infants are ready for peek-a-boo once they have gained this concept. They know their parent still exists even when hiding behind a hand or blanket and wait excitedly for the parent to reappear. Binocular vision, which is the ability to fuse two images into one, is demonstrated by 2-month-olds when the follow moving objects with their eyes, although not past the midline.

Which developmental milestone would the nurse expect an 11-month-old infant to have achieved? a) Sitting independently b) Walking independently c) Building a tower of four cubes d) Turning a doorknob

Sitting independently

Which of the following milestones would you expect an infant to accomplish by 8 months of age? a) Sitting without support b) Pulling self to a standing position c) Creeping on all fours d) Being able to sit from a standing position

Sitting without support

In working with the infant age child, the nurse recognizes which of the following as a characteristic of the infant. a) The child grows and develops skills more rapidly than at any other time in their life b) The child has an increased attention span and can be interested in an activity for a long length of time c) The child takes in new information at a rapid rate and asks "why" and "how" d) The child insists they can "do it," the next moment they revert to being dependent

The child grows and develops skills more rapidly than at any other time in their life

A new mother complains that she is exhausted and that the little sleep she gets is determined by her baby's daytime naps and the few hours the baby sleeps during the night. The nurse discusses with this mother the importance of helping the infant establish healthy sleeping patterns. Which of the following would be most helpful for this mother to do to encourage healthy sleeping patterns? The mother should a) Put the baby to bed a various times of the evening b) Let the baby cry during the night and she will eventually fall back to sleep c) Wake the baby from afternoon naps after 1 hour to ensure she is sleepy by nighttime d) Use the crib for sleeping only, not for play activities

Use the crib for sleeping only, not for play activities

The nurse is examining an 8-month-old girl for appropriate development during a regular check-up. Which observation points to a developmental risk? a) Picks up small objects using entire hand b) Cannot pull self to standing c) Uses only the left hand to grasp d) Crawls with stomach down

Uses only the left hand to grasp

The nurse is educating the mother of a newborn about feeding practices. The nurse correctly advises the mother: a) the newborn's stomach can hold between one-half to 1 ounce. b) most newborns need to eat about 4 times per day. c) the best feeding schedule offers food every 4 to 6 hours. d) demand scheduled feeding is associated with increased difficulty getting the baby to sleep through the night.

exam 1 peds

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