Health Promotion/Children

3 (understanding object permanence means the child is aware of the existence of objects that are covered or displaced. although at 10 months, neuromuscular development, curiosity has increased; neither are related to the thought process involved in object permanence)

A 10 month old looks for objects that should have been removed from his view. The nurse should instruct the parents that: 1. Neuromuscular development enables the child to reach out and grasp objects 2. The child's curiosity has increased 3. The child understands the permanence of objects even though the child cannot see them 4. The child is now able to transfer objects from hand to hand

2 (children are capable of this at 9. She is not too young, and should not have been expected to start earlier. She is not likely exaggerating.)

A 10 year old child proudly tells the nurse that brushing and flossing her teeth is her responsibility. How does the nurse interpret the statement? 1. she is too young to be given this responsiblity 2. she is most likely capable of this responsibility 3. she should have assumed this responsibility much sooner 4. she is probably just exaggerating the responsibility

2 (Any unusual event that occurs after the administration of a vaccination should be reported through an immunization surveillance system. Especially if it happens within 1 month of vaccine admin. In the US it is the Vaccine Adverse Event Reporting System (VAERS).)

A 13 month old has febrile seizure 3 weeks after the administration of the chickenpox vaccine. The nurse should: 1. recognize the events are unrelated 2. report the event thru an immunization surveillence system 3. explain to the parents that this is a rare but acceptable risk 4. refer the child to a neurologist

2 (The adult pinworm emerges from the rectum and colon at night onto the perianal area to lay its eggs. Itching and scratching introduces the eggs to the hands from where they can easily reinfect the child or others. Nightclothes and bedlinens can be sources of infection. The eggs can also be transmitted by dust in the home. Although transmission through contaminated food and water supplies is possible, it is rare. Contaminated animals can spread histoplasmosis and salmonella. The spread of infections by toilet seats has not been supported by research)

A parent asks how did my child get pinworms? The nurse explains that pinworms are most commonly spread by which route? 1. food 2. hands 3. animals 4. toilet seats

3 (craving to eat non food items is known as pica. Toddlers use oral gratification to cope with anxiety. )

A parent brings an 18 month old to the clinic because the child eats ashes, crayons, and paper. Which information should the nurse assess first? 1. evidence of eruption of large teeth 2. amount of attention from the parent 3. any changes in the home environment 4. intake of a soft, low roughage diet

3,6 (typical abilities demonstrated by 8 month old infants include playing peek a boo and transferring objects from one hand to another. the ability to say dada and mama is more typical of 10 months infants. Infants usually are at least 12 months old when they achieve the ability to walk independently. Infants who are 15 months old commonly can feed themselves with a spoon and stack two blocks.)

An 8 month old infant is seen in the well child clinic for a routine checkup. The nurse should expect the infant to be able to do which tasks? select all that apply 1. say mama and dada with specific meaning 2. feed self with a spoon 3 play peekaboo 4. walk independently 5. stack two blocks 6. transfer object from hand to hand

3

An uncle is shopping for a toy to give his niece. He has no children of his own and asks his neighbor, a nurse, what would be the most appropriate toy to give a 15 month old child. Which toy should the nurse recommend to facilitate learning and development? 1. a stuffed animal 2. a music box 3. a push pull toy 4. a nursery moblie

4 (A child younger than 3 is down and back. Older than 3 up and back)

When observing a parent instilling prescribed ear drops twice a day for a 2 year old, the nurse decides that the teaching about positioning of the pinna for instillation of the drops is effective when the parent pulls the toddlers pinna in which direction? 1. up and forward 2. up and backward 3. down and forward 4. down and backward

2

Which action initiated by the parents of an 8 month old indicates they need further teaching about preventing childhood accidents? 1. placing a fire screen in front of the fireplace 2. placing a car seat in a front seat front facing position 3. inspecting toys for loose parts 4. placing toxic substances out of reach or in a locked cabinet

2 (Toddlers around 15 months need 2-3 cups of milk per day to supply necessary nutrients such as Ca. A daily intake of more than 3 cups may interfere with ingestion of other necessary nutrients)

Which amount of daily milk intake should the nurse include in the plan of care for a 15 month old? 1. 1/2 to 1 cup (125 to 250 mL) 2. 2-3 cups (500 to 750 mL) 3. 3-4 cups (750-1000 mL) 4. 4-5 cups (1000-1250 mL)

3

After teaching the parents about the cause of ringworm of the scalp (tinea capitis), which statement by the parents indicates successful teaching> 1. It results from overexposure to the sun 2. it is caused by infestation with a mite 3. it is a fungal infection of the scalp 4. it is an allergic reaction

2

Parents of a 15 year old state their child is moody and rude. The nurse advises the parents to : 1. restrict their childs activities 2. discuss their feelings with their child 3. obtain family counseling 4. talk to other parents of teens

3 (info about why teens choose alcohol or other drugs can be used to determine whether they are becoming responsible users or problem users. The senior students probably know the legal implications of drinking, and the nurse will establish a more therapeutic relationship with the students by understanding their motivations for use. The type of alchohol and when and with whom they use are not the first data to obtain when assessing the situation)

Several high school seniors are referred t the nurse because of suspected alcohol misuse. When the nurse assesses the situation, what would be most important to determine? 1. what they know about the legal implications of drinking 2. the type of alcohol they usually drink 3. the reasons they chose alcohol 4. when and with whom they use alcohol

3 (family changes and stress can distract parents and contribute to accidents. Only children typically receive more attention than those with siblings. Thus the risk would be less. Families who live in the suburbs freq. are more affluent and therefore better able to maintain a home less conductive to accidents. A parents formal education is unrelated to accidents. )

The family of a 5 year old only child has just moved to a rural setting. At the well child visit the father expresses concern that his child seems prone to minor accidents such as skinning his elbow and knees or falling off his scooter. the nurse tells the father: 1. Only children use accidents as a way to seek attention 2. Children who live in the suburbs typically have more accidents 3. Children frequently have more accidents when families experience change 4. We see a relationship between accidents and parental education

1,2 (some parents find that time out until the child regains control is effective. For some ignoring the child works.. The other options are not appropriate to recommend. You cant reason with an out of control child)

The parents of a preschooler ask the nurse how to handle their childs temper tantrums. which technique should the nurse include in the teaching plan? select all that apply 1. putting the child in time out 2. ignoring the child 3. puttint the child to bed 4. spanking the child 5. trying to reason with the child

3 (during the school age years children learn to socialize with other children of the same age. The "best friend" stage, which occurs around 9-10 years of age is important to provide the foundation for self esteem and future relationships. Thinking independently and organizing, and planning are cognitive skills. Active play is motor skills.)

To assess a 9 year olds social development, the nurse asks the parents if the child: 1. thinks independently 2. is able to organize and plan 3. has a best friend 4. enjoys active play

1,3,4 (BP percentiles for children are referenced by the age, sex, and height. Measurements at or above the 95th percentile are considered indicative of hypertension. Weight and elevated BMI may contribute to HTN, but are not used to define it. The OFC is not routinely measured in children over 2 years old and is not used to reference BP readings)

To interpret the results of blood pressure screenings in children over 3, the nurse compares the results to percentiles for systolic and diastolic blood pressure based on what factors? Select all that apply 1. age 2. BMI 3. gender 4. height 5. occipital frontal circumference (OFC) 6. weight

4 (school age children are concerned about justice and fair play. They become upset when they think someone is not playing fair. Physical affection makes them embarrassed and uncomfortable They are concerned about others and are cooperative in play and school)

A nurse assessing the growth and development of a 10 year old child. What is the expected behavior of this child? 1. enjoys physical demonstrations of affection 2. is selfish and insensitive to the welfare of others 3. is uncooperative in play and school 4. has a strong sense of justice and fair play

1 (The values of height and weight percentiles are usually similar for an individual child. Measurements between the 5th and 95th percentile are considered normal. Marked discrepancies identify overweight and underweight children)

A nurse compares height and weight with standard growth charts and finds the child to be in the 50th percentile for height and 25th percentile for weight. The nurse interprets these findings as indicating the child is: 1. typical height and weight 2. overweight for height 3. underweight for height 4. abnormal in height

2,3,4,5 (Keep the child comfortable and prevent infection of lesions. Oatmeal baths may ease severe itching. Keep fingernails short to reduce trauma from scratching. Overheating can make itch worse. Children may return to school once all lesions have crusted over. Aspirin use in children with chickenpox is contraindicated due to link with Reyes Syndrome)

A parent asks the nurse how to care for a child with chickenpox. What should the nurse include in the plan of care? Select all that apply 1. Use OTC aspirin for fever 2. encourage oatmeal baths 3. keep fingernails short 4. avoid overheating 5. do not return to school until all lesions have crusted over

3 (children under 7 do not have the manual dexterity needed for teeth brushing. Parents should help until that time)

AFter teaching a group of parents of preschoolers attending a well child clinic about teeth brushing and dental hygiene, the nurse determines that the teaching is successful when the parents state the children can begin to brush their own teeth without help at what age? 1. 3 years 2. 5 years 3. 7 years 4. 9 years

3 (It is important to assist parents to assess speech development in their child so developmental delays can be identified early. According to Denver Developmental Screening Exam, at 8 months of age, the child should say "mama" and "dada" nonspecifically and imitate speech sounds. children cannot say "dada" or "mama" specifically or use more than three words until they are about 12 months of age. A child can not respond to specific commands or point to objects on request until about 17 months of age)

Which is appropriate language development for an 8 month old? The child should be: 1. saying "dada to father and "mama" to mother. 2. saying three other words besides mama and dada 3. saying dada and mama nonspecifically 4. saying "ball" when parents point to a ball.

4 (dark urine is not a potential side effect of taking an iron supplement. Families need education about the possible side effects, including placing liquid iron behind teeth to avoid teeth staining. Stools may become dark in color, even turn black, and some clients may experience anorexia)

The nurse teaches the parents of a 4 year old diagnosed with iron def. anemia about potential side effects of taking an iron supplement. The nurse knows more teaching is required when the parents state a side effect of taking an iron supplement is: 1. teeth staining 2. black stools 3. anorexia 4. dark urine

3 ( A child will regress behavior used in an earlier stage of development to cope with perceived threatening situations. Children are afraid of hospitalization, but bed wetting is compensatory mechanism done to regress to a previous stage of development that is more comfortable and secure for the child. )

A parent of a toilet trained 3 year old expresses concern over her childs bed wetting while hospitalized. The nurse should tell the parent: 1. your child was too immature to be toilet trained. In a few months your child should be old enough 2. Children are afraid in the hospital and frequently wet their bed 3. It is very common for children to regress when they are in the hospital 4. This is normal, your child probably received too much fluid the night before

3 (The nurse should provide her with info on toxic shock because of the identified relationship between tampon use and the syndromes development. Additionally 95% of cases of toxic shock occur during menses. Most teens can use tampons safely if they change them freq. Using tampons is not related to menstrual flow or sexual activity. There is no need to refer the girl to a gynocologist. A nurse can provide teaching about tampon use. )

A teen female tells the nurse that she would like to use tampons during her period. The nurse should first: 1. assess her usual menstrual flow pattern 2. determine whether she is sexually active 3. provide info on preventing toxic shock syndrome 4. refer her to a specialist in adolescent gynecology

4 (Griseofulvin is a antifungal agent that acts by binding to the keratin that is deposited in the skin, hair and nails as they grow. This keratin is then resistant to the fungus. But as the keratin is normally shed, the fungus enters new uninfected cells unless drug therapy continues. Long term admin of griseofulvin does not prevent sensitivity or allergic reactions. As the body adjusts to a new substance over time, side effects are variable and do not necessarily decrease)

Griseofulvin was prescribed to treat a childs ringworm of the scalp. The nurse instructs the parents to use the med for several weeks for which reason? 1. a sensitivity to the drug is less likely if it is used over a period of time 2. fewer side effects occur as the body slowly adjusts to a new substance over time 3. fewer allergic reactions occur if the drug is maintained at the same level long term 4. the growth of the causative organism into new cells is prevented with long term use

2 (National advisory committees on immunization practices review vaccination evidence and update recommendations yearly. Current vaccination catch up schedules are readily available on their websites. The lack of vaccinations is a strong indicator the child probably does not have a HCP. Even if the child has a provider, however they may be hard to reach on a weekend. If consulted the pharmacist would most likely have to review the latest guidelines that are equally available to the nurse. Reading each of the manufacturers inserts for multiple vaccines would be time consuming and synthesis of the info could possibly lead to errors.)

A parent brings a 5 year old child to a weekend vaccination clinic to prepare for school entry. The nurse notes that the child has not had any vaccinations since 4 months of age. What is the best way for the nurse to determine how to catch up the childs vaccinations? 1. ask the childs HCP 2. check the nationally published immunization guidlines 3. read each vaccines manufacturers insert 4. contact the pharmacist

2 (try to determine the source of concern to acknowledge feelings and provide the appropriate information.)

After reading the vaccine information sheets the parent of a 2 month old infant is hesitant to consent to the recommended vaccinations. The nurse should first ask the parent: 1 Did you know that vaccinations are required y law for school entry 2. What concerns you about vaccinations? 3. Would you prefer that fewer vaccines are given at this time? 4. Can you please sign the vaccine waiver form?

4 (Time out for toddlers. Remove from situation, helps them regain control. Structuring interactions with 3 year olds helps minimize unacceptable behavior. This approach includes setting clear reasonable rules and calling attention to unacceptable behavior as soon as it occurs. Reprimanding young children can reinforce undesirable behavior over time because it provides attention. Physical punishment such as spanking has limited effect and serious negative effect. Reasoning is more appropriate for older children, such as preschoolers and those older, especially when moral issues involved. Reasoning combined with scolding can take the form of shame or criticism and children take remarks seriously and believe themselves "bad")

The mother asks the nurse for advice about discipline for her 18 month old. Which discipline strategy should the nurse suggest that the mother use? 1. reprimand 2. spanking 3. reasoning 4. time out

3 (vaccination in the prescence of a moderate to severe infection, with or without fever, increases the risk for injury and decreases the chance of mounting good immunity. There are currently no evidence to suggest vaccines raise the risk of SIDS. A mild temp may be expected with the DTaP. A fever of >105 F within 48 hrs of vaccination could warrant caution. The DTaP is not a live vaccine. No special precautions are needed regarding immunosuppressed family members)

The nurse assesses a 6 month old for vaccination readiness. Which finding would most likely indicate the need to delay administering the DTaP vaccine? 1. A family history of SIDS 2. A fever of 101.3 F following 4 month old vaccinations 3. An acute bilateral ear infection 4. living with a family member who is immunosuppressed.

3 (MOST likely to be influenced by example and atmosphere provided by parents. Coaxing and badgering most likely will aggravate poor eating habits)

The nurse discusses eating habits of school age children with their parents, explaining that these habits are most influenced by: 1. food preferences of their peers 2. smell and appearance of foods offered 3. examples provided by parents at mealtimes 4. parental encouragement to eat nutritious foods

3 (snacks are necessary for school age children because of their high energy level. They can learn to classify or categorize and cause and effect. By preparing their own snacks they learn basics of nutrition. The mother and child should make decisions together about appropriate foods. Instinct is not a factor)

The parent asks the nurse about the 9 year old childs apparent need for between meal snack, especially after school. When developing a sound nutritional plan for the child with the mother, the nurse should advise the parent that: 1. The child does not need to eat between meal snacks 2. The child should eat the snacks the mother thinks is appropriate 3. the child should help with preparing his or her own snacks 4. the child will instinctively select nutritional snacks

2 (keep a routine.. can include story time, dont use food to reward, keep excitement level relaxed.)

The parent of a preschooler reports that the child creates a scene every night at bedtime. What is the best course of action? 1. allow the child to stay up later one or two nights per week 2. establish a set bed time and follow the routine 3. encourage active play before bed time 4. give the child a cookie to make bed time pleasant.

3 (It is normal behavior for teens to assert independence and begin to separete from their parents; the behavior is not changed by disability, nor unique to a girl. The nurse offers reassurance to the parents and then opens the conversation for additional discussion)

A 16 year old client and who has been confined to a wheelchair since early childhood has lately been acting rebellious and rude. Her parents asks the nurse, are all teens like this? The nurse should respond with which statement? 1. Yes although your daughters behaviors are more like those of an adolescent boy. 2. No, your daughter must need some help in dealing with her feelings 3. your daughters behavior seems typical teen behavior. Let us talk more about it. 4. your daughters behavior results from feelings about her disability; ignore them.

3 (some areas may specify a min. age for treatment usually 12-14 years old, generally teens have the right to seek treatment for STD without their parents permission. These medical records are not shared with parents, without the clients permission. However teens must be made aware that certain infections, including gonorrhea, must be reported by law to public health agencies. Partner notification will also take place but methods vary)

A 17 year old high school senior calls the clinic because she thinks she may have gonorrhea. She wants to be seen but wants assurances no one will know. Which is the most appropriate response by the nurse? 1. because you are underage, we will need your parents consent to treat you 2. we can treat you without your parents consent, but they have the right to review your medical record 3. we can see you without your parents consent but have to report any positive results to the public health dept. 4. We can see you and will not share your results with anyone

3 (behavior problems related to sleep and rest are common in young children. Consistent rituals around bedtime help to create and easier transition form waking to sleep. Allowing child to sleep with the parents creates more problems. Increasing activity before bed does not alleviate seperation anxiety in the toddler and causes further anxiety. Staying up late does not lessen fear)

A 2 year old tells his parents he is afraid to go to sleep because the monsters will get him. The nurse should tell the parent to: 1. allow him to sleep with his parents in their bed when he is afraid 2. increase his activity before he goes to bed so he eventually falls asleep 3. read a story to him before bedtime, and allow him to have a cuddly animal or blanket 4. allow him to stay up 1 hr later with the family until he falls asleep

2 (mono usually has an insidious onset, with fatigue and the inability to maintain usual activity levels as the most common symptoms. The lymph nodes are typically enlarged, and the spleen may also be enlarged. Fever and a sore throat often accompany mono. A persistent non productive cough can follow an upper respiratory tract infection. A blush like generalized skin rash is more characteristic of rubella.)

A father asks the nurse how he would know if his child had developed mono. The nurse explains that in addition to fatigue, which symptom would be most common? 1. liver tenderness 2. enlarged lymph glands 3. persistent nonproductive cough 4. a blush like generalized skin rash

1 (The cause of infectious mono is thought to be the Epstein Barr virus. The virus is believed to be spread only by direct intimate contact. No precautionary measures for the general public are recommended to prevent mono. However it is recommended that sharing food items and kissing be avoided with persons known to have mono. There is currently no vaccine for mono.)

A mother has heard that several children have been diagnosed with mononucleosis. she asks the nurse what precautions should be taken to prevent this from occurring to her child. The nurse should instruct the mother to: 1. take no particular precautionary measures 2. sterilize the childs eating utensils before they are reused 3. wash the child linens seperately in hot water 4. have the child vaccinated

3 (a child with 20/60 vision sees at 20 feet what those with 20/20 visioin see at 60 feet. A visual acuity of 20/200 is considered the boundary of legal blindness)

A mother states the HCP described her daughter as having 20/60 vision, and she asks the nurse what this means. The nurse responds based on the interpretation that the child is experiencing what condition? 1. a loss of approx 1/3 of her visual acuity 2. ability to see at 60 feet what she should see at 20 feet 3. ability to see at 20 feet what she should see at 60 feet 4.visual acuity 3 times better than avg.

3 (Teen boys lag about 2 years behind teen girls in growth. Most girls are 1-2 inches taller than boys beginning teen years, but tend to stop growing approx 2-3 years after menarche with the closure of epiphyseal lines of the long bones.)

A nurse is assessing the growth and development of a 14 year old boy. He reports that his 13 year old sister is 2 inches taller than he is. The nurse should advise the boy that the growth spurt in teen boys compared with the growth spurt of teen girls: 1. occurs at about the same time 2. occurs 2 years earlier 3. occurs 2 years later 4. occurs 1 year earlier

3 (lice are spread by close personal contact and by contact with infected linens, combs and brushes. Lice are more common in school age kids than in adults because of close contact in school or sleep overs or sharing possessions. Lice are not commonly spread by hand contact. There is no immunity conferred by having head lice. Adults can have head lice, particulary if they come in contact with their kids infected linen or clothing.)

A parent asks can I get head lice too? The nurse indicates that adults can also be infested with head lice but that pediculosis is more common among school age children. primarily for what reason? 1. an immunity to pediculosis usually is established by adulthood 2. school age children are more neglectful of hand washing 3. pediculosis usually is spread by close contact with infected children 4. the skin of adults is more capable of resisting the invasion of lice

3 (by the end of 3 months the infant should babble. Lack of babbling suggests a language delay and warrants further investigation. Infants typically begin peek a boo at around 7 months. The ability to roll front to back typically occurs at 5 months. Sitting unsupported is expected at 6 months)

A parent brings a 4 month old to the clinic for a regular visit and expressess concern that the infant is not developing appropriately. Which finding in the infant would indicate the need for further developmental screening? 1. has no interest in peek a boo games 2. does not turn front to back 3. does not babble 4. sits unsupported

2 (The preschool age child does not have an accurate concept of skin integrity and can view medical and surgical treatments as hostile invasions that can destroy or damage the body. The child does not understand. The child is acting consistent with their developmental age. If pain or not wanting another procedure was the issue the child would exhibit other symptoms.)

After having a blood sample drawn a 5 year old child insists the site be covered with a bandaid. When the parent tries to remove the bandaid before leaving the office, the child screams that all the blood will come out. The nurse encourages the parent to leave the bandage in place and tells the parent that the child: 1. fears another procedure 2. does not understand body integrity 3. is expressing pain 4. is attempting to regain control

4 (infants should be kept on formula or breast milk until 1 year of age. The protein in cows milk is harder to digest than is in formula. It does not matter what order fruits and veges are introduced as long as they are introduced slowly. Solids are introduced around 4-6 months, after the extrusion reflex has diminished and when the child will accept new textures. Iron def. develops in term infants between 4-6 months when the prenatal iron stores are depleted. Fortified cereals can be added to the diet at 4-6 months to prevent iron def. anemia.)

The nurse is teaching the parents of an 8 month old child about what the child should eat. The nurse should include which information points in the teaching plan? 1. veges should be introduced before fruits 2. solid foods should not be introduced until the infant is 10 months old 3. Iron fortified cereals should not be introduced until the child is 8 months old 4. The infants diet can be changed from formula to whole milk when the infant is 12 months old

6 2 1 4 3 5 (When dispensing the med from an inhaler the client should first shake the inhaler and then breath out through the mouth before putting the inhaler in the mouth. Next the client inhales slowly and then presses the canister to dispense the med while continuing to inhale. The client should hold the breath for 5-10 seconds before exhaling)

The nurse is teaching the teen with asthma how to use an inhaler. In which order should the nurse instruct the client to follow the steps from first to last? 1. put the inhaler in your mouth 2. breathe out 3. depress the top of the inhaler 4. begin to slowly breathe in 5. hold the breath for 5-10 seconds 6. shake the inhaler

3 2 1 4 (When obtaining a specimen from an infant, the nurse assists the client to drink fluids 30-60 mins prior to collection so the client voids as soon as possible after the collection bag is applied. Next, the nurse applies gloves and the cleanses the genital area with sterile water to prevent urine contamination. Finally the nurse applies the collection bag and then removes the bag when the specimen is obtained)

The nurse is to obtain a urine specimen from a toddler hospitalized with a UTI. In what order should the nurse perform the following steps? Place in order from first to last. Use all options 1. cleanse the genital area 2. apply gloves 3. offer fluids 4. apply collection bag

2 (holding the head erect when sitting, staring at an object placed in the hand, taking the object to the mouth, cooing and gurgling, and sustaining part of the body weight when in a standing position are behaviors characteristic of 4 months. A 2 month infant typically vocallizes, follows objects to the midline and smiles. A 7 month old typically is able to sit without support, turns towards the voice and transfers objects from hand to hand. Usually, a 9 month old can crawl, stand when holding on, and initiate speech sounds)

The nurse notes that an infant stares at an object placed in his hand and takes it to his mouth, coos and gurgles when talked to, and sustains part of his own weight when held in a standing position. The nurse correctly interprets these findings as characteristic of an infant at which age? 1. 2 months 2. 4 months 3. 7 months 4. 9 months

4 (according to the Denver Developmental Screening Exam, a child of 8 months should sit without support for long periods of time. An 8 month old child does not have the ability to stand without hanging onto a stationary object for support. Their muscles are not developed enough to support all their weight without assistance. Their balance is not yet developed to the point they can stand and stoop to reach an object)

The nurse should refer the parents of an 8 month old child to a HCP if the child is unable to: 1. stand momentarily without holding onto furniture 2. stand unsupported well for long periods of time 3. stoop to recover an object 4. sit without support for long periods of time

2 (Children this age have lots of energy and gross motor skills. A limitation of their motor ability is in moving quickly they may be unable to judge distances or estimate amount of balance and strength needed for activities so they have frequent mishaps. This level of activity is not usually associated with changes in home, however if it intensifies a referral to a pediatric neuro would be appropriate. Abused children are usually withdrawn not having endless energy.)

The parent of a 4 year old expresses concern that the child may be hyperactive. The parent describes the child as always in motion, constantly dropping and spilling things. Which action would be appropriate at this time? 1. determine whether there have been any changes in the home 2. explain that this is not unusual behavior 3. explore the possibility that the child is being abused 4. suggest that the child be seen by a pediatric neurologist

3 (Infants should remain on formula or breast milk until 1 year old. The nurse needs to first assess if the parent switched due to lack of info or resources. Then appropriate teaching and referrals may be made/determined. At 1 yr old the infant is switched to WHOLE Milk, which has higher fat content for brain growth. Demanding clients change behaviors without addressing the cause is unlikely to produce desired results.)

The parent of a 6 month old reports starting 2% milk. The nurse should first ask the parent: 1. Do you think your baby will be fine with this milk? 2. Is it possible to switch your baby to whole milk? 3. Can you tell me more about why you switched your baby to 2% milk? 4. You cannot switch to 2% milk right now. Did your pediatrician tell you to do this?

1 (typically a 9 month old infant should be voicing single syllables since 6 months. Absence of this finding would be a cause for concern. An infant usually is able to stand alone at about 10 months. An infant is usually able to build a tower of two cubes at about 15 months. An infant usually is able to drink from a cup with little spilling at about 15 months. )

The parent of a 9 month old expressed concern that the baby is developing slowly. the nurse is concerned about a developmental delay when finding the baby is unable to accomplish which skill? 1. vocalizing single syllables 2. standing alone 3. building a tower of two cubes 4. drinking from a cup with little spilling

4 (The anterior fontanelle, commonly known as the soft spot, closes between 12 to 18 months in most infants. The nurse normally measures an infants occipital frontal circumference at each well child visit. this action does not relieve the parents concerns. REferrals would be indicated for premature or delayed closures of fontanelles, especially with other abnormal findings. Closure of the anterior fontanelle by 12 months can only be expected to occur in approx a third of all infants.)

The parent of a 9 month old infant is concerned that the infants front soft spot is still open. The nurse should tell the parent: 1. I will measure your babys head to see if it is a normal size 2. your infant will need to be referred for more testing 3. you should contact your healthcare provider immediately 4. this is normal because this soft spot usually closes between 12 and 18 months

2 (school age children delight in riddles and jokes. Mastery of the ambiguities of language and of sentence structure allow the school age child to manipulate words and telling riddles and jokes is a way to practice this skill. Children who suffer from inadequate parental attention from parents tend to exhibit abnormal behaviors. Peer influence is less important to school age children, and while the child may learn a joke from a friend, he or or she is telling the joke to master language. Watching TV does not influence the extent of joke telling)

The parent tells the nurse that an 8 year old is continually telling jokes and riddles to the point of driving other family members crazy. The nurse should explain this behavior is a sign of: 1. inadequate parental attention 2. mastery of language ambiguities 3. inappropriate peer influence 4. excessive television watching

1 (vaccines are preventative in nature and ideally given before exposure. Focusing on the benefits of cancer prevention is most appropriate, as opposed to discussing with parents potential of their child becoming sexually active without their knowledge. It is true that HPV is most common in adolescnets and women in their late 20's, but parents still may not perceive that their child is at risk. Discussing exposure thru assault raises fears and does not focus on prevention)

The parents of a 12 year old girl ask why their daughter who is not sexually active should receive the HPV vaccine. The nurse should tell the parent: 1. The vaccine is most effective against cervical cancer if given before becoming sexually active 2. Parents are never sure when their child might become sexually active 3. HPV is most common in teens and women in their late 20's 4. If your daughter is sexually assaulted she may be exposed to HPV

3 (during the first few months of life, an infants eyes may wander and appear to be crossing. As the eye muscles mature between 2-3 months of age, both eyes will focus on the same thing. No intervention is necessary, as crossing of the eyes is normal in the first few months of life)

The parents of a 3 week old healthy newborn ask the nurse why their child is intermittently cross eyed. The nurses best response is: 1. An eye patch may be necessary for 6 weeks to correct your childs vision 2. Your child will likely need an ophthalmology consult 3. It is normal to have eye crossing in the newborn period 4. surgery may be necessary to correct your childs vision

3 (The MMR is a live vaccine. Neither the American Academy of Pediatrics nor the Public Health Agency of Canada recommends routine vaccination with the MMR (either alone or in combination with the varicella vaccine) to children younger than 12 months. The DTaP, Hib, and influenza are all indicated)

The parents of a 9 month old bring the infant to the clinic for a regular check up. The infant has recieved no immunizations. Which vaccine if prescribed would the nurse question? 1. DTaP 2. Hib 3. MMR 4. Infulenza (inactivated)

1 (many teens are fatigued from combo of fast food diets, many activities and a rapid growth spurt; this is normal behavior, and the nurse should explain possible reasons for the sleep pattern. Teens typically need 8.5-9.5 hrs of sleep. There is no data to suggest that activities are tiring this teen. It is not appropriate to suggest drug use based on this question)

The parents of a teen boy are concerned that their son seems to need 9 hrs of sleep a night. The nurse should advise the parents: 1. as long as he seems otherwise well this sounds typical teenager 2. teens need only 8 hrs sleep a night, anything over this is excessive 3. your son is probably engaged in too many activities and wearing himself out 4. the side effects of many drugs is sleepiness

4 (A 1 month old infant is usually able to lift the head from a prone position. the full term infant with no complications has probably been able to do this since birth. Smiling and laughing is expected behavior at 2-3 months. Rolling from back to side and holding a rattle are characteristics of a 4 month old)

To assess the development of a 1 month old, the nurse asks the parent if the infant is able to: 1. smile and laugh out loud 2. roll from back to side 3. hold a rattle briefly 4. lift head from prone position

2 (parents can be asked to assist when their child become uncooperative during a procedure. Most commonly, the childs difficulty in cooperation is caused by fear. In most situations the child will feel more comfortable with the parent present. Other methods such as asking a nurse to assist or waiting until the child calms down may be necessary, but obtaining the parents assistance is the recommended first action. Restraints should be used only as a last resort. )

When assessing a 2 year old child brought to the clinic by her parents is uncooperative when the nurse first tries to look in her ears. What should the nurse try first? 1. ask another nurse to assist 2. allow parent to assist 3. wait until the child calms down 4. restrain the childs arms

3 (2 year olds can usually kick a ball forward. 3 year olds can usually ride a tricycle. 5 year olds tie shoes laces. 3 year olds use blunt scissors)

When assessing a child (2 year old) at the clinic for a routine check up, which skill should the nurse expect the child to perform? 1. ride a tricycle 2. tie his or her shoes 3. kick a ball forward 4. use blunt scissors

2 (toddlers usually express pain through such behaviors as restlessness, facial grimaces, irritability and crying. It is not particularly helpful to ask toddlers about pain. In most instances, they would be unable to understand or describe the nature and location of their pain because of limited verbal and cognitive skills. However preschool and older children have the verbal and cognitive skills to be able to respond appropriatley. While the FACES pain scale can be used in young children, numeric rating scales are more appropriate for children who are of school age or older. changes in VS do occur as a result of pain, but behavioral changes are usually noticed first)

When assessing pain in a toddler which method should be the most appropriate? 1. ask the child about the pain 2. observe the child for restlessness 3. use a numeric rating pain scale 4. assess for changes in vital signs

3 (preschoolers may view illness as punishment for their fantasies. At this age children do not have the cognitive ability to seperate fantasy from reality and may expect to be punished for their "evil" thoughts. Viewing illness as a necessary part of life requires higher level of cognition. This view is seen in children of middle school age and older. Perceiveing illness as a test of self worth or the will of God is more characteristic of adults)

When developing a teaching plan about illness for the parent of a preschooler, which info should the nurse include about how to the preschooler perceives illness? 1. a necessary part of life 2. a test of self worth 3. a punishment for wrong doing 4. the will of God

3 (girls experience the onset of adolescence about 1-2 years earlier than do boys. )

When discussing the onset of adolescence with parents, the nurse explains that it occurs at what time? 1. same age for both boys and girls 2. 1-2 years earlier for boys 3. 1-2 years earlier for girls 4. 3-4 years later in boys than in girls

1,3,4 (Readiness is based on neurological, psychological and physical developmental readiness. The nruse can introduce concepts of readiness for toilet training and encourage parents to look for adaptive and psychomotor signs, such as the ability to walk well, balance, climb, sit in a chair, dress oneself, please the parent, and communicate awareness of the need to urinate or defecate. chronolgical age is not an indicator for toilet training. Two year olds engage in parallel play which is not an indicator of readiness for toilet training.)

Which development is necessary for toilet training readiness for a 2 year old? Select all that apply 1. adequate neuromuscular development for sphincter control 2. appropriate chronological age 3. ability to communicate the need to use the toilet 4. desire to please the parents 5. ability to play with other 2 year olds

4 (more than 90% of 9 month olds are able to stand holding onto objects. Rolling over is expected at 4-6 months, and sitting without support is expected at 6 months. Crawling is expected at 9 months)

Which infant most needs a developmental referral for a gross motor delay? 1. the 2 month old who does not roll over 2. 4 month old who does not sit without support 3. 6 month old who does not crawl 4. 9 month old who does not stand holding on

2 (simultaneous injection reduces anxiety from anticipation of the next injection. Needle length must be long enough to deposit the vaccine into the muscle. A 5/8 inch needle is appropriate for a newborn but is not long enough for a 1 month or older child. Aspirating for blood return does not confirm needle placement. Breast feeding during vaccines, not before, has been found to reduce pain.)

Which intervention should the nurse employ to reduce trauma caused by vaccine administration to an infant? 1. use a 5/8 inch needle 2. simultaneously admin vaccines at separate sites with a second nurse 3. Aspirate to verify needle placement 4. breast feed right before administering the vaccine

1 (guidlines recommend parents keep toddlers in rear facing seats until 2 years of age or they reach the max height and weight for the seat. Car seats are marked with expiration dates because the integrity of plastic deteriorates with age. Booster seats are recommended for older child until they are 4'9. (typically 8-12 years old). Children should ride in the backseat until the age of 13 to minimize injury from airbags)

Which statement by a parent reflects the need for further teaching regarding car seat safety? 1. My baby should stay in a rear facing car seat until he is 1 year old 2. I should check the car seats expiration date before using it 3. My older child will need to stay in a booster seat until he is 4' 9 4. My children should ride in the backseat until they are 13 years old

2 (The makers of the 'cides recommend manual removal of the nits following treatment with an extra fine tooth comb. None of the treatments are 100% effective in killing all the eggs. The FDA has issued a warning regarding the use of lindane because of potential for neurotoxicity. Clients are treated with lindane only when the benefits outweigh the risks. Lice treatment may be repeated in 7-10 days; the next day is too soon)

Which statement by a parent whose child was just diagnosed with pediculosis capitis (head lice) demonstrates an understanding of the safety and efficacy of the common meds used to treat the infection? 1. I am going to request a prescription for lindane since it works the best 2. after I shampoo I will use the special comb to get the nits out 3. Most OTC lice treatments are 100% effective at killing all the eggs 4. I like the OTC lice treatments because you can give a 2nd treatment the next day if any lice remain.