HESI Prep: Pediatrics

The nurse finds that an adolescent has episodes of binge eating followed by self-induced vomiting and strenuous exercise. Which condition is the adolescent likely to have? 1. Bulimia 2. Anorexia 3. Orthorexia 4. Binge behavior

1. Bulimia Bulimia is a disorder characterized by repeated episodes of binge eating followed by inappropriate compensatory behavior, such as self-induced vomiting and/or strenuous exercise. Anorexia is an eating disorder characterized by low body weight. Orthorexia is a disorder in which the individual avoids certain foods, believing them to be harmful. Binge behavior is consumption of large amounts of foods in a brief time but without the subsequent compensatory behavior.

Which gonadotropin-releasing hormone agonists are used to treat endometriosis? Select all that apply. One, some, or all responses may be correct. 1. Trazodone 2. Diclofenac 3. Leuprolide 4. Isotretinoin 5. Nafarelin acetate

3. Leuprolide 5. Nafarelin acetate Leuprolide and nafarelin acetate are gonadotropin-releasing hormone (GnRH) agonists used to treat endometriosis. Trazodone is used in cases of erectile dysfunction. Diclofenac is a nonsteroidal anti-inflammatory drug used to relieve pain in endometriosis. Isotretinoin is an oral agent that is effective against severe cystic acne.

Which teaching point would the nurse include in the plan of care to decrease the risk of water-related injury for a school-age client? 1. Securing seatbelts properly 2. Using a low-heat setting when cooking 3. Recommending enrollment in swimming lessons 4. Making sure smoke detectors are installed in the home

3. Recommending enrollment in swimming lessons The nurse would include a recommendation to enroll the client in swimming lessons in the plan of care for a school-age client to decrease the risk for drown injury. The nurse would include seatbelt education in the plan of care for the school-age client to decrease the risk of injury while riding in a motor vehicle. The nurse would include using a low-heat setting when cooking and making sure smoke detectors are functional in the home in the plan of care to decrease the risk for burn injury.

Which is the average annual increase in the height of preschoolers? 1. 2 inches (5 cm) 2. 2 to 8 inches (5-20 cm) 3. 4 to 8 inches (10-30 cm) 4. 2.5 to 3 inches (6.2-7.5 cm)

4. 2.5 to 3 inches (6.2-7.5 cm) The average increase in the height of preschoolers per year is 2.5 to 3 inches (6.2-7.5 cm). The average increase in the height of school-aged children per year is 2 inches (5 cm). The average increase in the height of adolescent girls is 2 to 8 inches (5-20 cm). The average increase in the height of adolescent boys is 4 to 8 inches (10-30 cm).

Which task would be considered developmentally appropriate for a 2-year-old to complete? Select all that apply. One, some, or all responses may be correct. 1. Putting socks on feet 2. Washing and drying hands 3. Using fingers to eat food 4. Building a tower of four cubes 5. Identifying facial body parts

All of the above. The Denver Developmental Screening Test is used to determine if a child is meeting appropriate developmental milestones. It incorporates sensorimotor and preoperational phases of growth and development. According to these phases, a 2-year-old child should be able to put socks on feet, wash and dry hands, use fingers to eat food, build a tower of four cubes, and identify facial body parts.

To implement primary prevention of sexually transmitted infections (STIs) the nurse is counseling an adolescent. Which would be the priority nursing action? 1. Help the adolescent recognize the risk. 2. Provide complete information about STIs. 3. Assess the adolescent's sexual risk behaviors. 4. Educate the adolescent about proper preventive measures.

3. Assess the adolescent's sexual risk behaviors. The priority step for primary STI prevention is to assess the sexual risk behavior of the adolescent to identify the risk factors and provide appropriate counseling accordingly. With that information in mind, the nurse can then help the adolescent recognize the risk, encourage usage of preventive measures, and provide proper information about STIs.

Which quantity of iron would be considered mildly to moderately toxic in a preschool child? 1. 8 mg/kg 2. 15 mg/kg 3. 35 mg/kg 4. 65 mg/kg

3. 35 mg/kg Ingestions of 20 to 60 mg/kg of iron are considered mildly to moderately toxic in children. Ingestion of either 8 mg/kg or 15 mg/kg is not considered toxic. Ingestion of amounts greater than 60 mg/kg (here, 65 mg/kg) is severely toxic and possibly fatal.

Which school-age children require close supervision when using a skateboard? Select all that apply. One, some, or all responses may be correct. 1. 5 year old 2. 6 year old 3. 7 year old 4. 8 year old 5. 9 year old

School-age children who are 6, 7, 8 or 9 years all require close supervision when using a skateboard. The 5-year-old school-age client should not be allowed to ride a skateboard due to the high risk for injury.

Which developmental skills should a preschooler exhibit? Select all that apply. One, some, or all responses may be correct. 1. Personal identity 2. Specific reasoning 3. Increased curiosity 4. Magical thinking 5. Understanding of others

2. Specific reasoning 3. Increased curiosity 4. Magical thinking Preschoolers begin to engage in specific and become curious. Preschoolers' thinking is often described as magical thinking. Between the ages of 12 and 36 months, toddlers start thinking of the self as separate from the mother. School-age children around the age of 12 years start concentrating on more than 1 aspect of a situation. They also start understanding different points of view.

Which would the nurse determine before preparing a child with cerebral palsy (CP) for crutch-walking? A. Weight-bearing ability of the child's four extremities B. The power in the child's trunk to drag the legs forward when the child is erect C. Whether the child's circulation can tolerate the body being placed in an erect position D. The ability of the child's shoulder girdle to support the body's weight when it leaves the floor

A. Weight-bearing ability of the child's four extremities The choice of gait is based on the weight-bearing capabilities of the four extremities. Assessment of the extremities takes priority over assessment of the trunk. The child with CP uses upper extremity strength for crutch control and lower extremity strength to facilitate some movement. The child with CP is unlikely to have orthostatic circulatory impairment. Because of decreased muscle control, it is unlikely that the child is able to use a gait involving complete support of body weight off the floor.

Which statement by the adolescent indicates a need for further teaching about the importance of sleep? 1. "I need 7 hours of sleep each night." 2. "Not getting enough sleep can affect my grades." 3. "Sleep deprivation can affect my physical health." 4. "I should leave my phone in the other room to improve my sleep."

1. "I need 7 hours of sleep each night." Adolescents need around 9 hours of sleep each night, although many teens get less than that. Not getting enough sleep can affect school performance and mental and physical health. Many factors cause a teen to not get the sleep he or she needs, including homework, extracurricular activities, time with friends, and use of electronic devices. Leaving the phone in the other room at bedtime can help improve quantity and quality of sleep.

Which concept of death would the nurse expect a 4-year-old child to have? 1. Cessation of life 2. Reversible separation 3. Only affects old people 4. Force takes one away from family

2. Reversible separation Preschoolers view death as a separation; they believe that the deceased will return to life. This is part of their fantasy world; they view death as a kind of sleep rather than a cessation of life and expect the deceased to return or wake up. The preschooler does not yet have the understanding that older people are more likely to die. The preschooler believes that the separation was initiated by the deceased, not by another force.

Which early sign of heart failure would the nurse recognize in an infant who has a congenital heart defect with left-to-right shunting of blood? A. Cyanosis B. Restlessness C. Decreased heart rate D. Increased respiratory rate

D. Increased respiratory rate Because the lungs are stressed by pulmonary edema, a quicker respiratory rate is the first and most reliable indicator of early heart failure in infants. Cyanosis is a late sign of heart failure; with early failure there is still adequate perfusion of blood. Infants with early heart failure do not mov about; they become fatigued quickly, especially when feeding, because of a decrease of oxygen to body cells. The heart rate of an infant in early heart failure increases, not decreases, in attempt to increase oxygen to body cells.

An adolescent is admitted to the burn unit with partial-thickness burns of both arms and the chest. Which information would guid the nurse's plan of care? A. Burns are extremely painful and disfiguring. B. Some grafting of the burned area is necessary. C. Pressure dressings and prolonged hydrotherapy are required. D. Spontaneous epithelial regeneration occurs within several weeks.

D. Spontaneous epithelial regeneration occurs within several weeks. If there is no subsequent infection of the burned areas, wound healing should be uneventful. Although partial-thickness burns are painful, they usually heal with little or no scarring. Regeneration will occur unless there is further insult to the burn injury, such as infection; grafting should not be necessary. Occlusive dressings may be applied to minimize the discomfort of frequent dressing change; hydrotherapy is not required for partial-thickness burns.

Which health education would the nurse prioritize when teaching the parents of preschoolers? 1. Nutrition and bullying 2. Toilet training and immunizations 3. Injury prevention and dental health 4. Organized sports and immunizations

3. Injury prevention and dental health Preschoolers are at risk for injury because of their increasing independence, and dentition issues are important because of the need to preserve the primary teeth until it is time for permanent teeth to erupt. Nutrition and bullying are more appropriate topics for school-aged children. Most preschoolers are not developmentally ready for organized sports, and immunizations should be up to date if in daycare. Toilet training is an appropriate topic for toddlers. Preschool-age children are usually already toilet trained.

A child watches an older sibling playing with a ball but makes no effort to participate in the play. Which social character is the child exhibiting? 1. Parallel play 2. Pretend play 3. Onlooker play 4. Associative play

3. Onlooker play In onlooker play a child actively observes other children playing and does not attempt to enter into the activity; the child is interested only in observation and not in participation. In parallel play children play independently among other children. In pretend play children act out any event of daily life and practice the roles and identities as established in their surroundings. In associative play children play together and are engaged in a similar or identical activity.

Which difficulties faced by an adolescent diagnosed with a chronic illness are attributed to normal development? Select all that apply. One, some, or all responses may be correct. 1. Risk taking 2. Rebelliousness 3. Peer socialization 4. Lack of cooperation 5. Hostility toward authority

1, 2, 4, 5 Risk taking, rebelliousness, lack of cooperation, and hostility toward authority are attributes of normal personal adolescent development. Peer socialization is something that should be encouraged to achieve independence from family.

Which source of stress would the nurse anticipate in a 4-year-old child? 1. Attention 2. Confusion 3. Stranger anxiety 4. Separation anxiety

1. Attention Attention is a particular source of stress in 4-year-olds. A child in this age group likes to talk and is frustrated if ignored or put off. Confusion and stranger anxiety are sources of stress in 3-year-olds. Separation anxiety is a source of stress to 3-year-olds and 5-year-olds as well.

Which developmental milestone would the nurse expect when assessing a preschooler? 1. Copying squares 2. Running with difficulty 3. Difficulty in walking stairs 4. Jumping and hopping with ease

1. Copying squares A preschooler learns to copy crosses and squares. Also, preschoolers run well and walk up and down steps with ease. They begin to learn to jump and hop rather jumping and hopping with ease.

Which pain scale is used to measure the intensity of pain in preschoolers? 1. FACES scale 2. Visual analog scale 3. Numerical rating scale 4. Verbal descriptor scale

1.FACES scale The FACES scale is used to measure the intensity of pain in a preschooler. The scale consists of six cartoon faces ranging from a smiling face ("no hurt") to increasingly less happy faces to a final sad and tearful face ("hurts worst"). The visual analog scale, numerical rating scale, and verbal descriptor scale can be used in young children and adults.

Which assessment would the nurse include when taking the health history of a toddler with an exacerbation of eczema? Select all that apply. One, some, or all responses may be correct. 1. Change in appetite 2. Wearing cotton clothes 3. Exposure to new foods 4. Exposure to a viral infection 5. Recent contact with someone with eczema

2 and 3 Eczema is a common manifestation of allergies in the young child and is often related to foods and clothing. Wearing cotton clothing indicates that the parents understand and are trying to minimize their child's allergic reaction. Exposure to new foods is a common trigger for eczema. Appetite does not play a role in the occurrence of eczema. Eczema is an allergic manifestation; it is not contagious.

Which ages are the most critical for speech development during the preschool years? Select all that apply. One, some, or all responses may be correct. 1. 2 years 2. 3 years 3. 4 years 4. 5 years 5. 6 years

2 and 3 The most critical ages for speech development for the preschool-aged client are 3 and 4 years of age. Although critical speech development occurs at the age of 2, this is the toddler, not preschool, stage of development. The ages of 5 and 6 years are not considered critical ages for speech development for the preschool-aged client.

A parent reports that his or her child just ate several multivitamins with iron. Which statement would the nurse say to the parent? 1. "Give your child orange juice." 2. "Call the Poison Control Center." 3. "Iron-fortified multivitamins are safe for your child." 4. "Administer an emetic—syrup of ipecac, if you have it."

2. "Call the Poison Control Center." The Poison Control Center will provide the best guidance for treatment of excess ingestion of a substance; enemas, lavage, or chelation therapy with deferoxamine, a heavy metal antagonist, may be recommended, depending on the amount ingested and the child's age and response. Orange juice will enhance absorption of the iron and will create a greater risk for toxicity. Iron is the most toxic substance in multivitamins. Although signs and symptoms may not be evident for several hours, treatment should be initiated before a problem develops. Emetics are not used for poisonings; they are not effective in removing the toxic substance and causing the child to vomit creates a risk for aspiration.

Which is the average weight of a 3-year-old child? 1. 26.5 lb (12 kg) 2. 32 lb (14.5 kg) 3. 41 lb (18.5 kg) 4. 36.5 lb (16.5 kg)

2. 32 lb (14.5 kg) The average weight of a 3-year-old child is 32 lb (14.5 kg). The average weight of a 2-year-old child is 26.5 lb (12 kg). The average weight of a 5-year-old child is 41 lb (18.5 kg). The average weight of a 4-year-old child is 36.5 lb (16.5 kg).

According to Erikson's theory of psychosocial development, which task does the nurse recognize as the chief psychosocial task of preschoolers? 1. Control over bodily functions 2. Development of a sense of initiative 3. Toleration of separation from parents 4. Ability to interact with others in a less egocentric manner

2. Development of a sense of initiative According to Erikson, the chief psychosocial task of preschoolers is acquiring a sense of initiative. Control over bodily functions, toleration of separation from parents, and the ability to interact with others in a less egocentric manner are the psychosocial tasks of toddlers.

Which stage describes the Oedipus complex, according to Freud's theory? 1. Stage 2 2. Stage 3 3. Stage 4 4. Stage 5

2. Stage 3 According to Freud's theory, there are five stages in a child's development. Stage 3 is the Oedipal stage, which is also known as the phallic stage. Stage 2 is the anal stage. Stage 4 is the latency stage. Stage 5 is the genital stage.

During which week of pregnancy does placental development occur? 1. First 2. Third 3. Fifth 4. Seventh

2. Third Placental development begins during the third week of pregnancy. The other answer options, first, fifth, and seventh, are not when placental development occurs.

A 3-month-old infant with tetralogy of Fallot suddenly becomes cyanotic and begins breathing rapidly. In which position would the nurse immediately place the infant? 1. Supine 2. Lateral 3. Knee-chest 4. Semi-Fowler

3. Knee-chest The infant is experiencing a hypercyanotic ("tet" spell) episode caused by a sudden decrease in pulmonary blood flow and an increase in right-to-left shunting. It usually occurs after increased activity. The knee-chest position decreases venous return from the legs, which increases systemic vascular resistance, thereby increasing pulmonary blood flow. The supine and lateral positions increase venous return, which exacerbates the problem. Although the semi-Fowler position is recommended for infants with cardiac disease, it is not adequate for an infant experiencing a tet spell.

Which afternoon snack would the nurse recommend to a group of school-aged students? 1. Bowl of cereal with whole milk 2. Pudding cup made with skim milk 3. Low-fat cheese and a piece of fruit 4. Two cookies and a glass of fruit juice

3. Low-fat cheese and a piece of fruit Low-fat cheese and a piece of fruit are nutritious and provide protein, fiber, and many vitamins and minerals to help the child feel and stay full. A bowl of cereal made with whole milk contains a lot of sugar and a lot of fat. A pudding cup, although made with skim milk, contains a lot of sugar and not much nutrition. Two cookies and a glass of juice are both high in sugar.

A young pregnant adolescent is diagnosed as having bacterial vaginosis. Which complications related to bacterial vaginosis may occur? Select all that apply. One, some, or all responses may be correct. 1. Neonatal sepsis 2. Cervical dysplasia 3. Preterm labor and birth 4. Intraamniotic infection 5. Postpartum endometritis

3. Preterm labor and birth 4. Intraamniotic infection 5. Postpartum endometritis Preterm birth and labor may occur because bacteria that enters the cervix irritates the uterus, which cause contractions. Bacterial vaginosis is associated with high risk of intraamniotic infection and postpartum endometritis. Neonatal sepsis occurs because of gonococcal infections. Cervical dysplasia occurs in clients with human immunodeficiency virus infections.

Which insect or arthropod is the most common allergen for children with asthma? 1. Spider 2. Centipede 3. Carpenter ant 4. Household cockroach

4. Household cockroach Research has identified that the presence of the common household cockroach can trigger an asthma exacerbation in children with asthma. Spiders, centipedes, and carpenter ants have not been identified as triggers in children who are prone to asthmatic attacks.

Which gross motor milestone is exhibited by 3-year-olds? 1. Walking backward with heel to toe 2. Repeatedly catching a ball 3. Skipping and hopping on one foot 4. Riding a tricycle

4. Riding a tricycle Riding a tricycle is a gross motor skill exhibited by 3-year-olds. Repeatedly catching a ball, skipping, and hopping on one foot are gross motor skills expected in 4-year-olds. Walking backward with heel to toe is a gross motor skill exhibited by 5-year-olds.

Which action would the nurse take when an infant begins to cough and gag after a nasogastric tube insertion? A. Auscultating for breath sounds B. Removing the tube, then reinserting it C. Administering the tube feeding slowly D. Observing the infant for circumoral cyanosis

B. Removing the tube, then reinserting it The infant's response indicates that the tube may be in the trachea rather than the stomach. The tube should be removed, reinserted, and verified for its placement before the feeding is started. Auscultating for breath sounds does not provide information about the placement of the tube. The tube should be removed immediately; it is unsafe to assess the infant for additional signs of respiratory distress. It is unsafe to administer the feeding until placement in the stomach has been confirmed.

The nurse has taught newborn care and safety to a group of expectant mothers. Which statement by a mother indicates the need for additional teaching? 1. "I need to put my baby to bed on his back." 2. "I need to toddler-proof my house when the child starts crawling." 3. "My baby could choke on any small object that will fit in her mouth." 4. "I'll keep my baby in a backward-facing car seat until he's a year old."

4. "I'll keep my baby in a backward-facing car seat until he's a year old." New guidelines recommend keeping a child in a backward-facing car seat until 2 years of age. Putting a baby to bed in the supine position will reduce the risk of sudden infant death syndrome. The house should be toddler-proofed when the child starts crawling. Choking is a major hazard for the young infant, who will place anything at hand in the mouth.

At which age would the nurse anticipate that the preschool-aged client will overcome many fears? 1. 2 years 2. 3 years 3. 4 years 4. 5 years

4. 5 years Most preschool-aged children will relinquish fears by 5 years of age. A 2-year-old is a toddler. Preschool clients who are 3 or 4 years of age will often still have many fears.

The nurse gives a teenager discharge instructions regarding cast care. The nurse concludes that the instructions have been understood when which statement is made? 1. "If I get itchy around the cast, I'll rub the itchy area gently." 2. "If I get itchy around the cast, I'll pat the area with an alcohol swab." 3. "If I get itchy around the cast, I'll ask my doctor for a prednisone prescription." 4. "If I get itchy around the cast, I'll sprinkle a layer of powder around the itchy spots."

1. "If I get itchy around the cast, I'll rub the itchy area gently." Gentle rubbing may soothe the skin; stimulation of sensory neurons by rubbing may decrease the itching sensation. Alcohol is a drying agent and should not be used. Steroids such as prednisone are not routinely given for itching caused by a cast. Powder may become caked, slip under the cast, and cause additional discomfort. Also, powder, which is a respiratory irritant, may be inhaled.

Which education would the nurse provide the parent of a 4-year-old child? 1. They are easy to please with food. 2. They master the ability to draw diamond shapes. 3. They double their birth length at this age. 4. They have an average weight of 32 pounds (14.51 kg).

3. They double their birth length at this age. By around the age of 4 years, preschoolers have doubled their birth length. At this age, preschoolers develop finicky eating habits and are not easy to please with food. Drawing triangles and diamonds is usually mastered between the ages of 5 and 6 years. The average weight of preschoolers at the age of 4 years is 37 pounds (16.78 kg). Three-year-old children have an average weight of 32 pounds (14.51 kg).

Which play activity is the best choice to suggest to the parents of a school-aged child with autism? A. Holding a cuddly toy B. Climbing a jungle gym C. Building with small blocks D. Riding on a playground merry-go-round

The rhythmic movement of the merry-go-round provides an opportunity for the child to practice spatial and sensory orientation. This is important in helping the child increase interaction with the environment. The autistic child rejects cuddling and anything that feels cuddly. Jungle gyms and blocks do not provide rhythmic movements that will engage the child.

The parents of a child with newly diagnosed celiac disease ask the nurse what the intestinal biopsy revealed. Before responding, which would the nurse consider about the results of the biopsy? 1. The mucosal wall exhibits trophic changes. 2. There is diffuse degenerative fibrosis of the acini. 3. The mucosal wall has small areas of fatty plaques. 4. There are irregular areas of superficial ulcerations.

1. The mucosal wall exhibits trophic changes. Celiac disease is a primary defect in which the intestinal mucosal transport system is impaired; the inability to digest gluten results in an accumulation of glutamine, which is toxic to mucosal cells and causes atrophy of the villi. The pancreatic acini degenerate with cystic fibrosis not with celiac disease. Small areas of fatty plaques on the mucosal walls and irregular areas of superficial ulceration do not occur in celiac disease.

According to Kohlberg's theory of moral development, which statement about conventional reasoning is true? 1. A person wants to fulfill family expectations. 2. A child's thinking is mostly based on likes and pleasures. 3. A child recognizes that there is more than one correct view. 4. An individual moves away from moral decisions based on authority.

1. A person wants to fulfill family expectations. When a child wants to be on time for a family dinner, this thought exemplified the instrumental relativist orientation stage. A child at this stage follows his or her parent's rules. During the good boy-nice girl orientation stage, a child wants to win the approval of and maintain the expectations of one's immediate group. During the society-maintaining orientation stage, an individual expands focus from a relationship with others to societal concerns. During the universal ethical principle orientation stage, the concept of "rightness" is defined by self-chosen ethical principles.

Which would the nurse implement to help a chronically ill infant to establish trust? 1. Encouraging consistent caregivers for the infant 2. Encouraging the infant to hold his or her own bottle 3. Encouraging periodic respite for the infant's parents 4. Emphasizing the healthy attributes of the infant to the parents

1. Encouraging consistent caregivers for the infant An intervention that the nurse can implement to help the infant with a chronic illness to establish trust is to encourage consistent caregivers while providing care. Encouraging the infant to hold his or her bottle encourages sensorimotor development. Encouraging periodic respite for the infant's parents decreases the likelihood of parental overinvolvement and burnout. Emphasizing the healthy attributes of the infant to the parents enhances the bond between infant and parent.

Which statement about language development in preschoolers is correct? 1. Preschoolers find words such as die and dye confusing. 2. Preschoolers realize that words have arbitrary rather than absolute meanings. 3. Preschoolers become aware of the rules for linking words into phrases and sentences. 4. Preschoolers accept language as a means of representing the world in a subjective manner.

1. Preschoolers find words such as die and dye confusing. Preschool children find phonetically similar words such as die and dye confusing. School-aged children realize that words have arbitrary rather than absolute meanings. School-aged children become aware of the rules for linking words into phrases and sentences; they also accept language as a means of representing the world in a subjective manner.

Which parent teaching would the nurse provide about signs of shunt failure in a 4-month-old infant with a ventroperitoneal shunt? Select all that apply. One, some, or all responses may be correct. 1. Vomiting 2. Dehydration 3. Sunken eyeballs 4. Distended fontanels 5. Abdominal distention

1. Vomiting 4. Distended fontanels Vomiting is a sign of increased intracranial pressure in an infant; a malfunctioning shunt will produce the typical signs of hydrocephalus. Bulging fontanels indicate increased cerebrospinal fluid and increased intracranial pressure in an infant. Dehydration and sunken eyeballs are signs of severe fluid volume deficit caused by prolonged vomiting or diarrhea; they are not associated with the projectile vomiting of increased intracranial pressure. Abdominal distention is a typical sign of gastroenteritis, not shunt failure.

The mother of a 2-year-old child is concerned about how to handle temper tantrums. Which information would the nurse give the mother regarding tantrums? 1. The child will require counseling by a behavioral child psychologist. 2. Tantrums can be reduced with the provision of a less stressful environment. 3. Tantrums should be ignored because they are an expected occurrence in toddlers. 4. Tantrums will subside quickly if the mother holds the child during the tantrum.

2. Tantrums can be reduced with the provision of a less stressful environment. Tantrums are the result of frustration, stress, and confusion about demands of the environment; limiting these factors reduces the occurrence of tantrums. They are expected in children of this age, but attention is required to protect the child from injury and to limit stressful situations. Professional counseling is indicated only if conservative care is ineffective or a pathological process or behavior is evident. Holding a child during the tantrum is rarely effective and provides secondary gains for this behavior.

Which statement describes stage 4 of Kohlberg's theory? Select all that apply. One, some, or all responses may be correct. 1. The child recognizes that there is more than one right view. 2. The child shows respect for authority and maintains the social order. 3. Adolescents choose to avoid a party where they know beer will be served. 4. The individual wants to win approval and maintain the expectations of one's immediate group. 5. The child's response to a moral dilemma is in terms of absolute obedience to authority and rules.

2,3. According to stage 4 of Kohlberg's theory, adolescents show respect for authority and maintain the social order. They choose not to attend a party where beer will be served because they know this is wrong. During stage 2, the child recognizes that there is more than one right view. Stage 3 states that an individual wants to win approval and maintain the expectations of one's immediate group. During stage 1, the child's response to a moral dilemma is in terms of absolute obedience to authority and rules.

A 5-year-old girl is undergoing a course of chemotherapy. One day the nurse sees the child crying. The child tells the nurse, "All my hair is gone, and everyone stares at me." Which is the bestresponse by the nurse? 1. "Let's take the hair off your doll so you two will look alike." 2. "Let's ask your mother to bring in a hat for you to wear until your hair grows back." 3. "You just think that everyone is staring at you because you feel funny without your hair." 4. "You shouldn't have to look at yourself without hair, so I'm going to take this mirror out of your room."

2. "Let's ask your mother to bring in a hat for you to wear until your hair grows back." Having the child wear a hat until her hair regrows meets her current needs while assuring her that her hair loss is temporary. Removing the doll's hair demeans the child's feelings. Denying the child's feelings by stating that she just thinks that everyone is staring at her is not the best response. Taking the mirror out of the room demeans the child's feelings and implies that the hair loss is unsightly.

Which characteristics would the nurse observe in a client who has secondary amenorrhea? 1. No uterine bleeding for 4 years after breast development 2. Absence of menstrual bleeding for 3 cycles after menarche 3. Absence of uterine bleeding and secondary sex characteristics at age 16 years 4. No uterine bleeding for 1 year after attaining a sexual maturity rating of 5 on the Tanner scale

2. Absence of menstrual bleeding for 3 cycles after menarche The client's menstrual cycle is absent 3 successive times after menarche. This is an indication of secondary amenorrhea. The absence of uterine bleeding 4 years after breast development, the absence of uterine bleeding and secondary sex characteristics at age 16 years, or no uterine bleeding for 1 year after attaining a sexual maturity rating of 5 on the Tanner scale are indicative of primary amenorrhea.

Which feeding education would the nurse provide the parent of a 2-month-old infant with the diagnosis of heart failure? 1. Use double-strength formula. 2. Avoid using a preemie nipple. 3. Refrain from feeding until crying from hunger begins. 4. Feed slowly while allowing time for adequate periods of rest.

4. Feed slowly while allowing time for adequate periods of rest. Because of limited exercise tolerance and fatigue, infants with heart failure become too tired to feed; allowing rest and feeding slowly limit the fatigue associated with feeding. Although the infant may be given a formula with a higher caloric value (30 kcal/oz [30 kcal/30 mL] rather than 20 kcal/oz [20 kcal/30 mL]), double-strength formula is too high of an osmotic load for the infant. A soft nipple used for preterm infants or a regular nipple with an enlarged opening is preferred to conserve the energy required for sucking. Crying consumes energy and is exhausting. The infant should be fed when exhibiting signs of hunger, such as sucking on a fist.

Which parental statement would the nurse interpret as indicating a need for further teaching when educating the Hispanic parents of a preschooler about preventing lead exposure? 1. "We'll use cold water to cook and drink." 2. "We know to not store food in open cans." 3. "We can use orange powders for diarrhea." 4. "We'll start planning healthy midmorning and afternoon snacks."

3. "We can use orange powders for diarrhea." Greta and azarcon (also known as alarcon, coral, luiga, maria luisa, and rueda), traditional Hispanic remedies taken for upset stomach, constipation, diarrhea, and vomiting, are also used for teething babies. Both are fine orange powders with a lead content as high as 90%. Further teaching is required if the family indicates that they will continue treating diarrhea with a home remedy. Food should not be stored in open cans, particularly those that have been imported. Cold water for consumption (drinking, cooking, and especially reconstitution of powdered infant formula) should be used; hot water dissolves lead more quickly than does cold water, yielding a higher level of lead. Frequent healthy snacks are encouraged because lead is absorbed better on an empty stomach.

A 15-year-old with type 1 diabetes has a history of noncompliance with the therapy regimen. Which would be considered about the teenager's developmental stage before starting a counseling program? 1. They usually deny their illness. 2. They have a need for attention. 3. The struggle for identity is typical. 4. Regression is associated with illness.

3. The struggle for identity is typical. Striving to attain identity and independence are tasks of the adolescent, and rebellion against established norms may be exhibited. Although the adolescent may be using denial, denial is not developmentally related to adolescence. This behavior is not a bid for attention; adolescents want to be like their peers and not stand out. Nor is this behavior regression; regression is the use of patterns of coping associated with earlier stages of development. Test-Taking Tip: Noncompliance with (or misuse of) a prescribed drug regimen is viewed as deviant behavior by primary health care providers. In reality, the client may not be aware of the proper dose and regimen or may have chosen not to take the drug as prescribed for a variety of reasons.

Which statement by the parents satisfies the nurse that they understand the principles of care for the child with sickle cell who recently had a vasoocclusive (painful crisis) episode? 1. "We are having the child schooled by a private tutor." 2. "We are restricting the child's fluid intake during the night." 3. "We are permitting the child to play with just one peer at a time." 4. "We are encouraging the child to engage in low-intensity activities."

4. "We are encouraging the child to engage in low-intensity activities." Low-intensity activities should be encouraged, because strenuous exercise leads to increased cellular metabolism, resulting in tissue hypoxia, which can precipitate sickling. Having the child schooled by a private tutor is detrimental to the child's developmental needs and may result in social isolation. Some parents restrict fluids at night to discourage bedwetting. However, fluids should not be restricted in this case because keeping the child well hydrated helps prevent sickling. Restricting the child's play activities is unnecessary unless the other children have an infectious disease; a variety of peer relationships should be encouraged.

Which type of play would the nurse encourage when providing age-appropriate care to a preschool-age child who is hospitalized? 1. Team 2. Parallel 3. Solitary 4. Associative

4. Associative The nurse would encourage the hospitalized preschool-age client to participate in associative play. Team play is appropriate for the school-age child. Parallel play is appropriate for the toddler-age client. Solitary play is appropriate for the infant.

Which adolescent's thought corresponds to the good boy-nice girl orientation stage? 1. "I should avoid parties where alcohol is served." 2. "I should follow the rules or else the teacher will punish me." 3. "I should follow all the laws formulated by the government." Correct4 "I should complete my homework on time so that the teacher will reward me."

4. "I should complete my homework on time so that the teacher will reward me." When an individual thinks that completing the homework will help win a reward, this thought corresponds to good boy-nice girl orientation stage. Individuals in this stage seek the approval of and want to maintain the expectations of their immediate group. When an individual thinks of avoiding parties where alcohol is served, this thought corresponds to the society-maintaining orientation stage. When an individual thinks that breaking a rule will lead to physical punishment, this thought corresponds to the punishment and obedience orientation stage. When an individual feels that he or she should follow all the laws formulated by the government, this thought corresponds to the universal ethical principle orientation.

According to Piaget's theory, which of these statements would be provided regarding a 4-year-old child? Select all that apply. One, some, or all responses may be correct. 1. "The child will only be able to consider his or her own point of view." 2. "The child will consider that inanimate objects may be alive." 3. "The child will think about an action before performing it." 4. "The child will believe that his or her actions are scrutinized." 5. "The child will be able to order things according to length."

1, 2. According to Piaget's theory, a 4-year-old child will see others only from his or her point of view. In addition, the child will consider inanimate objects as living. Between the ages of 4 and 11 years, the child thinks about an action before performing it physically. From the age of 11 years to adulthood, a child believes that his or her actions and appearance are constantly scrutinized. The child has an "imaginary audience." This is the period of formal operations. Between the ages of 4 and 11 years, a child is able to correctly order or sort objects by length or weight.

Which anticipatory guidance would be provided for a growing child to prevent obesity? Select all that apply. One, some, or all responses may be correct. 1. "Eat small meals throughout the day." 2. "Put a video game system in your bedroom." 3. "Drink fewer sweetened beverages every day." 4. "Watch television for less than 2 hours every day." 5. "Skip breakfast and eat a healthy lunch and dinner."

1. "Eat small meals throughout the day." 3. "Drink fewer sweetened beverages every day." 4. "Watch television for less than 2 hours every day." Sweetened beverages are high in sugar and calories, which increase the risk of obesity. The nurse instructs the client to avoid sweetened beverages. Eating small meals at regular intervals keeps the person feeling full, reduces overeating, and improves metabolism. A sedentary lifestyle also increases the risk of obesity. The nurse would instruct the client to reduce television watching to less than 2 hours a day. Playing video games is primarily a sedentary activity. Breakfast is a very important meal, and the nurse would instruct the client to eat a healthy breakfast every day.

Which child would the nurse plan to start initial tests for lead screening at a scheduled health maintenance visit? 1. 18-month-old toddler 2. 36-month-old toddler 3. 4-year-old preschooler 4. 6-year-old school-age child

1. 18-month-old toddler Initial lead screening should occur between the ages of 1 and 2 years; therefore, the toddler-age client who is 18 months old should have laboratory tests drawn to assess for lead toxicity. Initial screenings are not necessary for the 36-month-old toddler, the 4-year-old preschooler, and the 6-year-old school-age child.

Which blood lead level would the nurse recognize as the threshold for identifying children with abnormal lead exposure, according to the Centers for Disease Control and Prevention, 2012? 1. 5 mcg/dL 2. 10 mcg/dL 3. 80 mcg/dL 4. 0.2 mcg/dL

1. 5 mcg/dL In 2012 the CDC recommended the use of a reference value based on the 97.5th percentile of blood lead levels (BLLs) among 1-year-old to 5-year-old children in the United States. The current level to identify children with exposure to lead hazards is 5 mcg/dL or higher. Before 2012, the level of concern for an elevated BLL was 10 mcg/dL; 80 mcg/dL was the BLL threshold in 1950. BLL of 0.2 mcg/dL is too little to be considered hazardous.

Which symptoms would cause the nurse to suspect the toddler-age child who presents to the emergency department may have acute aspirin poisoning? Select all that apply. One, some, or all responses may be correct. 1. Emesis 2. Nausea 3. Tinnitus 4. Ecchymosis 5. Hypoventilation

1. Emesis 2. Nausea 3. Tinnitus Emesis, tinnitus, and nausea are all early clinical manifestations of acute aspirin poisoning; therefore, it would be appropriate for the nurse to initiate treatment for an aspirin overdose. Ecchymosis is a late symptom associated with a chronic aspirin overdose. Hyperventilation, not hypoventilation, would support the initiation of treatment for an aspirin overdose.

What should the nurse tell the mother concerning an exercise program for her child diagnosed with idiopathic scoliosis who has a mild structural curve? 1. Exercise is used in conjunction with a brace. 2. Exercise can be used if the child appears highly motivated. 3. Exercise might exaggerate the curvature if the curve is severe. 4. Exercise is needed to correct the curvature without the need for a brace.

1. Exercise is used in conjunction with a brace An exercise program and a brace are the treatments of choice for mild structural scoliosis. Although compliance will affect the ultimate outcome of treatment, exercises alone are not helpful in this type of scoliosis. Exercises are to be encouraged, regardless of the type or extent of scoliosis. Exercises alone are used only with postural-related, not structural-related, scoliosis.

Which type of fracture is common in preschool children? 1. Greenstick 2. Transverse 3. Compound 4. Comminuted

1. Greenstick Ossification of the long bones is incomplete in childhood; children's bones can flex to about a 45-degree angle before breaking. When the bone is angulated beyond 45 degrees, the compressed side bends and the torsion side breaks (greenstick fracture). A transverse fracture is usually a complete fracture seen in blunt trauma; it occurs in adults because bone ossification is complete. A compound fracture is a fracture with an open wound from which the bone protrudes; it is seldom seen in children. A comminuted fracture is a fracture in which small fragments of bone are broken from the fracture site and lie in the surrounding tissue; it is rarely seen in children.

Which is the classic clinical manifestation of scabies? 1. Pruritic, threadlike lesions in skin folds 2. Grayish-white particles adhering to hair shafts 3. Central necrotic ulcer surrounded by petechiae 4. Reddened, round areas of alopecia over the scalp

1. Pruritic threadlike lesions in skin folds As the mite burrows into skin folds (e.g., interdigital, axillary, inguinal), it creates threadlike burrows that are intensely pruritic. Grayish-white particles adhering to hair shafts are nits, an indicator pediculosis wapitis, not scabies. A central necrotic ulcer surrounded by petechiae is not an indicator of scabies; this is the bite of a brown recluse spider, which results in a lesion that progresses to necrotic ulceration in 7 to 14 days. Reddened areas of alopecia are consistent with ringworm, not scabies.

Which clinical manifestations are associated with rabies infection? 1. Seizures and difficulty swallowing 2. Encephalopathy and opisthotonos 3. Septicemia and bone deterioration 4. Immunosuppression and opportunistic infections

1. Seizures and difficulty swallowing Seizures and swallowing difficulties are characteristics of rabies infection, which affects the nervous system; the disease is usually fatal if it goes untreated. Rabies is not a bacterial infection. Although rabies is a viral infection, it is not characterized by immunosuppression and opportunistic infections. Immunosuppression and opportunistic infections are associated with acquired immunodeficiency syndrome (AIDS).

Which sensory function is difficult to assess in preschoolers? 1. Smell 2. Taste 3. Vision 4. Touch

1. Smell Smell is difficult to assess in preschoolers; smell can be assessed in children 6 years of age or older. Taste, vision, and touch can be assessed in a preschooler.

Which parental description would the nurse recognize as characteristic of sleep terrors in a preschool-age child? 1. Sweating profusely 2. Calling out after a dream 3. Awakening during the second half of the night 4. Being aware that others are in the room after awakening

1. Sweating profusely Profuse sweating is a characteristic that would cause the nurse to believe that the child is experiencing a sleep terror versus a bad dream. Calling out after the dream is over, awakening during the second half of the night, and being aware that others are in the room after the dream is over are characteristics associated with a bad dream, not a sleep terror.

According to Erikson's theory of psychosocial development, which is the correct order of a child's behavior as he or she ages?

1. The child develops autonomy by making choices. 2. The child develops feelings of superego or conscience. 3. The child concentrates on work and play. 4. The child is concerned about appearance and body image. According to Erikson's theory, a toddler develops his or her autonomy by making choices. The child moves on to the next stage and develops a superego, or conscience. During the industry versus inferiority stage, the child learns to work and play with their peers. During the identity versus role confusion stage, an adolescent can be seen having a marked preoccupation with his or her appearance and body image.

The parents of an infant with newly diagnosed cystic fibrosis ask the nurse what causes the foul-smelling, frothy stool. Which response would the nurse provide? 1. Undigested fat 2. Sodium and chloride 3. Partially digested carbohydrates 4. Lipase, trypsin, and amylase release

1. Undigested fat Because of a lack of the pancreatic enzyme lipase, fats remain unabsorbed and are excreted in excessive amounts in the stool. Sodium, chloride, and partially digested carbohydrates do not cause the typical characteristics of the stools. Lipase, trypsin, and amylase are the pancreatic enzymes whose passage into the intestine is prevented by blocked pancreatic ducts.

Which observations would indicate findings found in a child with Turner syndrome? Select all that apply. One, some, or all responses may be correct. 1. Webbed neck 2. Impaired language 3. Tall stature with long legs 4. Low position of posterior hairline 5. Shield-shaped chest with wide space between the nipples

1. Webbed neck 4. Low position of posterior hairline 5. Shield-shaped chest with wide space between the nipples Turner syndrome is a chromosomal abnormality seen in females in which an X chromosome is partly or completely absent. The clinical manifestations of Turner syndrome include a webbed neck, low posterior hairline, and shield-shaped chest with wide space between the nipples. Impaired language skills are seen in clients with triple X, or superfemale syndrome. The client with Turner syndrome has short stature. Tall stature with long legs is a finding in Klinefelter syndrome.

Which instructions would the nurse give to the parents of a toddler? Select all that apply. One, some, or all responses may be correct. 1. "You should direct the actions of your child." 2. "You should serve finger foods to your child." 3. "You should give 5 cups of milk to your child daily." 4. "You should give graded independence to your child." 5. "You should use television to keep the child entertained."

2, 4. The nurse would instruct the parents to serve finger foods to the child. This allows the toddler to feed himself or herself and satisfy his or her need for independence and control. The nurse would instruct the parents to provide graded independence to their child, allowing the toddler to do things that do not result in harm to himself or herself or others. The strong will of a toddler is often exhibited in negative behavior when a caregiver attempts to direct the child's actions. Milk intake should be limited to 2 to 3 cups a day. Consumption of more than a quart of milk per day will decrease the child's appetite for essential solid foods and result in inadequate iron intake. Parents should not use television as a substitute for quality parent-child interaction.

The parent of a 14-month-old child asks how to proceed with bowel training. Which is the best response by the nurse? 1. "Place the child on the toilet every 2 hours." 2. "Start by purchasing a potty chair." 3. "Avoid bowel training until the child is 2 years old." 4. "Begin before the child's diet consists mainly of solid foods."

2. "Start by purchasing a potty chair." A potty chair is sized for a child and allows the child to display its contents with pride. A potty chair also allows the child to place the feet on the floor for an effective Valsalva maneuver to aid bowel evacuation. Sitting on a toilet seat can be frightening for a toddler. Timing of bowel training should coincide with the gastrocolic reflex. Bowel training should be started whenever the child shows readiness. A diet consisting mainly of solid foods will make stools bulkier and easier to control.

Which preoperative goal would the nurse establish while caring for an infant born with a myelomeningocele? 1. Keeping the infant sedated 2. Keeping the infant infection-free 3. Ensuring maintenance of leg movement 4. Ensuring development of a strong sucking reflex

2. Keeping the infant infection-free Prevention of infection is the priority both before and after the repair of the sac. Sedatives are not indicated; analgesics are administered as needed. Leg movement may be a postoperative goal, although it may be unrealistic because these infants' lower bodies are usually paralyzed. The sucking reflex is not associated with myelomeningocele.

Which plan of care would the nurse provide an infant who has just undergone myelomeningocele repair? 1. Maintaining a supine position 2. Monitoring for cerebrospinal fluid leakage 3. Teaching clean catheterizations to parents 4. Applying sterile moist dressings to the incision

2. Monitoring for cerebrospinal fluid leakage Leakage of cerebrospinal fluid indicates incomplete closure of the defect and must be reported. The supine position is contraindicated, because it places pressure on the surgical site. Teaching clean catheterization is not appropriate at this time. Moist dressings are applied before surgery, not after, to prevent drying of the sac.

Which period of Piaget's theory explains animism in a child? 1. Period I 2. Period II 3. Period III 4. Period IV

2. Period II During period II of Piaget's theory, children demonstrate animism, in which they personify objects. During period I, infants develop a schema or action pattern for dealing with the environment. During period III, a child is able to think about an action that previously was performed physically. During period IV, adolescents demonstrate feelings and behaviors characterized by self-consciousness.

Determine how an adolescent can establish group identity during psychosocial development? 1. By evaluating his or her own health with a feeling of well-being 2. By fostering his or her independence with balanced family structure 3. By building close peer relationships to achieve acceptance in the society 4. By achieving marked physical changes with masculine and feminine behaviors

3. By building close peer relationships to achieve acceptance in the society By building close peer relationships, adolescents develop a sense of belonging, approval, and the opportunity to learn acceptable behavior. This behavior establishes the group identity. By evaluating his or her own health with a feeling of well-being, an adolescent establishes health identity. An individual establishes family identity by fostering his or her independence with balanced family structure. The sound and healthy growth of an adolescent with marked physical changes helps build sexual identity.

An adolescent is severely injured in a motor vehicle collision. There are multiple fractures, contusions, and muscle spasms, causing the teenager to refuse to move. How can the nurse best support the adolescent in movement? 1. Allowing friends to visit daily 2. Explaining that some pain is inevitable 3. Encouraging decision-making regarding care 4. Setting specific limits regarding this behavior

3. Encouraging decision-making regarding care Decision-making fosters and supports independence, a developmental need of the adolescent. It also increases a sense of self-worth and control. Allowing friends to visit daily promotes social interaction, not movement. Although it may be true that pain is inevitable, explaining this is not a motivating intervention. Setting specific limits is confrontational; limit-setting meets the security needs of young children.

Which statement should be considered when teaching measures to prevent lead poisoning in children? 1. Lead poisoning is known to be caused by the ingestion of foods that are high in fat. 2. Lead poisoning is attributed to an indigent and passive parent who fails to supervise the children. 3. Environmental factors are involved because lead is available for ingestion and inhalation. 4. Increasing milk intake will counteract the adverse effects of lead ingestion.

3. Environmental factors are involved because lead is available for ingestion and inhalation. Lead poisoning is caused by lead in the environment. Sources of lead may include deteriorating paint in a home (inhaled or ingested); lead in products that are used daily, such as batteries, pottery, and glass (ingested); and lead in the atmosphere (which may be inhaled or fall on food that is then ingested). Unless the fat has been exposed to lead, it is not a causative factor. The role of parents is not an identified factor. Socioeconomic status is just one causative factor; there are many others. Milk does not counteract the effects of lead. Also, the teaching regards causes of lead poisoning, not treatments.

Why would the nurse include in nutrition education that eating in fast-food restaurants should be limited? 1. Eating is rushed. 2. Portions are too large. 3. Food is high in calories. 4. Sanitation is inadequate.

3. Food is high in calories. The American Dietetic Association (Canada: Public Health Agency of Canada) has indicated that the food in fast-food restaurants is calorie dense and higher in fat, sugar, and sodium than the food served at home or in other restaurants. Although fast-food restaurants encourage patrons to eat quickly, this is not the major reason that their food is discouraged. Portions in fast-food restaurants are not large; they are smaller than those in diners and many other restaurants. Fast-food restaurants encourage safe food handling to meet the standards of local health departments.

Identify the stage at which an adolescent develops abstract thinking. 1. Genital stage 2. Conventional reasoning 3. Formal operations period 4. Identity vs. role confusion

3. Formal operations period According to Piaget's moral development theory, an adolescent develops abstract thinking during the formal operations period. According to Freud's genital stage, sexual urges reawaken and are directed to an individual outside the family circle. During the conventional reasoning stage, a person establishes his or her morals based on his or her own personal internalization of societal expectations. According to the identity versus role confusion stage, there is a marked preoccupation with appearance and body image.

Which education would the nurse provide the parents of a 2-month-old infant about home care in the event of an immunization reaction? 1. Give aspirin for pain; if swelling at the injection site develops, call the health care provider. 2. Apply heat to the injection site for the first day after the injection; apply ice if the arm is inflamed. 3. Give acetaminophen for fever; call the health care provider if the child exhibits marked drowsiness or seizures. 4. Apply ice to the injection site if soreness develops; call the health care provider if the child comes down with a fever.

3. Give acetaminophen for fever; call the health care provider if the child exhibits marked drowsiness or seizures. Fever is a common reaction to immunizations, and acetaminophen may be given to minimize discomfort. A central nervous system reaction such as marked drowsiness or seizures is rare and requires notification of the health care provider. Aspirin should not be given to infants and children because it is linked to Reye syndrome. Infants do not tolerate the application of ice, which will increase discomfort. Fever is a common reaction to the immunizations; it is not necessary to notify the health care provider.

A child wants to be on time for a family dinner. According to Kohlberg's theory, which stage of development is the child experiencing? 1. Good boy-nice girl orientation 2. Society-maintaining orientation 3. Instrumental relativist orientation 4. Universal ethical principle orientation

3. Instrumental relativist orientation When a child wants to be on time for a family dinner, this thought exemplified the instrumental relativist orientation stage. A child at this stage follows his or her parent's rules. During the good boy-nice girl orientation stage, a child wants to win the approval of and maintain the expectations of one's immediate group. During the society-maintaining orientation stage, an individual expands focus from a relationship with others to societal concerns. During the universal ethical principle orientation stage, the concept of "rightness" is defined by self-chosen ethical principles.

A child is admitted to the emergency department with signs and symptoms of Reye syndrome. Which information from the child's history is most important for the nurse to obtain in light of the child's tentative diagnosis? 1. Recent rash 2. Tonsillitis attacks 3. Recent viral infection 4. Recurrent high fevers

3. Recent viral infection There is a strong relationship between Reye syndrome and an antecedent viral infection, especially one treated with aspirin. Rash, tonsillitis, and high fever are not specifically related to Reye syndrome.

Several hours after admission of a child to the pediatric unit with laryngotracheobronchitis (viral croup), the nurse determines that tachypnea and tachycardia, accompanied by intercostal and substernal retractions and increased restlessness, have developed. Which is the priority nursing action? 1. Suctioning secretions from the trachea 2. Dislodging mucus by striking the back 3. Reporting the respiratory status to the practitioner 4. Increasing the concentration of oxygen (O2) being delivered

3. Reporting the respiratory status to the practitioner. These are signs of increasing hypoxia; intubation may be necessary to maintain an open airway. The signs are not indicative of increased secretions; suctioning could precipitate sudden laryngospasm. Striking the back is ineffective against laryngeal spasms. The inflammation is preventing the O2 from reaching the lungs; increasing the amount of O2 will not be effective until the inflammation is reduced.

Which action will most help school-aged students feel comfortable during a class about puberty and body hygiene? 1. Refer questions back to the student's parents. 2. Have students attend the class with their parents. 3. Separate the boys and girls into two different classes. 4. Provide only basic biological and reproductive information.

3. Separate the boys and girls into two different classes. School-aged children may feel more comfortable attending this type of class with the group separated into boys and girls. The nurse would be prepared to answer all questions in an honest and straightforward, yet age-appropriate, manner. Students may not feel comfortable asking sensitive questions to their parents or attending the class with their parents. In addition to basic biology, the nurse would also provide practical information to the students, such as what to do when getting a period for the first time in class.

Which feature of a child's outfit would the nurse recognize as the most important to address with the parents? 1. Metal bells are laced into the shoestrings. 2. Overly long pant legs are folded up to form cuffs. 3. The child's name is embroidered on a jacket pocket. 4. A safety pin holds the shirt together where a button is missing.

3. The child's name is embroidered on a jacket pocket. Clothes and accessories should not be personalized; child predators may use a child's name to build trust and trick the child into assuming familiarity with the stranger. Metal bells are not broken as easily as plastic ones are, posing a lower risk than the personalized outfit. Although long cuffs pose a tripping hazard, the risk is far lower than the personalized outfit. Safety pins are unlikely to create problems for a child of preschool age who is capable of understanding the importance of leaving them alone. A stick from a safety pin is harmful but not as dangerous as a child predator.

Which finding supports the conclusion that a 12-month-old infant has normal development? 1. The child's head bends toward the side that the nurse strokes. 2. The child's hips move toward the side that the nurse stimulates. 3. The child's toes hyperextend when the nurse strokes from the heel upward across the foot. 4. The child abducts the arms while flexing the elbows when the nurse makes a loud noise.

3. The child's toes hyperextend when the nurse strokes from the heel upward across the foot. A 1-year-old child will exhibit the Babinski reflex. To assess the Babinski reflex, the nurse strokes from the heel of the child upward across the foot, which results in hyperextension of the infant's toes. To assess the rooting reflex, the nurse strokes the child's cheek; the child's head bends toward the side being stroked, and the child begins to suck. This reflex disappears at the age of 4 months. To assess trunk incurvation, the nurse strokes the child's spine. In response the child's hips move to the side of stimulation or toward the stroke. This reflex disappears at age 6 months. When assessing the child's startle reflex, the nurse makes a sudden loud noise. In response to the noise the child abducts his or her arms while flexing the elbows. The reflex disappears at the age of 3 to 4 months. The appearance of the rooting reflex, trunk incurvation, or startle reflex in a 1-year-old child would indicate abnormal development.

A mother of a 7-year-old child complains to the nurse that her child wets the bed at night. Upon interaction with the child, the nurse learns that the child is afraid of the dark. Which would the nurse recommend to the mother? Select all that apply. One, some, or all responses may be correct. 1. "Take your child for a walk before going to bed." 2. "Provide nutritious food to your child at dinner." 3. "Give your child a glass of milk before going to bed." 4. "Allow your child to keep a light on in the bedroom at night." 5. "Encourage your child to copy his siblings who sleep alone in their rooms."

4. "Allow your child to keep a light on in the bedroom at night." 5. "Encourage your child to copy his siblings who sleep alone in their rooms." Keeping a light on at night will help comfort a child who is afraid of the dark. Encouraging the child to copy his or her siblings who sleep alone in their rooms helps develop desensitization to darkness and reduces the child's fear. Taking the child for a walk before going to bed may promote sleep but does not reduce fear of darkness. Providing nutritious food to the child will be beneficial to improve overall growth and development. Providing milk before bed promotes sleep but does not address the fear of darkness.

The mother of a 2-year-old child tells the nurse that her child is frequently constipated. The nurse asks the mother how she handles the child's toileting. Which response indicates to the nurse that the mother requires further education? 1. "My child drinks a lot of fluids." 2. "I give my child high-fiber foods." 3. "My child has one bowel movement a day." 4. "I schedule my child's toileting for before each meal."

4. "I schedule my child's toileting for before each meal." Scheduling toileting before meals does not take advantage of the gastrocolic reflex; having the child go to the toilet after meals will probably be more successful. Increasing fluid intake may help relieve constipation; no additional teaching is needed. High-fiber foods help prevent constipation; no additional teaching is needed. One bowel movement per day makes scheduling easier; no additional intervention is needed.

Which response would the nurse have to parents who are worried about their child's "imaginary friends"? 1. "I'll get the primary health care provider to prescribe an antianxiety medication." 2. "Your child should be seen by a psychiatrist for this issue." 3. "You need to get a developmental assessment for your child." 4. "This is completely normal behavior for a child in this age group."

4. "This is completely normal behavior for a child in this age group." Imaginary friends and imaginary play are normal for children at the preschool developmental level. Their thinking is influenced by role fantasy. Children believe that their wishes are real and that dreams come to life. They believe that inanimate objects have feelings and thoughts. It is important for the parents to know that this form of thinking is normal for a child of this age and that there is no need for a psychiatrist, medication, or a developmental assessment.

Which developmental characteristic would the nurse recognize as contributing to a 4-year-old child's difficulty relating to some of the children in the playroom? 1. Preschoolers engage only in parallel play. 2. Preschoolers are extremely dependent on their parents. 3. Fierce temper tantrums and negativism are typical behaviors of preschoolers. 4. Exaggerating and boasting to impress others are typical behaviors of preschoolers.

4. Exaggerating and boasting to impress others are typical behaviors of preschoolers. It is common for 4-year-old children to boast and exaggerate and to be impatient, noisy, and selfish. More advanced cooperative play, not parallel play, is characteristic of 4-year-old children. Extreme dependence on parents is unusual in 4-year-old children because they are striving for more initiative and less dependence. The toddler's tendency toward tantrums and negativism should have waned by 4 years of age.

Which statement would the nurse recognize as accurate about a preschooler's imaginary playmates? 1. Imaginary playmates make the preschooler feel inferior to them. 2. Imaginary playmates attempt to achieve what the child accomplishes. 3. Imaginary playmates cause a child to confuse reality and fantasy. 4. Imaginary playmates experience what a preschooler wants to remember.

4. Imaginary playmates experience what a preschooler wants to remember. Imaginary playmates experience what preschoolers want to remember or forget. Imaginary playmates do not make preschoolers feel inferior. They accomplish what a child attempts to achieve and help preschoolers distinguish between reality and fantasy.

Which foods would the nurse order for a 30-month-old toddler on a regular diet? 1. Hamburger with bun and grapes 2. Chicken fingers and French fries 3. Hot dog with bun and potato chips 4. Macaroni and cheese and Cheerios

4. Macaroni and cheese and Cheerios Macaroni and cheese and Cheerios are foods that a toddler enjoys and can handle; in addition, they are nutritious. Grapes are dangerous because both the skins and the shape pose a choking hazard to toddlers. Chicken fingers and French fries each have a high fat content and, if eaten regularly, can cause obesity. The skin and shape of a hot dog may cause choking, and potato chips are not nutritious.

An infant with a 3-day history of decreased fluid intake and diarrhea is admitted with dehydration and lethargy. Which explanation would the nurse give the parent for the infant's rapid deterioration? 1. Cellular metabolism is unstable in young children. 2. Renal function is immature in children until they reach school age. 3. The proportion of water in the body is less in infants than that in adults. 4. The extracellular fluid requirement per unit of body weight is greater in infants than in adults.

4. The extracellular fluid requirement per unit of body weight is greater in infants than in adults. Complications of fluid loss occur much more rapidly in infants compared with children and adults because extracellular body fluid represents 45% of the body at birth, 25% at 2 years of age, and 20% at maturity. Another measurement is fluid's percentage of total body weight, which is 80% at birth, 63% at 3 years, and approximately 60% at 12 years. Cellular metabolism in children is stable, but its rate is higher than that in adults. The proportion of total body water in children (up to 2 years) is greater than it is in adults. Renal function is immature through the second year of life, not until school age, which makes it more difficult to maintain fluid balance.

Which factor is most significant for the nurse working with the family of an infant born with a genetic disorder? 1. The family's willingness to give physical care to their infant 2. The family's understanding of the factors causing the infant's disorder 3. The family's response to the reactions of significant others to their infant

4. The family's readiness to talk about problems their infant may have in the future When the parents verbalize recognition that their infant may have current or future problems, it usually signifies that they are beginning to face reality. Facing the reality of the situation is necessary before they will be able to provide physical care for the infant. Although willingness to provide care may be a problem, it is not the most significant factor for the nurse working with this particular family. Understanding of the factors causing the infant's disorder is usually not the most significant factor at this time; it may become more important if the parents want more children. Although the response by others to their infant may have an effect on the parents' own reaction, it is probably not critically significant for the nurse at this time.

Which behavior would the nurse recognize as a sign of a hearing deficit in a 7-month-old infant? 1. The infant does not always turn the head when called by name. 2. The mother says that the infant is unable to learn the word mama. 3. The infant fails to demonstrate the Moro reflex in response to handclapping. 4. The mother says the infant stopped making verbal sounds about a month ago.

4. The mother says the infant stopped making verbal sounds about a month ago. Deaf infants commonly babble until they are about 6 months old, but then stop because their vocalizations are not reinforced with hearing. Learning to say one word starts at about 11 to 12 months of age. Infants with no hearing impairment do not respond to their names all the time. The Moro reflex is not expected at 7 months; it usually disappears when the infant is 3 to 4 months old.

The nurse in the family planning clinic reviews the health history of a sexually active 16-year-old girl whose chief concern is a thick, burning discharge accompanied by low abdominal pain. After her examination, the girl is informed that she may have a sexually transmitted infection (STI) that requires treatment. The adolescent is concerned that her parents will discover that she is sexually active. She asks the nurse whether her parents will be contacted. How would the nurse respond? A. "Your parents will not be contacted because treatment at this clinic is confidential." B. "Your parents need to be informed to sign a consent form for testing and treatment." C. "Your parents will be notified when the insurance company is billed for testing and treatment." D. "Your parents will not be told if you promise to have your sexual contacts tested."

A. "Your parents will not be contacted because treatment at this clinic is confidential." To prevent disclosure, family planning clinics treat these adolescents as emancipated minors who can sign their own consent forms. Federal law allows family planning clinics to maintain minors' confidentiality, although individual states may have different regulations. There is a concern that teenagers will not seek or continue treatment if they fear disclosure. Most family planning clinics receive funding and charge on a sliding schedule based on income, thereby encouraging adolescents to seek treatment. Not telling the parents in exchange for the client having her sexual contacts tested could be viewed as coercion; if the STI is reportable follow-up of sexual partners is indicated, but the adolescent will not be held responsible for ensuring that they report for testing.

Which item would the nurse instruct parents to keep locked up and away from preschool-age children? Select all that apply. One, some, or all responses may be correct. 1. Vitamins 2. Cosmetics 3. Sunscreen 4. Mouthwash 5. Aloe vera gel

All of the above. Many parents identify pesticides, cleaning products, and medications as hazards to children. However, many common items should also be locked away from preschool-age children. These include vitamins, cosmetics, sunscreen, mouthwash, and aloe vera gel.

Which question will the nurse find most effective when eliciting information from a 5-year-old child regarding the reason for the child's hospitalization? A. "Do you know what this place is?" B. "What are you doing here at the hospital?" C. "Do you know what's going to happen to you?" D. "You do know why you're in the hospital, don't you?"

B. "What are you doing here at the hospital?" "What are you doing here at the hospital?" is an open-ended question that should elicit the desired information. Asking the child whether he knows where he is, what's going to happen to him, or why he's in the hospital may not elicit the desired information because each is a yes-or-no question.

The parent of a 2-year-old child asks when the child would first be taken to the dentist. Which is the best response by the nurse? A. Before starting school B. Within the next few months C. When the first deciduous teeth are lost D. The next time a family member visits the dentis

B. Within the next few months The child should be taken to the dentists between 2 and 3 years of age, when most of the 20 deciduous teeth have erupted. Before the child starts school and when the first deciduous teeth are lost are both too late. The suggestion that the child come to the dentist the next time a family member visits the dentist is too indefinite.

Which education would the nurse provide the parents of an infant with cerebral palsy to support setting care goals? A. Cognitive impairments require special education. B. Progressive deterioration requires future institutionalization. C. Unknown extent of the disability requires continual adjustments. D. Diminished immune responses require protection from infection.

C. Unknown extent of the disability requires continual adjustment. The infant is too young for a specific long-term plans; care planning should incorporate the plan to continually reevaluate care plans because different needs may manifest as the child grows older. Children with cerebral palsy may or may not have cognitive impairments. Cerebral palsy does not get progressively worse; placement outside the home depends on the child's needs and the parents' abilities and desires. There is no relationship between cerebral palsy and a lowered immune response.

Which foods would the nurse suggest for inclusion in a toddler's diet who has been diagnosed with iron-deficiency anemia? A. A slice of pumpkin pie B. One cup of seedless grapes C. Slices from a whole apple D. Gingerbread molasses cookies

D. Gingerbread molasses cookies Gingerbread cookies made with molasses are an excellent source of iron. They may be eaten as a finger food, which toddlers prefer. Pumpkin pie provides some protein and iron but has a spicy taste that is generally not a favorite of toddlers. Although grapes contain iron, a cup is an excessive amount for an 18-month-old child to ingest. Apples, although nutritious, are low in protein and iron.