Kaplan Pediatrics Review Questions

The nurse instructs a parent about the appropriate way to instill ear drops in the right ear of a toddler client. The nurse determines teaching is effective if the parent makes which statement? a. "I should pull my child's ear down and back." b. "I will have my child stand next to me." c. "I will place a dry cotton ball in my child's ear." d. "My child should lie on the right side after I instill the drops."

a. "I should pull my child's ear down and back." In children younger than 3 years of age, the nurse would straighten the ear canal by pulling the pinna down and straight back. In children older than 3 years of age, the nurse should pull the pinna up and back. The child should like supine with head turned to left side for the drops to be instilled. A dry cotton ball will cause wicking and medication will be absorbed by the cotton. It is best to moisten the cotton ball with medication prior to inserting. After insertion of the ear drops, the child should lie with head turned to left side to keep the drops in the correct position.

(Case study 6/6) Which parental response indicates successful understanding of the nurse's instructions? (Select all that apply) a. "I will provide training cups at each meal for drinking." b. "I will limit television to just bedtime." c. "I will offer different colors of foods." d. "I will make sure my child wears the corrective boots as instructed." e. "I will read to my child at least 1 hour per day." f. "I will ask my neighbor's children to play with my child."

a. "I will provide training cups at each meal for drinking." d. "I will make sure my child wears the corrective boots as instructed." e. "I will read to my child at least 1 hour per day." Providing cups to drink from instead of the bottle indicates the parent is engaging the process of weaning from the bottle. It is imperative the child wear the boots as prescribed to obtain optimal results. Reading to the child versus watching extensive television shows an understanding of the need for more personal interaction with the child. The parent statement to limit television to only bedtime is also not successful understanding. A story before bedtime would be a better choice to prepare the child for calming, and help the child to learn how to self regulate to sleeping. It has been confirmed the child eats with fingers, so there is no need for food specifics. Asking the neighbors for playdates with other children is not a priority.

The nurse provides care for an infant client diagnosed with a cyanotic congenital heart defect. The nurse understands that chronic hypoxia from this disorder can result in which finding? a. Intellectual disability b. Polycythemia c. Respiratory infections d. Fluid retention

b Polycythemia In chronic hypoxia, the body tries to compensate by producing more red blood cells (polycythemia) to carry the limited amount of oxygen available to the tissues. A congenital heart defect does not cause intellectual disability, however the child may be small for its age. Chronic hypoxia does not result in respiratory infections; however, it is important to prevent respiratory infections by good handwashing, and protecting the infant from exposure to individuals with obvious respiratory infections. A client with a cyanotic heart defect may develop heart failure which can cause fluid retention.

(Case study 5/6) For each concern about the toddler's development, specify the nursing instruction that is appropriate: (Select all that apply) 1. Drinks only from a bottle a) Parent to use colorful cups at mealtimes b) Parent to cut a bigger hole in the bottle nipple c) Parent to hold solid food until training cup is used by child 2. Child not walking a) Parent to have the child assist with putting on boots each day b) Parent to hold child's hand while walking barefoot up the stairs c) Parent to call child to cross the floor to come to the parent for a toy 3. Watches television most of the day a) Parent to keep television off except for designated time and program b) Parent to give books to child c) Parent to play children's songs for sing-along

1. a 2. a, c 3. a, c The nurse can provide examples of instruction for the parent to perform at home. To help the child wean from only using the bottle, the parent can provide colorful training cups as a fun way to engage the child to hold and drink from the cup. Cutting a hole in the nipple does not encourage cup use and is not recommended. Also, withholding food is not a positive way to encourage use of the cup. Encouraging the child to walk can be prompted by making sure the boots are applied each day, and having the child assist with this new piece of clothing. Encouraging the child to come to the parent for a toy increases the child's mobility with a reward. The child is incapable of standing alone, so making the child climb stairs is not an appropriate action at this time. To discourage television usage, the parent is encouraged to keep the television off except for a specific show for the child, and to limit the overall time the child spends in front of the television. Music with children's songs can be played for sing-along instead of watching television. While it is important to have books available, it is of no benefit unless the parent is reading and interacting directly with the child.

(Case study 4/6) Complete the following sentence by choosing from the list of options: Based on Erikson theory, the child is at risk for ____1____ due to ____2____ and ____3____. 1. a) Shame and doubt b) A sense of mistrust c) Guilt 2. a) Being in control b) A lack of independence c) Over-confidence 3. a) Inability to be separated from the parents b) Lack of enthusiasm when playing with other children c) Limited opportunities to make choices

1. a) Shame and doubt 2. b) A lack of independence 3. c) Limited opportunities to make choices Without successful walking, the child will lack the independence of obtaining success during the autonomy vs. shame/doubt stage of Erikson theory. Without being able to walk, the child will continue to be dependent on the caregivers and have a lack of control and confidence. An important task during this stage is for a child to make choices of food, toys, and clothes, so the parent should provide many opportunities for the child to do so. In Erikson theory, trust vs. mistrust is the psychological stage for an infant age birth-18 months and initiative vs. guilt is the stage for a child age 3-6 years. Being in control and over-confidence are not the deciding factors in achieving mastery over these milestones. An inability to be separated from the parents in toddlerhood usually signals that the infant has not achieved a sense of trust. Toddlers engage in parallel play, not interactive play with other children.

(Case study 2/6) The nurse is most concerned the client has developed a ____1____. The client is also at high risk for ____2____. The nurse will ____3_____. 1. a) sexually transmitted infection (STI), b) urinary tract infection (UTI), c) latex allergy 2. a) depression, b) an unintended pregnancy, c) school and learning difficulties 3. a) notify the client's parents, b) praise the client for seeking help, c) ask the client about any problems in school

1. a) sexually transmitted infection (STI) 2. b) an unintended pregnancy 3. b) praise the client for seeking help Adolescents who engage in risky behaviors, such as unprotected sex, are at high risk for STI and unintended pregnancy. It is very important for the nurse to encourage the client to seek treatment and guidance for sexual activity. The client's symptoms are more suggestive of vaginal infection than UTI or latex allergy. Depression and school difficulties are possible concerns for a teenage client, however, there is not enough information presented to determine the client is at risk for either of these issues. The client's behavior places the client at highest risk for unintended pregnancy. The nurse in the health department does not need to notify the parents of a 16-year-old adolescent seeking medical help. The client is seeking assistance for a medical issue. The priority is not potential issues the client may or may not be having in school.

(Case study 5/6) Which statement is important for the nurse to make during discharge teaching? (Select all that apply) a. "It is extremely important for you to use condoms every time you have sexual intercourse." b. "Now that you have had chlamydia once, you cannot get this infection again." c. "Having sex with multiple partners increases your risk of getting a sexually transmitted disease." d. "It is necessary to avoid all sexual activity until after you have taken all of this medication." e. "You are correct to leave your parents out of this if they would get upset." f. "You need to stop having sex until you are old enough to handle the possibility of pregnancy."

a. "It is extremely important for you to use condoms every time you have sexual intercourse." c. "Having sex with multiple partners increases your risk of getting a sexually transmitted disease." d. "It is necessary to avoid all sexual activity until after you have taken all of this medication." The nurse needs to emphasize the importance of taking precautions to avoid future STIs. The client needs to use a condom every time the client engages in sexual activity. The client also needs to be aware that having sex with multiple partners increases the risk of STI. Avoiding all sexual activity while being treated for chlamydia is important to avoid further spread of infection. The client can get chlamydia repeatedly if exposed to the infection. The nurse should explore the relationship the client perceives to have with the parents, rather than assuming the parents cannot be supportive of the client. The client may be correct, but should consider the possibility that the parents could be a resource. The nurse should not tell the client what to do or not to do. This statement is an opinion, and the nurse should communicate factual information to the adolescent.

The nurse evaluates the parent's knowledge of the infant client's immunization schedule. Which statement by the parent indicates a correct understanding of the immunization schedule? a. "My child will receive 4 Haemophilus influenzae type b (Hib) vaccines as part of the immunization schedule." b. "My child needs 2 hepatitis vaccines, one at 1 month and the other at 4 months." c. "I'm going to let my child get chickenpox and measles rather than have all those painful vaccines." d. "I'm glad the baby can be vaccinated against chickenpox before age 6 months old, so there's no way to catch it from older siblings."

a. "My child will receive 4 Haemophilus influenzae type b (Hib) vaccines as part of the immunization schedule." Only 4 Hib vaccines are required. The Haemophilus influenzae type b (Hib) vaccine schedule is 2, 4, 6, and 12-15 months. Children under age 2 years and who develop a Hib-related illness still need to be immunized. The vaccine is not recommended for children over age 5 years, since children that age can usually fight off Haemophilus influenzae type b infections. Diphtheria, pertussis, tetanus toxoid (DTaP) vaccine is given at ages 2 months, 4 months, 6 months, 18 months, and 4-6 years. Nursing responsibilities include observing for severe reactions indicated by extremely high temperature and redness at the injection site. Fever may occur within 24 to 48 hours. The vaccine is given intramuscularly (IM) in the anterior or lateral thigh. Inactivated polio vaccine (IPV) is given at ages 2 months, 4 months, 18 months, and 4-6 years. Reactions are very rare. The child needs 3 hepatitis B vaccines that are usually scheduled to begin at birth, then 1-3 months, and 6 months up to 18 months. If no hepatitis B vaccine has ever been given, the child can receive a "catch-up" vaccine at age 11-12 years. The danger with allowing rubella (one of the measles in the MMR vaccine) to occur in the general population is the damage that occurs to the fetus if the mother is exposed to rubella during pregnancy. This exposure can be from any individual, regardless of age. The chickenpox vaccine can be given after 12 months, usually between 12-15 months of age. A second dose is needed at 4-6 years.

A child client is admitted with chronic lead poisoning. Which symptoms does the nurse expect to see? a. Anemia, seizures, and learning disabilities b. Tinnitus, confusion, and hyperthermia c. Polycythemia, hypoactivity, and impaired liver function d. Shortness of breath, dependent edema, and bounding pulse

a. Anemia, seizures, and learning disabilities Anorexia, nausea, vomiting, excess salivation, lead line on the gums, abdominal pain, muscle cramps, kidney failure, encephalopathy, and pain in the joints are symptoms of chronic lead poisoning. Treatment includes removal of the child from the lead source. If the lead level is very high, treatment will include chelation. Symptoms of tinnitus, confusion, and hyperthermia indicate aspirin poisoning. Polycythemia is an increase in red blood cells and can be due to dehydration or a secondary cause from low oxygen concentration in the blood. Hypoactivity is related to a low activity level. Impaired liver functioning can result from multiple conditions, but lead poisoning is more likely to cause renal damage. Shortness of breath, dependent edema, and bounding pulse indicate heart failure symptoms.

The nurse plans care for an infant client diagnosed with a myelomeningocele. Which principle of nursing care is most important to apply when caring for this infant? a. Asepsis b. Exercise c. Hygiene d. Rest

a. Asepsis Myelomeningocele is a birth defect of the spine and spinal cord. Infection around the area may cause meningitis and damage to the brain. Asepsis is extremely important to prevent the spread of infection to the infant's central nervous system. The infant is placed in prone position with the head turned to one side for feeding. The nurse may perform gentle range-of-motion to the foot and knee joints. Hygiene is important, but diapering may be contraindicated until after the surgical repair of defect. The nurse should change the padding beneath the infant as needed. The nurse should perform frequent stroking and caressing to meet the need for tactile stimulation. Rest is not the most important principle.

When assessing the 9-month-old client, the nurse expects which reflex to be present? a. Babinski b. Moro c. Tonic neck d. Palmer

a. Babinski The Babinski reflex disappears at 12 months to 2 years; stroking the outer sole of the foot upward from the heel across the ball of the foot causes the big toe to dorsiflex and the toes to hyperextend. The Moro reflex disappears by 4 months. A sudden loud noise or stimulus causes the infant to extend the arms (abduction) and then draw them back (adduction), occasionally accompanied by crying. The tonic neck reflex disappears at 3-4 months of age. The infant's head is turned to one side, arm and leg extend on that side and opposite arm and leg flex. The palmer grasp lessens around 2-4 months. Touching the palms of the hands near base of the digits causes flexion of the hands.

(Case study 4/6) In planning care for the adolescent client, the nurse knows which 3 additional tests will be included during the visit? (Select 3) a. Pregnancy test b. Complete blood count (CBC) c. Complete metabolic panel (CMP) d. Human immunodeficiency virus (HIV) antigen test e. Abdominal ultrasound f. Papanicolaou (Pap) test

a. Pregnancy test d. Human immunodeficiency virus (HIV) antigen test f. Papanicolaou (Pap) test The adolescent having unprotected sex is at high risk for STI, and human papillomavirus (HPV), which can be detected with a Pap smear. Results of those tests have a direct impact on the client's continuing plan of care. A CBC, CMP, and abdominal ultrasound are not indicated at this time.

(Case study 3/6) Which 3 findings are most concerning to the nurse? a. Child not walking b. Both parents working c. Child eats with fingers d. Watches television most of day e. Drinks only from a bottle f. Has home babysitter g. Used bouncy walker until age 12 months

a. Child not walking d. Watches television most of day e. Drinks only from a bottle The nurses focuses on the most concerning findings for the child for the developmental age. Not walking by 18 months indicates a developmental delay. Other concerns for the nurse include the child watching more television instead of engaging in interactive play, reading, or self exploration. Weaning from a bottle is recommended to start by 12 months of age. The child should be drinking from a training cup at this age. Both parents working is not a concern since a babysitter is being used. Eating with fingers is expected at this age. Using a bouncy walker until age 12 months is not a concern because this activity helps the child up upright and use the legs.

A toddler client accidentally drinks some drain cleaner and is brought to the emergency department. Which piece of equipment is most essential for the nurse when caring for this client? a. Intubation tray b. EKG machine c. Dialysis machine d. Gastric lavage tube

a. Intubation tray An intubation tray is the most essential piece of equipment for the nurse to have on hand. Because drain cleaner is a caustic substance, there is potential for massive swelling, which would compromise respirations. An intubation tray should be immediately available so that the toddler's airway is protected. An EKG machine is not the most important piece of equipment for this client. The toddler has swallowed a caustic substance which will damage the esophagus and may cause burns. Protection of the airway is the priority. Ensuring a patent airway is the priority intervention. A dialysis machine is not an essential piece of equipment. A gastric lavage tube or nasogastric tube is needed, however the priority is protection of the airway.

(Case study 1/6) Indicate areas of the assessment which concern the nurse: (Select all that apply) a. Not walking as other children are at this age b. Is eating with fingers c. Uses a bottle for drinking d. Enjoyed a bouncy walker until the age of 12 months e. Watches television six (6) hours a day f. Noise helps put the child to sleep g. Can pull up h. Will not walk alone i. Outside person babysits j. Other patient is rarely at home during the day

a. Not walking as other children are at this age c. Uses a bottle for drinking e. Watches television six (6) hours a day f. Noise helps put the child to sleep h. Will not walk alone The nurse will explore the parent's concern that the child is not walking at age 19 months. Weaning from the bottle is suggested between 12-15 months of age. Watching 6 hours of television a day takes away from active, physical play or any 1:1 parental interaction with the child. The child not walking alone by 18 months of age is a sign of developmental delay or due to a physical problem. Normal findings include eating with the fingers and using a bouncy walker until the age of 12 months. It is expected the child can pull up, before taking walking steps. It is okay for an outside person to babysit since the parent is working remotely and the other parent works outside the home during the day.

(Case study 2/6) For each of the following assessment findings, determine if the finding is expected for the normal growth and development of a 19-month-old or if the finding indicates a possible delay: a. Not walking b. Able to pull up c. Eats with fingers d. Drinks only from a bottle

a. Not walking: delay b. Able to pull up: expected c. Eats with fingers: expected d. Drinks only from a bottle: delay By the age of 18 months, a child should be walking and climbing stairs with assistance. Weaning from a bottle to a cup typically starts at age 12 months. Not walking alone and drinking only from a bottle indicates a developmental delay for a 19-month-old child. Pulling up to standing and eating with the fingers are developmental milestones which are achieved at an earlier age. It would be expected that this child could perform those activities.

The newborn nursery nurse provides care for a client diagnosed with hip dysplasia. The nurse anticipates which treatment to be prescribed for the client? a. Pavlik harness b. Double diapering c. Placing a small pillow between the legs d. Bracing the affected leg

a. Pavlik harness A Pavlik harness is used to treat hip dysplasia in a newborn client to stabilize and keep the hip joint in proper alignment. During the early newborn period, a Pavlik harness is applied to hold the hips in wide abduction. An undershirt is placed on the client under the chest straps. Knee socks are placed on the client under the foot and leg pieces. The parents are taught to check for skin breakdown 2-3 times per day, avoid lotions and powders, and place the diaper under straps. If the treatment does not achieve the correct hip placement in a few months, then surgery is indicated and a postoperative spica hip bandage or body cast is applied. Double diapering is not recommended because it causes hip extension. Placing a pillow between the legs will not achieve the proper abduction that is required for correction of the hip dysplasia. To achieve proper position and healing of the hip dysplasia, both legs are placed in wide abduction not just the affected leg.

The nurse performs assessments on infants at the health department. The nurse identifies which finding as an early indication of cerebral palsy (CP)? a. The 4-month-old infant lacks head control b. The 7-month-old infant sits with support c. The 8-month-old infant is unable to crawl d. The 3-month-old infant smiles at the patient

a. The 4-month-old infant lacks head control The earliest indication of CP is delayed gross motor development. Signs include stiff or rigid arms or legs, arching back, and floppy or limp body posture. A 7-month-old sitting with support is an appropriate behavior. The infant with CP is unable to sit without support by 7 months. An infant would not be expected to crawl until around 9 months. There are many variations of crawling and a baby may not crawl at all, but begin to pull up and cruise. An infant with CP uses only one side of the body or only the arms to crawl. A 3-month-old smiling at the parent is an expected behavior. An infant with CP may fail to smile by 3 months.

Which guideline is appropriate for the nurse to give a parent concerning the normal development of a young school-aged child? a. The child's periods of shyness should be tolerated b. Nightmares are characteristic at this age c. The child's participation in group activity should be mandated d. Punishment may be necessary for any acts of independence

a. The child's periods of shyness should be tolerated A young school-age child may become shy at times because of experiencing a conflict regarding independence from the parent. In order to allow the child to become independent, the parent should allow these episodes of shyness. School-age children do experience nightmares, but nightmares are more common in preschool children. Nightmares that occur with school-age children are a reflection of conflict. Therefore, resolving the child's worry will reduce incidence of nightmares. While clubs and peer groups are important to the school-age child, the child should not be forced to participate. Children are working toward independence during the school-age years. It is not appropriate to recommend any form of punishment with acts of independence.

A toddler is newly diagnosed with a seizure disorder. The nurse intervenes if which finding is observed during a visit in the family's home? a. The child's temperature is taken using an oral electronic thermometer b. The child is encouraged to play with soft toys during daily bath time c. The parents make the child wear a helmet when riding a tricycle d. The parents make the child a peanut butter and jelly sandwich

a. The child's temperature is taken using an oral electronic thermometer Seizures can occur without warning. It is dangerous to have a thermometer in the mouth because the child may start seizing. Playing with soft toys is an appropriate bath time behavior. However, the child should be closely supervised in the bathtub. Wearing a helmet is an appropriate behavior to prevent head injuries. Encourage children to always swim with a companion. Eating peanut butter and jelly is appropriate. Seizures are not triggered by peanut allergies.

(Case study 6/6) For each client statement, specify whether the statement indicates the client understands the information provided at the previous visit or if the client needs further instructions: a. "My partner doesn't like using a condom, but I make sure we use one every time." b. "I am wearing sunscreen and I need to stay out of the sun while taking the medicine." c. "I know that when I am having my period I can't get pregnant." d. "I told my last partner about getting tested for chlamydia, but I don't need to tell the other two."

a. Understands b. Understands c. Further instruction d. Further instruction The client is indicating understanding by correctly stating that condom use must be consistent to be effective. The client is also accurately describing the necessary actions needed while taking doxycycline for the chlamydia infection. In thinking that pregnancy is not possible while menstruating, the client is exhibiting a knowledge deficit and misconception about how pregnancy occurs. More education is needed. The nurse also needs to reinforce instruction to the client to discuss STI with all sexual partners to ensure all individuals are aware of the risk and possibility of infection.

A parent of an infant born with a clubfoot asks the nurse how the deformity is usually treated. Which statement by the nurse is appropriate? a. "A series of braces is used until the foot is gradually moved back into place. Then the foot is casted." b. "A series of casts will be applied and changed every few days to weeks until the foot is positioned correctly, then the foot is braced." c. "The infant undergoes massage to stretch the tendons of the affected foot, then is placed in the first cast at around 6 months of age." d. "The infant will undergo several surgical procedures, then will be casted for several months."

b. "A series of casts will be applied and changed every few days to weeks until the foot is positioned correctly, then the foot is braced." Clubfoot is a deformity that cannot be moved into proper alignment with manipulation. It is treated by a series of casts that allow for gradual stretching of structures as they grow. Casting usually starts when the infant is a week or two old. The infant will wear a series of 5-7 casts over a few weeks or months. When the foot is in its final, correct position, the infant is fitted with a brace. The nurse instructs parents of children with positional deformities to gently manipulate and passively stretch the foot. A clubfoot must be surgically corrected. The first cast is put on by an orthopedic surgeon a week or two after the infant is born. This timing works best because an infant's ligaments and tendons are very elastic, which makes them easy to stretch and move. Clubfoot is not surgically corrected unless correction is not achieved with casting and bracing.

The office nurse receives a phone call from a parent of an infant client who received the DTaP vaccine 3 days ago. The nurse is most concerned if the parent makes which statement? a. "There is redness at the injection site." b. "My baby is crying continuously." c. "My baby's temperature is 101F (38.3C)." d. "My baby seems to be eating less."

b. "My baby is crying continuously." High pitched, continuous crying is a serious adverse effect of the DTaP vaccine. Other serious adverse effects include convulsions, high fever, and loss of consciousness. Redness and swelling at the injection site is an expected outcome. A slight temperature is a more common adverse effect. The nurse should instruct the parent to administer acetaminophen. Poor appetite for a few days after receiving the DTaP vaccine is a common adverse effect.

The nurse recognizes which child is at greatest risk for poisoning? a. A 5-month-old b. A 2-year-old c.. A 5-year-old d. A 7-year-old

b. A 2-year-old A 2-year-old is very curious and likes to explore and does not have the judgment necessary to avoid dangerous substances, so would be at the highest risk for poisoning. An infant is not mobile enough to ingest poison, so would be at low risk for poisoning. A 5-year-old is less reckless than younger children, and could be educated to leave dangerous liquids alone. A 7-year-old child should be educated about the hazards of taking nonprescription medications and chemicals.

The nurse in the emergency department (ED) provides care for a toddler client with a fever. The parents report the toddler has received regular adult acetaminophen 325mg every 4 hours for the past 4 days. Which medication does the nurse have available for the treatment of acetaminophen overdose? a. Vitamin K b. Acetylcysteine c. Aspirin d. Naloxone

b. Acetylcysteine Acetylcysteine (Acetadote/Mucomyst) is given as an antidote following an acetaminophen overdose. This toddler received more acetaminophen than the recommended dose of 10-15mg/kg/dose not to exceed 5 doses in 24 hours. The acetaminophen has been excessive and absorbed into the bloodstream over 4 days and is near or at toxic levels for this toddler. Vitamin K is the antidote for warfarin (Coumadin) overdose. Aspirin is not considered an antidote for any medications. The CDC warns not to administer aspirin to children and adolescents who have a viral disease due to the possible development of Reyes syndrome. Naloxone (Narcan) is an antidote for narcotics and illicit drugs that may cause central neurological system (CNS) or respiratory depression.

The nurse provides care for a school-age client scheduled for a cardiac catheterization. Which strategy is best for the nurse to use in preparation for the procedure? a. Explain the long-term consequences of the procedure b. Allow time for the client to manipulate the equipment used during the procedure c. Wait until shortly before the procedure to explain it d. Explain the procedure to the client's parents while the client is in the playroom

b. Allow time for the client to manipulate the equipment used during the procedure School-age children need to practice using equipment (IV, bandages) to prepare for any procedure. School-age children fear the loss of control. The nurse explains the procedure in simple terms and allows choices when possible. Explaining the long-term consequences would be part of the preparation for an adolescent. Waiting to explain until shortly before the procedure would be part of the preparation for a toddler. The client and the parents should be prepared at the same time.

Soon to be new parents are taking a class at the hospital. The nurse is educating on prevention dysfunctional parent-child interactions. Which is the most important action to include? a. Detail how to report potential abuse to the appropriate authorities b. Discuss with the parents any problems or fears about child rearing c. Tell the parents that they will need to get their family into counseling d. Suggest to the parents that they have the child stay with a relative

b. Discuss with the parents any problems or fears about child rearing It is important that parents become active listeners, and become actively involved in their child's wellbeing. Warning signs of abuse include physical evidence of abuse, conflicting stories about the injury, and the injury is inconsistent with the story. Anyone can report potential or suspected abuse. This is not productive at this time. Allow the parents to express their feelings and frustrations. The nurse is to remain supportive and nonjudgmental. Assessment is needed before suggesting and implementation.

(Case study 1/6) Select the assessment findings that require follow-up by the nurse: a. Client is accompanied by another adolescent b. Foul-smelling vaginal discharge c. Experiencing some pain during urination d. Denies any fever and denies any abdominal pain, flank pain, urinary frequency, or urinary urgency e. Admits to being sexually active f. Three different partners g. "My parents are very strict. They would kill me if they knew." h. Client does not use oral contraceptives i. A condom has only been used a few times during sexual activity j. Last menstrual period was 18 days ago

b. Foul-smelling vaginal discharge c. Experiencing some pain during urination e. Admits to being sexually active f. Three different partners g. "My parents are very strict. They would kill me if they knew." h. Client does not use oral contraceptives i. A condom has only been used a few times during sexual activity Foul-smelling vaginal discharge is a symptom that is concerning for vaginal infection. Painful urination can indicates a urinary tract infection (UTI), but without any other symptoms of UTI, can also be a symptom of a sexually transmitted infection (STI). The client is sexually active with various partners and is not consistently using any form of contraception. These behaviors increase the risk of STI and pregnancy. The nurse needs to explore the client's relationship with the parents, and how the client feels they would react to the client being sexually active. Absence of fever, abdominal pain, and urinary frequency and urgency limits the concerns for other infections, such as pelvic inflammatory disease and UTI. The client indicates a normal menstrual period 18 days ago, which limits the possibility of an advanced pregnancy.

During a well child check-up for a 6-month-old client, the parent reports the client received the first DTaP at two months of age, and has received no other vaccinations. Which action by the nurse is most appropriate? a. Repeat first DTaP, starting the schedule again b. Give second DTaP c. Give MMR d. Give two DTaP vaccinations today

b. Give second DTaP By the age of 6 months, the child should be ready for the third immunization. When the schedule has been interrupted, it is appropriate to simply continue with the schedule. The child is due for the second DTaP vaccination. If the vaccination schedule is interrupted, the nurse should not start the schedule again. The nurse will continue the schedule at the next visit. The MMR is initially administered at 12-15 months, with the second dose given at 4-6 years. The nurse should not give 2 doses of vaccine at the same time. The nurse should continue the schedule. Contraindication to immunization includes severe febrile illness, previous allergic response to the vaccine, and recently acquired passive immunity.

The nurse observes parents interacting with their newborn shortly after birth. It is most important for the nurse to make which assessment during this observation? a. Proper parenting skills b. Healthy or pathologic relationships c. Normal neurologic functioning of the neonate d. Parental knowledge of the neonate's behavioral responses

b. Healthy or pathologic relationships Observing the parents' behavioral responses to their newborn, including holding and interacting with the child, gives some indication of a healthy or pathological response to the child. Early observation by the nurse may also be used to identify newborns and infants who are at risk due to parental isolation, financial stress, or parental illness. A referral to appropriate follow-up service may help lead to the establishment of a healthy parent-child relationship. Proper parenting skills are important, but the nurse should assess the parent-child interaction during the time frame. Assessing normal neurologic functioning of the neonate is not part of the parent-child interaction. Assessing parental knowledge of the neonate's behavioral response is appropriate, but assessing the parent-child interaction is most important.

The nurse observes a preschool-age client playing with several other children of about the same age. The nurse identifies which play activity as the one in which the child is most likely to engage? a. Taking part in group play activities with several children b. Imitating the actions of the nurse or healthcare provider c. Playing "doctor" with another child taking a sick role d. Playing independently with a "doctor" doll, does not share

b. Imitating the actions of the nurse or healthcare provider Preschool-age children are involved in imitative play and will play house, play "doctor," or pretend to be engaged in the occupational role of the adults around them. Preschoolers' play is imitative, imaginative, and dramatic. The preschool-age child takes part in parallel play. Playing independently, but with the same toy as another child, describes parallel play and is expected for the toddler child. Group play is seen at school-age development. Cooperative play with another child, as described here, is more likely to occur during the early school-age stage of development. Playing with a "doctor" doll is more likely to occur during the toddler, not preschool, stage of development.

A toddler client diagnosed with cystic fibrosis is admitted to the hospital with a respiratory infection. The nurse expects to see which characteristic feature of cystic fibrosis? a. Absence of gastric enzymes b. Increased viscosity of mucus c. Absence of liver enzymes d. Inability to cough

b. Increased viscosity of mucus Cystic fibrosis is an autosomal recessive trait with generalized involvement of the exocrine glands, resulting in altered viscosity of mucus-secreting glands. Mucus becomes thick and tenacious. Pancreatic enzymes are not able to reach the duodenum, which impairs digestion and the absorption of nutrients. Gastric enzymes are not affected. There is no alteration of liver enzymes in cystic fibrosis. Due to thick, tenacious mucus, the child has difficulty expectorating secretions despite vigorous coughing. Inability to clear secretions causes atelectasis and emphysema.

An infant client is diagnosed with a cyanotic congenital heart defect (CCHD). The nurse knows a cyanotic congenital heart defect is associated with which symptom as reported by the parent? a. Clubbing of the fingers and swelling of the feet b. Poor feeding with no or very poor weight gain c. Increased crying with increased physical activity d. Warm, pink, dry skin

b. Poor feeding with no or very poor weight gain Reports of poor feeding, difficulty feeding, and poor weight gain or no weight gain are symptoms that occur in infants with congenital heart defects usually seen on the well baby check following birth. There are respiratory-related symptoms such as cyanosis, tachypnea, labored breathing, pulmonary edema, and sternal retractions. Circulatory-related symptoms are tachycardia, heart murmur, weak femoral pulses, or shock. The infant can also demonstrate lethargy, hepatomegaly, and failure to thrive. Cyanotic congenital heart disease includes Tetralogy of Fallot, transposition of the great arteries. Cyanotic heart defects cause poorly oxygenated venous blood to enter the systemic circulation. Clubbing of the fingers does occur secondary to disease with low oxygen levels. Swelling of the feet is associated with congestive heart failure. Position of comfort for infants with hypoxemia is either flaccid with extremities extended or side-lying with knees toward chest. The infant is lethargic with a decreased tolerance for activity. Cyanotic coloration results from hypoxemia and will cause pale and dusky skin that is cool to the touch.

The nurse teaches about early signs and symptoms of rubeola that may appear before the notable rash. Which are included in the instructions? a. Diarrhea, intestinal cramps, and anorexia b. Runny nose, sneezing, and coughing c. Itching, fever, and cold sores d. Sore throat, ear pain, and swollen lymph nodes

b. Runny nose, sneezing, and coughing The client will likely exhibit respiratory symptoms such as runny nose, sneezing, and coughing before the rash appears. Rubeola is communicable during the prodromal phase. The client should be isolated until the fifth day after the rash appears, and should maintain bedrest during the first 3-4 days. Gastrointestinal symptoms are not expected with rubeola. Other prodromal symptoms of rubeola include fever, malaise, conjunctivitis, and Koplik spots. Itching and cold sores are not expected prodromal symptoms of rubeola. The nurse should expect generalized lymphadenopathy in rubeola. The rash appears 3-4 days after the onset of prodromal symptoms.

The clinic nurse teaches a parent how to care for a child with impetigo. Which information does the nurse include in the teaching plan? a. Impetigo is not contagious to others b. Soften and remove crust and debris c. Leave draining lesions open to air to dry out d. Avoid topical antibacterial ointment on infected areas

b. Soften and remove crust and debris Care of the infected skin is important to prevent worsening wounds. The parent should remove crusts and debris by softening them with 1:20 Burrow solution compresses, then apply topical bactericidal ointment to the affected areas. Impetigo is highly infectious and is spread by direct contact. The nurse should stress the importance of handwashing. The client should be discouraged from touching the lesions and the infected areas should be covered. Oral and topical antibiotics are used. Impetigo is caused by streptococcal or staphylococcal infection.

An 18-month-old client is admitted to the hospital. When the parents leave, the child starts to cry loudly. After a while the child stops crying and becomes quiet and withdrawn. Which statement about the child's behavior is correct? a. The child has accepted the separation and has adjusted well b. The child has entered the second stage of separation anxiety c. The child has entered the third stage of separation anxiety d. The child is behaving very unexpectedly for that age group

b. The child has entered the second stage of separation anxiety The second stage of separation anxiety is despair. At this stage, crying stops and the child becomes depressed, apathetic, and withdrawn. The nurse should continue to soothe the child. The child becoming quiet and withdrawn does not indicate adjustment. The third stage of separation anxiety is denial. The toddler or infant appears adjusted and appears interested in the environment, but will ignore the parents when they return. This behavior is normal for this age child. Separation anxiety begins at 6-7 months of age, peaks around 10-12 months, and is usually resolved by age 3.

A 4-month-old, full-term infant is seen in the well-child clinic. The nurse is most concerned when which finding is observed? a. The infant's head turns to the side when a sound is made at the level of the ear b. The infant's head lags when pulled from a lying to a sitting position c. The infant is drooling d. The infant does not focus on a toy held close to the face

b. The infant's head lags when pulled from a lying to a sitting position The nurse anticipates almost no head lag at 4 months of age. This finding in a full-term infant demonstrates poor neurological behavior and suggests complications in motor development. The infant's head turning to the side when a sound is played at ear-level is an expected behavior for a 4-month-old. Drooling is an expected behavior for a 4-month-old. An infant should be able to focus on items in close proximity to the face at 4 months. However, this is not the most concerning.

The nurse visits the family with three small children who live in a three bedroom home built in 1952. The nurse counsels the family how to avoid lead poisoning. The nurse determines the teaching is effective if the parent makes which statement? a. "I plan to scrape paint off the walls after the children go to bed tonight." b. "My children eat meals whenever they are hungry." c. "I wet mop all my floors and wash all of the windowsills weekly." d. "I'm going to leave that patch of dirt uncovered so the children will have somewhere to dig."

c. "I wet mop all my floors and wash all of the windowsills weekly." Homes with lead paint should be cleansed weekly by wet cleaning all hard surfaces to remove dust that may contain lead; no not dry sweep. During renovation, children should not live in homes that contain lead-based paints. Should eat regular meals with adequate intake of calcium and iron; more lead is absorbed on an empty stomach. Lead can be found in dirt, plant grass, or other ground cover.

The nurse is instructing nursing students on care for a newborn client diagnosed with hemophilia A. Which statement about the hemophilia trait should be included? a. "It is an X-linked recessive trait found primarily in females." b. "It is an X-linked dominant trait found primarily in females." c. "It is an X-linked recessive trait found primarily in males." d. "It is an X-linked dominant trait found primarily in males."

c. "It is an X-linked recessive trait found primarily in males." This trait very rarely shows itself in females, since the second sex chromosome is also an X. Females would need to have the trait linked to both chromosomes in order to show the disease. Since the second sex chromosome in males is a Y, males will show the disease. A female who has the trait linked to one X chromosome and not the other is considered a carrier. Hemophilia is a group of bleeding disorders in which there is a deficiency of one of the clotting factors. The disease is manifested by prolonged bleeding time with subcutaneous and intramuscular hemorrhage. Treatment includes factor VIII concentrate and DDAVP.

The nurse counsels a parent of a school-age child diagnosed with chickenpox about when the client can return to school. The nurse determines the teaching is effective if the parent makes which statement? a. "My child can return to school after the blisters stop erupting." b. "My child can return to school when the itching is controlled." c. "My child can return to school when the lesions are crusted." d. "My child can return to school when the macules disappear."

c. "My child can return to school when the lesions are crusted." About one week after onset of the disease the vesicles will form a crust. Chickenpox is also communicable two days before the rash appears. The rash begins as macules, then papules, then vesicles. The child should be isolated until all vesicles are crusted. The parent should bathe and change the child's clothes and linens daily. The parents should keep the child's fingernails short and should apply topical calamine lotion to help relieve itching. The appearance of macules is the beginning of the disease.

An infant client is able to stand holding on to objects, plays "peek-a-boo," and is starting to say "mama" and "dada." The nurse identifies these behaviors are characteristic of which age? a. 5 months b. 6 months c. 9 months 4. 12 months

c. 9 months At 9 months of age, the infant is able to pull self up and assumes a seated position as well as say words such as "dada," "mama," and "baba." At 5 months of age, the infant squeals and makes cooing sounds. The infant is also able to reach for objects with one hand, and hold the head steady. At 6 months of age, the infant takes pleasure in hearing own voice and begins to imitate sounds. The infant also begins to sit unsupported and show curiosity in surroundings. At 12 months of age, the infant comprehends the meanings of several words, recognize objects by name, and says 3-5 words besides "dada" and "mama." The 1-year-old is able to respond to simple spoken requests and make simple gestures like waving or nodding "yes."

The nurse instructs parents of a school-age client about how to collect a 24-hour urine specimen at home using a clean, empty jar. Which size does the nurse recommend that the client use for the collection? a. An 8-ounce jar b. A 16-ounce jar c. A 48-ounce jar d. A 128-ounce jar

c. A 48-ounce jar The expected amount of urine output for a school-age child is about 1,200mL. Since 30mL equals 1 ounce, 1,200mL equals 40 ounces. A 48-ounce jar would be best to hold 40 ounces of urine. For a 24-hour urine test, all urine is collected during a 24-hour period and placed into a single container with a preservative or the container is placed in ice. An 8-ounce (240mL) jar is not big enough to hold all the urine produced in a 24-hour period for school-age child. A 16-ounce (480mL) jar is not big enough to hold all the urine produced for a school-age child. A 128-ounce container is equivalent to 1 gallon. This container would be too large for an average amount of urine in a 24-hour period for a school-age child.

A preschool-age client comes to the clinic for a routine exam. The parent reports the child likes to jump and climb, questions everything, and is often observed interacting with an "imaginary" best friend. The nurse advises the parent to take which action? a. Encourage the child to play more often with other children b. Tell the child that the playmate is not real c. Allow the child to engage in imaginary play d. Never leave the child alone

c. Allow the child to engage in imaginary play Having imaginary friends is a normal and common occurrence for preschool-age children. By the time the child reaches school-age, the child outgrows the imaginary friend. The school-age, not preschool-age, client engages in associative/interactive/cooperative play. Child fantasy is a sign of health because it helps the child differentiate between fantasy and reality. The parent should acknowledge the presence of the imaginary friend, but not allow the child to use the imaginary friend to avoid responsibility or punishment. The nurse should reassure the parent that this is normal behavior and while the preschool-age client requires supervision, it is not appropriate to tell the parent that the child can never be left alone.

A parent of a preschool-aged client calls the clinic to report that the child has been exposed to chickenpox. The nurse informs the parent the incubation period for chickenpox is which length of time? a. 24 hours b. 2-4 days c. 1 month d. 2-3 weeks

d. 2-3 weeks The incubation period for varicella zoster is about 10-21 days, approximately 2-3 weeks. Chickenpox is spread by direct contact, droplet, and via contaminated objects. A person with chickenpox is contagious beginning 1-2 days before rash onset until all the chickenpox lesions have crusted. Vaccinated people who get chickenpox may develop lesions that do not crust. Those individuals are considered contagious until no new lesions have appeared for 24 hours. Prodromal symptoms include slight fever, malaise, and anorexia.

The nurse in a pediatric clinic during health record audits and notices that a preschool client is on a delayed immunization schedule per the parents' request. The client is 5 years old, and it has been 3 weeks since the initial administration of the measles, mumps, and rubella (MMR) vaccine. Which is the best response by the nurse? a. Nothing, this is completely normal and goes along with the catch-up schedule by the CDC b. Call the parents and harshly explain the dangers of the delayed immunization schedule c. Call the parents and explain that the child will need to be seen in the next week to receive the second dose of the MMR vaccine to keep on schedule d. Call Child Protective Services (CPS) because the child is clearly in an abusive situation

c. Call the parents and explain that the child will need to be seen in the next week to receive the second dose of the MMR vaccine to keep on schedule According to the CDC, the MMR vaccine requires a 4-week time period between the first and second dose. The CDC does have a catch-up schedule, and although this is correct, the nurse needs to take action to ensure the parents are aware of the schedule so the preschooler gets the dose in the correct time frame. This is an appropriate action by the nurse. The nurse should provide unbiased teaching to ensure that the parents comply with the schedule as set by the CDC. The CDC provides recommended guidelines for vaccinations. The child is late on the MMR vaccine, but is not clearly in an abusive situation. This action by the nurse is inappropriate and unprofessional.

A parent of a preschool-aged client diagnosed with frequent acute otitis media asks the nurse why this keep happening to the child. The nurse's explanation is based on which correct information? a. Children have weaker tympanic membranes b. Children have immature immune systems c. Children have shorter eustachian tubes than adults d. Children frequently introduce foreign substances into the ears

c. Children have shorter eustachian tubes than adults The eustachian tubes of children are shorter, wider, and straighter than those of adults. The organism causing the infection travels from the pharynx via the eustachian tube to the middle ear. Acute otitis media is an infection of the middle ear. Symptoms include fever, chills, headache, ear noises, deafness, and sharp pain. It is caused by an infectious organism, not by a weak tympanic membrane. Otitis media is typically caused by Streptococcus pneumoniae, or Haemophilus influenzae. Other risk factors include exposure to passive smoke from cigarette smoking and attendance in daycare. Obstruction of the eustachian tube causes an accumulation of secretions in the middle ear. Placing objects in the ear is not the cause of otitis media.

The nurse prepares discharge teaching for parents of a toddler diagnosed with nonorganic failure to thrive (NFTT). Which suggestion by the nurse is most appropriate to include about mealtimes with the parents? a. Allow the toddler 10 minutes to eat each meal b. Insist the toddler eat age-appropriate foods c. Develop a structured routine for all activities d. Invite other children to eat with the client

c. Develop a structured routine for all activities Children respond better if activities of daily living (ADLs) are structured. An unstructured lifestyle will be reflected in the child's unwillingness to eat. Bathing, dressing, playing, sleeping, and eating should occur in a structured routine. Nonorganic failure to thrive (NFTT) is due to causes unrelated to disease, such as the parents' inadequate nutrition information, disturbances in maternal-child attachment, or an inability by the child to separate from the parents. The parents should feed the child in same way each meal and allow about 30 minutes for eating. The parents should not force-feed the child, but calmly persevere when the child is refusing food. If the child won't accept solid food, the parents should begin with pureed foods and progress to more solid foods. The parents should provide a quiet, unstimulated mealtime so the child can focus on eating.

The nurse knows the DTaP vaccine protects against which diseases? a. Diphtheria, typhoid fever, and polio b. Diphtheria, typhoid fever, and pertussis c. Diphtheria, tetanus, and pertussis d. Diphtheria, tetanus, and polio

c. Diphtheria, tetanus, and pertussis DTaP refers to the combination of diphtheria, tetanus, and pertussis vaccines

A preschool-age client is diagnosed with idiopathic hypopituitarism. Which hormone is most commonly prescribed for a preschool client with idiopathic hypopituitarism? a. Estrogen b. Parathormone c. Growth hormone d. Insulin

c. Growth hormone The most common hormone affected in children with hypopituitarism is growth hormone. Growth hormone promotes growth of bone and soft tissues, affects linear growth, and conserves carbohydrate utilization. Estrogen accelerates growth of epithelial cells in utero, promotes protein anabolism, promotes breast development during puberty and pregnancy, and stimulates ripening of ova. It would not be the priority hormones prescribed for the child with hypopituitarism. Parathormone is not affected by hypopituitarism, but is regulated by a feedback loop due to levels of phosphorus and calcium in the blood. Parathormone promotes calcium reabsorption from blood, bone, and intestines. It promotes excretion of phosphorus in the kidneys. Insulin is produced by the beta cells of the pancreas in response to elevations of blood glucose. If blood sugar levels are affected in hypopituitarism, they are usually decreased. Hypoglycemia is more prevalent in hypopituitarism.

A parent brings a newborn client to the healthcare provider's office. The newborn is vomiting, has abdominal distention, and is diagnosed with pyloric stenosis. Which characteristic of the newborn's emesis does the nurse expect? a. Black in appearance b. Diminished after feedings c. Projectile and forceful d. Thick and full of mucus

c. Projectile and forceful An infant with pyloric stenosis will present with projectile vomiting and abdominal distention. Other symptoms include weight loss, constipation, dehydration, and visible peristaltic waves. Pyloric stenosis is partial obstruction of the passageway from the stomach to the duodenum due to a thickening or obstruction of the pylorus. Emesis that is black is expected with bleeding, but not with pyloric stenosis. In pyloric stenosis, vomiting occurs after feeding. The food or liquid is unable to pass through the obstructed pylorus and vomiting results. The emesis is liquid and not thick with mucus. The treatment for pyloric stenosis is surgical repair.

The nurse is teaching a parenting class. Which action does the nurse include as the most important to promote mobility in infants? a. Encourage a daily exercise program b. Use a playpen whenever possible c. Provide safe toys and play areas d. Teach noncompetitive activities

c. Provide safe toys and play areas Be aware of safety concerns for the infant, including aspirating foreign objects, poisoning, burns, and falls from infant seats, high chairs, walkers, and swings. Infants are very active. Therefore, formal exercise programs are not recommended. The use of a playpen restricts movements and prevents the infant from exploring and developing gross motor skills. The nurse should recommend that the infant be allowed to explore the environment safely.

During a visit, the home care nurse observes a preschool-age client sitting near a fireplace. The client's clothing catches fire and covers the client in flames. Which action does the nurse take first? a. Obtain water from a sink and pour it on the client b. Immediately wrap the client in a nearby blanket c. Push the client to the ground and make the client roll d. Remove the client's clothing as quickly as possible

c. Push the client to the ground and make the client roll The nurse will smother the flames, and not let the child run because it will fan the flames. A preschool-age child can be taught to stop, drop, and roll in the event of fire. Another person can pull the child to the ground and roll the child until the flames are smothered. Obtaining water from a sink will take too long. Wrapping the child in a blanket may smother the flames, but may keep the burning clothing smoldering next to the child's skin. As soon as the flames are smothered, the nurse will assess the breathing and airway. Then, any burned clothing will be removed. The nurse will cover the wound with a clean cloth, keep the victim warm, and ensure the client is transported to the hospital.

The nurse understands that, according to Erikson, adolescence is regarded as the period associated with establishment of which developmental goal? a. Sense of trust b. Sense of autonomy c. Sense of identity and intimacy d. Sense of initiative

c. Sense of identity and intimacy According to Erikson, there is an overlap of late adolescence and early adulthood in which the individual tries to develop intimate relationships. Sense of trust develops during infancy; learns to trust self and others. Sense of autonomy develops during toddlerhood; learns to exercise self-control and influence the environment directly. Sense of initiative develops during preschool years; begins to evaluate own behavior and learn limits on influence in the environment.

A school-age client is admitted to the hospital with a diagnosis of idiopathic hypopituitarism. Which clinical manifestation is the nurse most likely to observe? a. Hyperglycemia b. Early sexual maturation c. Short stature d. Decreased urination

c. Short stature Pediatric clients with idiopathic hypopituitarism characteristically have short stature and slow growth. Children typically fall off the growth curve in height and may have weight gain that is out of proportion to height. Idiopathic hypopituitarism is diminished or deficient secretion of one or more of the pituitary hormones, including adrenocorticoids and growth hormone. Evidence of hypoglycemia is more common. Sexual development is usually absent or delayed due to the lack of pituitary hormones that stimulate sexual development. Increased thirst and urination may be seen in hypopituitarism due to a lack of antidiuretic hormone.

A 5-month-old infant is brought to the clinic by a parent for a well-baby checkup. The nurse expects to make which observation? a. The infant sits for an extended time without support b. The infant transfers an object from hand-to-hand c. The infant rolls to back (supine) from prone position d. The infant exhibits signs of stranger anxiety when staff enter the room

c. The infant rolls to back (supine) from prone position The 5-month-old infant can roll over from abdomen to back, is able to hold the head erect and steady when in a sitting position, and is able to grasp objects voluntarily, and taking objects directly to the mouth. The infant should sit with support by leaning on the hands at 7 months. Sitting without support occurs at 8 months of age. Transferring objects from hand-to-hand occurs at 7 months of age. Fear of strangers begins at about 7-8 months of age.

A toddler client diagnosed with autism is admitted to the pediatric unit with a tracheostomy after swallowing a small toy. The unlicensed assistive personnel (UAP) reports to the nurse that the child does not respond to questions. Which response by the nurse is best? a. "The child is probably frightened due to the hospital environment." b. "Ok, I will perform a detailed neurological assessment on the client." c. "Thank you for reporting, I will investigate the observation further." d. "The inability to respond to questions is a characteristic of autism."

d. "The inability to respond to questions is characteristic of autism." This response offers the staff members an explanation about the lack of response. While in the hospital, parents should be encouraged to stay with the child. The plan of care should include decreased stimulation, as physical contact may upset a child with autism, and the nurse should establish trust. Autism is an impairment of social interaction. Characteristics include poor eye contact, fixed facial expression, and delay of the development of spoken language. The client's lack of response is due to autism and not fear of the environment. There is no reason to perform a neurological assessment. The nurse acknowledged the staff member's observation, but it's not the best response.

A 15-month-old client crawls but is not yet able to walk. The parents are concerned and ask the nurse if this is normal. Based on the nurse's assessment, the toddler's muscle tone is within normal limits, legs even, and the baby responds to visual and auditory stimuli appropriately. Which response by the nurse is accurate? a. "I will refer you to a specialist." b. "Delayed motor development is a sign of autism, prepare yourself." c. "It might be wise to stop carrying the child for a while." d. "Children often set their own pace."

d. "Children often set their own pace." It is important for the nurse to explain to the parents that the children achieve certain developmental tasks such as walking at their own pace. Many children do not walk until 16-17 months of age, while others begin walking before 12 months. Therefore, there is no need for concern. The pediatric client should walk alone between the ages of 12-15 months. However, this is not a reason to refer the client to a specialist. Although delayed motor development is a sign of autism, the child is not exhibiting any other signs/symptoms of autism spectrum disorder (ASD). To make this statement would causes undue stress to the parents at this point, and it out of the scope of practice of the nurse. Children develop at their own pace. Toddlers may begin walking before the age of 12 months and others don't walk until 16-17 months. Based on the data, this response by the nurse is not accurate or appropriate. There are multiple perspectives on parenting and no right or wrong way to raise a child. Attachment parenting holds the view that infants/toddlers learn and thrive when their needs/wants are constantly met and therefore a secure attachment is formed to assist in forming attachments as the child continues to develop. This is a personal choice and therefore it is not accurate or appropriate for the nurse to make this statement.

The nurse counsels parents of a school-age client diagnosed with attention deficit hyperactivity disorder (ADHD). Which statement by the nurse is most appropriate? a. "Consider your child's chronological age when setting goals." b. "Your child will be unsuccessful if faced with a difficult task." c. "Be spontaneous and unpredictable to stimulate your child." d. "Hug and praise your child after a task is correctly performed."

d. "Hug and praise your child after a task is correctly performed." The school-aged child diagnosed with ADHD is often an underachiever in school, and may display impulsive, aggressive, and hostile behavior. The child responds to positive reinforcement. The parent should recognize and praise desired behavior. School-aged children with a diagnosis of ADHD may be less mature than chronological age. Goals should be very individualized. The school-aged child may help with organizational skills, but can succeed with difficult and complex tasks. The diagnosis should not be used as an excuse to refuse to attempt a task. Consistency is important to the success of a school-aged child diagnosed with ADHD. Routine, schedule, and predictability provide needed stability.

An adolescent client is evaluated for scoliosis. The client asks the nurse, "What is scoliosis?" Which statement by the nurse best describes scoliosis? a. "It is an inward curvature of the lower spine." b. "It is an exaggerated convexity in the thoracic region of the spine." c. "It is the herniation of an intervertebral disc." d. "It is a lateral curvature of a portion of the spine."

d. "It is a lateral curvature of a portion of the spine." Scoliosis is a lateral curvature of a portion of the spine. It is diagnosed by having the client bend at the waist to assess the spine. If the client wears a brace, good skin care under pressure areas is necessary and the brace is worn 23 hours per day. Scoliosis is a lateral deviation of one or more vertebrae commonly accompanied by rotary motion. It is not an inward curvature. Scoliosis is a lateral deviation of the spine that causes unevenness of the hips or scapulae. Herniation of a disc is not scoliosis.

The home care nurse visits aa child client diagnosed at birth with phenylketonuria. The nurse assesses the client's intake for the previous week. The nurse is most concerned if the parent makes which statement? a. "My child snacks on oranges." b. "My child eats low-protein pasta for dinner." c. "My child really likes potato chips." d. "My child's favorite lunch is a peanut butter and jelly sandwich."

d. "My child's favorite lunch is a peanut butter and jelly sandwich." Peanut butter is not allowed on diet because of the high protein. The child can have a jelly sandwich made with low-protein bread, but no peanut butter. Phenylketonuria is an inherited disorder where there is an absence of an enzyme needed to metabolize the essential amino acid phenylalanine. The treatment is dietary with consumption of foods that contain how phenylalanine levels, such as vegetables, fruit, juices, and some low protein breads and cereals. Oranges are allowed on the diet. Low protein pasta is allowed, however high protein foods such as meat and dairy products are eliminated or very restricted. Potato chips are allowed in the diet. Strict dietary control is essential to prevent intellectual disability.

A client delivers a healthy 8lb-2oz infant. The client mentions to the nurse that the baby's "soft spot" bulges out when the baby cries. Which statement made by the nurse is most appropriate? a. "The anterior fontanel should close within 1 month." b. "The baby could be brain damaged if the soft spot is injured." c. "The baby's posterior fontanel should close after 1 year." d. "The anterior fontanel will normally bulge out when the baby coughs or cries."

d. "The anterior fontanel will normally bulge out when the baby coughs or cries." The fontanels should feel flat, firm, and well-demarcated when the baby is at rest. Coughing or crying may cause the anterior fontanel to bulge. Providing information about when the fontanels will close does not address the client's concern. The anterior fontanel takes 12 to 18 months to fully close. The posterior fontanel closes at around 2 months of age. The nurse stating that the baby's brain could be damaged due to a soft spot injury could alarm the parent and does not address the client's concern.

The nurse provides teaching to an adolescent client and parent about the brace the adolescent will wear to correct a scoliosis deformity. Which statement made by the parent indicates teaching is successful? a. "A bed board may replace the brace at night." b. "My child's diet should be low in calories." c. "Daily tub baths are preferred to showers.' d. "The brace should be worn 23 hours a day."

d. "The brace should be worn 23 hours a day." The brace should be worn 23 hours per day. The nurse should assess the home environment for safety hazards and teach the client how to prevent falls by using handrails and avoiding slippery surfaces. The brace should be removed for bathing. The parent and client should assess the skin for signs of irritation. The client should wear a cotton T-shirt under the brace to prevent irritation. The client requires a balanced diet with enough calories to support rapid growth. It is easier for the client to shower than have a tub bath. The nurse should assess the client to demonstrate alternative ways to get out of bed and dress with the brace.

The nurse observes a child client walk up and down steps. The nurse notes the child has a steady gait and can use short sentences. The nurse estimates the child's age to be how many months? a. 8 months b. 12 months c. 16 months d. 24 months

d. 24 months The 24-month-old child goes up and down stairs alone, runs well with a wide stance, builds a tower of six to seven blocks, and has a vocabulary of about 300 words. The 8-month-old child can roll over from stomach to back and begins to distinguish and recognize strangers. The 12-month-old child needs help walking, eats with fingers, and says three to five words other than "dada" and "mama." The 16-month-old child walks without help, kneels without support, and says four to six words including names.

The nurse assesses a young child who has socialization skills characterized by associative play, eagerness to please the parents, and a strong identification with the parent. At which age are these behaviors most consistent will normal developmental activities? a. 2 years b. 3 years c. 4 years d. 5 years

d. 5 years A 5-year-old child participates in associative play, has an eagerness to please the parent, and identifies with the parent. Growth and development of a preschooler includes increasing musculoskeletal strength and coordination, dressing without help, has a 2100-word vocabulary, and imitating adult patterns and roles. Appropriate toys for this age are playground materials, housekeeping toys, and coloring books. Safety instruction includes using bicycle helmet, safety restraints in the car, and teaching to look both ways before crossing the street. Erikson stage is initiative versus guilt. A 2-year-old would not participate in associative play. The toddler is at the stage of parallel play. The toddler will begin to be able to separate from the parent. The toddler is egocentric in thoughts and behavior. A 3-year-old will participate in both parallel and associative play. A 4-year-old child will identify strongly with the parent of the opposite sex and will rebel if parental expectations are too high.

The nurse provides care for clients in the pediatric clinic. The nurse investigates which pediatric client for a possible speech impairment? a. A 3-month-old who babbles b. An 8-month-old who laughs spontaneously c. A 4-year-old who jumps when the nurse asks d. A 5-year-old who only answers questions with single words

d. A 5-year-old who only answers questions with single words The 5-year-old should have a vocabulary of 2100-3000 words and use mostly complete sentences containing 5-7 words. This finding indicates a possible developmental delay. Babbling of a 3-month-old is expected behavior. Other expected findings for a client of this age include bringing objects to the mouth at will, holding the head erect and steady, and smiling in the parent's presence. Spontaneous laughing of an 8-month-old is expected behavior. Other expected findings for a client of this age include sitting alone and having anxiety with strangers. The 4-year-old has a 1500-word vocabulary, climbs and jumps well, laces shoes, skips and hops on one foot, and throws overhead. This client is able to follow instructions and therefore understands the spoken word.

The school nurse assesses children enrolled in a kindergarten class. The nurse is most concerned if which finding is observed? a. A child throws and catches a ball b. A child is able to neatly tie shoelaces c. A child eats with the fingers d. A child walks down stairs by placing both feet on one step

d. A child walks down stairs by placing both feet on one step A child at this stage of development should be able to walk down stairs using alternating feet. This indicates a delay. Throwing and catching a ball is an appropriate skill for a child at this stage of development. Neatly tying knots is an appropriate skill for a child at this stage of development. While a child at this stage of development is more aware of hands as a tool, it is not unusual to revert to finger feeding.

(Case study 3/6) Which is the priority action for the nurse to take? a. Obtain a list of the client's sexual partners b. Discuss appropriate hygiene during toileting c. Review importance of condom use with sexual activity d. Assist in obtaining vaginal swabs for chlamydia and gonorrhea

d. Assist in obtaining vaginal swabs for chlamydia and gonorrhea The priority for this adolescent client will be to determine if there is infection and, if so, the type of infection present so appropriate treatment can be initiated. At this point, there is no need for the client to present a list of sexual partners. If the client is positive for STI, the client will need to inform all sexual partners of potential infection and need for treatment. Appropriate hygiene when toileting can decrease the incidence of UTI, but is not a priority for the nurse to discuss at this time. A discussion about condom use will also be important, but can occur after determination of infection is made.

An adolescent client diagnosed with attention deficit hyperactive disorder (ADHD) asks why methylphenidate was prescribed. The nurse educates the client and parents that methylphenidate is prescribed for which desired effect? a. Antidepressant b. Anxiolytic c. Sedative-hypnotic d. CNS stimulant

d. CNS stimulant Pharmacological therapy is useful in the management of attention deficit hyperactive disorder. Central nervous system stimulants improve concentration and adaptive behavior. CNS stimulants include methylphenidate, atomoxetine, modafinil, armodafinil, and the amphetamines. Adverse effects include depersonalization, dizziness, facial tics, headaches, insomnia, increased blood pressure, and irritability. The medication is not an antidepressant. Methylphenidate is not used to decrease or control anxiety. Methylphenidate is not a sedative-hypnotic. Examples of sedative-hypnotics include phenobarbital, secobarbital, flurazepam, and lorazepam.

Which action does the nurse take to minimize separation anxiety experienced by a toddler client? a. Assigns different nurses until the toddler responds to one b. Reassures the parents that the toddler is adjusting well c. Brings other children in to visit and play with the toddler d. Encourages familiar objects or toy be brought from home

d. Encourages familiar objects or toy be brought from home Bringing familiar objects and toys from home provides a familiar environment that will help comfort the toddler. If the toddler has a special blanket or stuffed animal which provides comfort or consolation, the parent should bring the object to the hospital. The nurse should provide continuity for the toddler by assigning the same nurse and encouraging the parents to be involved in care. The nurse should encourage the family's participation in care and inform the parents that separation anxiety is expected behavior. It is more important for parents to room-in or bring favorite articles from home to console the toddler.

A toddler client has nausea, vomiting, and diarrhea. Which implementation is best for the nurse to use to maintain an adequate fluid intake? a. Keep the client NPO and give hypotonic solutions intravenously b. Force fluids and give hypertonic solutions intravenously c. Provide gelatin and ice pops to increase fluid intake d. Offer oral rehydration solutions (ORS) to rehydrate

d. Offer oral rehydration solutions (ORS) to rehydrate Oral rehydration solutions contain sodium, potassium, chloride, citrate, and glucose. The amount given is determined by the degree of dehydration and child's weight. If the child is vomiting, give a small amount of oral rehydration solution at frequent intervals. Offer the client oral rehydration solutions; monitor for indications of dehydration. Offer regular diet after the child is rehydrated. Parenteral fluids are necessary only if the toddler is severely dehydrated or in shock. It is no longer recommended to give clear fluids such as fruit juices, carbonated soft drinks, or gelatin because these are high in carbohydrates, low in electrolytes, and have a high osmolality.

Which immunizations does the nurse administer to an adolescent client who has never been immunized? a. MMR, Hepatitis A, and DTaP b. Polio, MMR, and DTaP c. MMR, varicella, and HiB d. Tdap, MMR, and polio

d. Tdap, MMR, and polio The tetanus and diphtheria toxoids and acellular pertussis (Tdap) vaccine is given to persons after the age of 6 years. Nursing responsibilities include teaching the client/parent to observe for severe reactions of extremely high temperature and redness at injection site. Fever may occur within 24-48 hours. Vaccine given intramuscularly (IM). IPV (inactivated polio) vaccine is given at ages 2 months, 4 months, 18 months, and 4-6 years and reactions are very rare. Adolescents who have not received the full immunization with diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine should receive the tetanus and diphtheria toxoids and acellular pertussis (Tdap) vaccine as the first in the series followed by tetanus and diphtheria toxoids (Td). DTaP should not be given to children over the age of 6. HiB is given to children under the age of 18 months.

The nurse performs a home care visit for a young adult diagnosed with cystic fibrosis. The nurse intervenes is which finding is discussed? a. The young adult eats a high-protein, high-calorie diet b. the young adult has two to three regular stools per day c. The young adult swallows the medication capsules whole d. The young adult takes pancreatic enzymes one hour after eating

d. The young adult takes pancreatic enzymes one hour after eating Enzymes should be taken at the beginning of a meal, with a snack, or within 30 minutes of eating. One hour is too long after eating. Chewing or crushing beads destroys the enteric coating. A high-protein, high-calorie diet is appropriate. A diet should be well-balanced and adequate to maintain adequate growth. Two to three is an appropriate number of stools per day. An increase in the number of stools indicates that the amount of pancreatic enzymes is inadequate. Swallowing the medication whole is an appropriate action. The young adult should swallow capsules whole or sprinkle medication on a small amount of food is possible.