Pediatric Growth and Development, Nursing Care of Children Health Promotion and Maintenance

A single woman brings her 10-year-old daughter in for the first well-child visit at the clinic. The nurse discovers they recently relocated to that area due to the mother's job, the child is now attending a "tough" school and she is home, scared and alone, for several hours after school. Which action should the nurse prioritize to assist this family?

Provide a list of local after-school programs

A parent states, "I do not let my child eat any carbohydrates because they will make her fat." What is the best response by the nurse?

"Carbohydrates are a necessary fuel for the body, especially neurologic functions."

A parent is comparing a child's development on the growth chart with those of another child and is concerned that her child is not in the "normal" range. What can the nurse inform the parent to alleviate her anxiety?

"Growth charts are just a standard measurement. If your child doesn't fall into the 'normal' range, it doesn't indicate something is wrong."

The parent cannot understand why the 12-month-old can throw a ball but cannot catch the ball. Which statement by the nurse helps the parent understand this?

"Maturation of neurological and muscular functioning has not occurred for this skill"

A mother, who is vegan, when asked about the nutritional intake of her 18-month-old tells the nurse not to worry, that she is providing plenty of protein to her daughter. "And," she says, "I avoid giving her fats." Which of the following would be the most appropriate response for nurse to give this mother?

"Your child needs fat in the diet at this age, as it is needed for myelination of spinal nerves."

The infant weighs 7 lb 4 oz (3,248 g) at birth. If the infant is following a normal pattern of growth, what would be the expected weight for this child at the age of 12 months?

21 lb 12 oz (9.9 kg)

Which of the following nurses is most likely to care for patients who are trying to resolve identity versus role confusion?

A nurse who provides care in a large junior high school

Preventing injuries in children is a nursing responsibility accomplished through which of the following?

Anticipatory guidance education

While preforming a preoperative assessment on a 3-year-old client, a nurse should be aware of what type of cognitive thought process by the child?

Preoperational - The child will want to play with the equipment.

Which observation by the nurse indicates that an adolescent's cognitive thinking is developing at an expected level?

Adolescent explains how working a part-time job will help pay for a car.

Which activity should the nurse encourage a new mother to perform to foster the developmental tasks of a toddler according to Erikson's developmental stages?

Allow the child to pull a talking duck toy.

The nurse is caring for a child who underwent an appendectomy 12 hours ago. The child has reported incisional pain. When the nurse attempts to administer the prescribed analgesic the child's mother declines the medication. What initial action by the nurse is most appropriate?

Ask the child's mother to elaborate on her concerns about the medication. Some people may not approve of the administration of narcotics or medications containing alcohol. The nurse must first determine the cause of the concern. Then action can be taken to best provide care to the child. Continuing observation of the child does not address the needs related to pain management. Although the client's physician or the nursing supervisor may be contacted, it is not the initial action in this scenario.

A new mother asks for advice from the nurse about bathing her infant. Which of the following should the nurse tell her?

Be sure to wash the infant's face, hands, and diaper area daily

Which of the following actions should a nurse take in order to apply theories of development into nursing care?

Choose outcomes that are reflective of patients' developmental stages.

The nurse is admitting a 10-year-old child the night before surgery, and the child is very concerned about what will happen. Which action should the nurse prioritize in caring for this child to minimize the possible trauma related to this hospitalization?

Encourage the child to ask questions and express fears.

The nurse is caring for a 16-year-old boy with injuries from a car accident. Which activity describes the nurse's manager role?

Facilitating return to school by working with the school nurse

Following the discharge of a child who has a chronic health condition from the hospital, the nurse case manager follows up with a visit to the home and meets with the family and child. This visit best represents which philosophy of pediatric nursing?

Family-centered care The home visit by the case manager to some degree meets principles of each type of care, but is most representative of family-centered care because family-centered care is described as a mutually beneficial partnership between the child, the family, and health care professionals.

The nurse is observing an infant and notices that the infant has learned to roll over from one side to the other and then back again. The nurse identifies this as which of the following?

Gross motor skills

What is a current trend in child health care?

Health promotion rather than health restoration is stressed. It is recognized that keeping individuals well is more cost effective for a system than helping ill individuals return to wellness.

The adolescent is in an auto accident and sustained a cut above his forehead and needs stitches. Which developmental task would be a major concern for the adolescent at this stage?

Identity

A nurse is conducting developmental surveillance. Which factor may negatively influence an accurate assessment of the child?

Inability to evaluate progress over time

A 10-year-old girl is excited when she receives the "most improved player" award on her softball team. Although she was not the strongest player on the team, she always tried to perform at her best level and never gave up on practicing her skills. What stage of psychosocial development according to Erik Erikson is this child demonstrating?

Industry versus inferiority

According to the theories of child development of Sigmund Freud, the child who is between 6 and 10 years old is in which stage?

Latency stage

The parent of an 11-year-old girl with an inoperable brain tumor confides to the nurse that her daughter's physician is "pushing them" to convince their daughter to participate in a controversial treatment that has a high risk for side effects. She further states that she told him twice that they were not interested. What would be the nurse's best response to this situation?

Meet with the physician and disclose the concerns of the family; refer the case to the institutional ethics committee if not resolved. When a nurse believes the physician has unduly coerced parents in their treatment decision, the nurse would be obliged to intervene and disclose any concerns. Such intentional or unintentional action would violate ethical principles of conduct. pg 18

The nurse is playing with the 8-month-old infant. The nurse hides the toy to assess cognitive function of the infant. The infant tries to find the toy. The nurse is assessing which characteristic of Piaget's stages of cognitive development?

Object permanence

A mother is concerned about her 2-year-old son acquiring sufficient protein while following the family's vegan diet. Which of the following foods would be appropriate for the nurse to recommend to this mother?

Peanut butter and wheat bread

The nurse is focusing on health promotion for a 6-year-old girl. Which intervention best supports Healthy People goals?

Recommending a helmet for biking Recommending that the child wear a protective helmet best supports the goals of Healthy People because unintentional injury remains a leading cause of mortality and morbidity for children. Proper diet, adequate sleep, and after-school child care are important but do not affect child health status as much as injury prevention does.

The nurse watches a child arranging sugar packets from his meal trays in order of their weight. This activity of conservation is most typical of what age child?

School-aged

The nurse is talking with the mother of a 2-year-old girl during a scheduled visit. Which teaching subject best supports the emphasis on preventive care?

Showing the mother how to teach hand washing to her child. Teaching hand washing helps to prevent infection, emphasizes preventive care, and is basic to avoiding many common illnesses. Reminding the mother that the child will imitate her may promote safe parental role-modeling but does not reach the level of prevention that hand washing does. Knowing about developmental milestones and typical physical changes in toddlers does not directly promote preventive care.

A 4-year-old is being seen in the emergency department after a fall down the steps. How can the nurse communicate with the child to develop rapport? Select all that apply.

Stand at eye level with the child when speaking to him or her. Speak in short sentences. Speak in a slow, clear, positive voice.

To decrease childhood mortality, pediatric nurses need to consistently engage in what activity throughout all age groups?

Teach injury prevention and proper safety practices. The leading cause of death throughout childhood is unintentional injury. pg 15

The nurse is running an education program for early grade-school children. Which topic would address the number one cause of death for this age group?

The importance of crossing streets safely Motor-vehicle accidents are a leading cause of death in this age group. p 10

In observing an infant who is 6 months of age, which fine motor skill would the infant have most recently attained?

The infant can hold a bottle.

The nurse in the emergency center admits a 16-year-old girl who looks like she weighs more than her stated weight. After collecting data from the adolescent, the nurse suspects the child is a runaway. Which of the following topics would be most important for the nurse to gather data about?

The possibility that the adolescent is pregnant

According to Erikson, normal adolescent behavior includes trying on new roles and possibly even rebelling. What is the purpose of this behavior in adolescents?

To establish a sense of identity

Estimating illness in an infant is difficult. To help an infant's parents do this, which of the following would you instruct them to use?

Use her interest in eating as a good gauge.

A nurse is planning community education focusing on the principles of first aid. Which of the following strategies is likely to be most effective with adolescent learners? Select one: a. Actively involve the participants in practice of techniques. b. Simple lecture format. c. Teach the most crucial content early in the session. d. Divide the planned program into several sessions over several weeks.

a. Actively involve the participants in practice of techniques. Adolescent learners will learn best when actively involved in participation and use of psychomotor skills.

The parent of a two-year-old child reports feeling frustrated with the fact that her son is saying no to everything. The nurse should teach the parent that this behavior is a normal expression of the child's desire to accomplish which of the following? Select one: a. Increase their independence. b. Gratify their oral fixation. c. Develop their sense of trust. d. Finish a project they set out to do.

a. Increase their independence. The drive for independence is expressed by the toddler opposing the desires of those in authority (tantrums) and attempting to do everything for themselves. The Erickson developmental stage for this age is "Autonomy vs. Shame and Doubt."

A nurse is helping parent's select appropriate independent activities for their 8-year-old child. Which of the following would be an appropriate activity? Select one: a. Providing frequent trips to the library b. Encouraging the child to assume care of the family pet c. Allowing the child to play video games d. Playing touch football

a. Providing frequent trips to the library

A seasoned pediatric nurse realizes that a hospitalized child's need for identity is strongest in which of the following groups?

adolescents

The mother of an infant asks you when to begin brushing her son's teeth. Your best response would be

as soon as the first tooth erupts.

A 2-year-old child is in which stage of Erikson's theory of psychosocial development?

autonomy versus shame and doubt

A nurse is changing a dressing on a preschool-aged child who has a healing wound on a lower extremity. Which of the following nonpharmacologic comfort measures would be most appropriate for this child? Select one: a. Promising the child a special treat in exchange for cooperation. b. Encouraging the child to watch a favorite cartoon on television. c. Assisting the child to take deep breaths and focus on relaxing. d. Teaching the child how to go 'to a different place' using their imagination.

b. Encouraging the child to watch a favorite cartoon on television.

A nurse is taking the health history of a school-age girl. Which statement by the client's mother indicates a need for further teaching regarding the client's nutritional status? Select one: a. "We increase her protein intake when she's playing sports." b. "She enjoys helping to prepare her snacks in the kitchen." c. "We allow her to pick out a treat at the grocery store for good behavior." d. "She eats a large breakfast every morning."

c. "We allow her to pick out a treat at the grocery store for good behavior." This statement indicates a need for further teaching. This client's mother should be educated about the importance of praising the client's abilities and skills rather than using food as a reward, which may lead to an increased risk for obesity.

A nurse is educating the parents of an infant about symptoms that should be reported to the provider. What finding should be immediately reported? Select one: a. Mild diarrhea b. Difficulty evacuating bowels c. Decreased urine output d. Abdominal distension

c. Decreased urine output