Pediatrics Exam 2: Wong Chapters 1, 2, 3, 11, 12, 17-20

The nurse is talking to a group of parents about different types of play in which children engage. Which statement made by a parent indicates a correct understanding of the teaching? 1 "Parallel-play children borrow and lend play materials and sometimes attempt to control who plays in the group." 2 "In associative play, children play independently but among other children." 3 "During onlooker play, children play alone with toys different from those used by other children in the same area." 4 "Cooperative play is organized, and children play in a group with other children."

"Cooperative play is organized, and children play in a group with other children."

A mother tells the nurse that she will visit her 2-year-old son tomorrow about noon. During the child's bath, he asks for Mommy. What is the nurse's best reply? "Mommy will be here after lunch." "Mommy always comes back to see you." "Your Mommy told me yesterday that she would be here today about noon." "Mommy had to go home for a while, but she will be here today."

"Mommy will be here after lunch." Because toddlers have a limited concept of time, the nurse should translate the mother's statement about being back around noon to a familiar activity that takes place at that time. Telling the child that his mother always comes back to see him does not give the child any meaningful information about when his mother will visit. Twelve noon is a meaningless concept for a toddler. Stating that his mother had to go home but will be back today does not provide the child with any meaningful information related to when she will actually visit.

S2

"dubb" aortic and pulmonary valves close

S1

"lubb" mitral and tricuspid calces close

Improper use of firearms cause death among...

- 5-14 years - especially in males

List 3 strategies that may be used to prevent fatal accidents in children

- Car restraints - Bicycle helmets - Smoke detectors

List 3 Factors that contribute to increasing morbidity of any disorder in children

- Homelessness - Poverty - Low birth weight - Chronic illnesses - Adoption - Daycare attendance

Identify one major category of disease that children tend to contract in infancy and early childhood

- Respiratory illness - Infection - Acute illnesses

Overweight youth have increased risk for...

- altered glucose metabolism - dyslipidemia - HTN - metabolic syndrome

The National Quality Strategy focuses on...

- better care - healthy people/healthy communities - affordable care

Prevention strategies for childhood injuries

- car restraints - bike helmets - smoke detectors *decreased fatalities in children

Prevention strategies with firearm dangers in children

- childproof safety devices - loading indicators

What behaviors do children who live with chronic violence exhibit?

- difficulty concentrating in school - memory impairment - aggressive play - uncaring behaviors - constricted activities & thinking for fear of reliving traumatic event

List 3 patient-centered outcome measures that may be applicable to an acutely ill, hospitalized child

- falls prevalence - failure to rescue - central line catheter infection (p 14, Box 1-5)

Examples of atraumatic care

- fostering parent-child relationship during hospitalization - preparing child before unfamiliar treatment or procedure - controlling pain - allowing privacy - providing play activities for expression of fear & aggression - providing choices - respecting cultural differences

What are the types of children that nurses need to be concerned by when it comes to potential of future violent behavior?

- harming animals - starting fires - depressed - repeatedly in trouble with criminal justice system - associated with gangs or violent groups

Unintentional injuries in children

- head injuries - drowning - burns - firearm accidents - poisoning - falls

Second leading cause of death in adolescent females & third leading cause of death in adolescent males is?

- intentional poisoning related to drugs & alcohol - suicide attempt

Anatomic characteristics leading to childhood injuries

- large head: predisposes to cranial injury - large speen & liver with wide costal arch: predisposes to direct trauma to these organs - small & light body: may be thrown easily, especially inside moving vehicle

Support & counseling for children include...

- listening - touching - physically present

Advantages of breast feeding

- micronutrients - immunologic properties - several enzymes that enhance digestion & absorption of these nutrients

Children with alcohol & drug use are at increased risk for...

- motor vehicle injuries - drownings - homicides - suicides

Reasons for noncompliance when it comes to children not wanting to wear helmets

- stylishness - comfort - social acceptability

Role of pediatric nurse

- therapeutic relationship -family advocacy & caring -disease prevention & health promotion -health teaching -injury prevention -support & counseling -Coordination & collaboration -ethical decision making ( nonmalefience -obligation to minimize or prevent harm, beneficence-obligation to promote pt's well being, Justice-concept of fairness)

________ decrease with age, whereas other disorders such as ________ increase

- upper respiratory tract infections & diarrhea - acne & headaches

Appetite Changes

-Picky eaters -May want certain foods

Identity vs Role Confusion

-adolescence (12 to 18 yrs) -peer groups are most important social support system

Piaget's Formal Operational Stage

-ages 12 to 18 -develop the capacity for abstract, systematic, scientific thinking

Piaget's Preoperational Stage

-ages 2 to 7 -gains in mental representation: make-believe play symbol-real-world relations -limitations in thinking: egocentrism lack of conservation lack of hierarchical classification

Piaget's Concrete Operational Stage

-ages 7 to 12 -characterized by the active, and appropriate, use of logic

Piaget's sensorimotor stage

-birth to 2 years old -infant builds an understanding of himself or herself and reality (and how things work) through interactions with the environment.

Autonomy vs Doubt and Shame

-early childhood (2 to 3 yrs) -children need to begin asserting control and power over the environment -success in this stage leads to a sense of purpurse -children who try to exert too much power experience disapproval, resulting in a sense of guilt -negativism, ritualism, animism, domestic mimicry, temper tantrums, parallel play, toilet training, gender identity

Outcomes identification

-establish priorities & select expected pt outcomes or goals conclude: A.no problem evident, health promotion is emphasized B.Risk for health problem , intervention needed for health promo and illness prevention c.Actual problem is evident, interventions or management, prevention and health promo d.specific outcome formulated to address realistic pt & family focused goals

Narcan (naloxone)

-gold standard for opioid reversal -doses depends on age -only lasts 15 mins -infants to 20kg children (0.01 mg/kg IM)

Trust vs Mistrust

-infancy (birth to 18 mos) -children need to develop a sense of personal control over physical skills and a sense of independence -success leads to feelings of autonomy, failure results in feelings of shame and doubt

Opioids

-moderate to severe pain -morphine, hydromorphone, fentanyal, and lortab

Ibuprofen

-nonopiod -8-10 mg/kg

Acetaminophen

-nonopioid -mild to moderate pain 10-15 mg/kg

Initiative vs Guilt

-preschool (3 to 5 yrs) -children need to cope with new social and academic demands -success leads to a sense of competence, while failure results in feelings of inferiority

Industry vs Inferiority

-school age (6 to 11 yrs) -young adults need to inform intimate, loving rltshps with other people -success leads to strong rltshps, while failure results in loneliness and isolation

How should the nurse respond to a 53-year-old woman who appears anxious and distressed who wants to have children and approaches the nurse for counseling? 1 Refer her to local adoption agencies. 2 Advise the woman to attend prenatal classes. 3 Explain the consequences of having children later in life. 4 Explain the process of having children through surrogate mother.

1 A 53-year-old woman is likely to have attained menopause and may be able to have children only through adoption. Therefore, the nurse should refer the woman to a local adoption agency. Prenatal classes are recommended for women who are of childbearing age. Explaining the woman's inability to have children after menopause might not solve the problem. The woman likely will have attained menopause and would be unable to produce ovum, so surrogacy is not possible. Test-Taking Tip: Look for options that are similar in nature. If all are correct, either the question is poor or all options are incorrect; the latter of which is more likely. Example: If the answer you are seeking is directed to a specific treatment and all but one option deal with signs and symptoms, you would be correct in choosing the treatment-specific option.

One word sentence

1 Year

Toddlers age range

1 to 3 years

Infants weight should triple by when?

1 year

The parents of a teenaged child tell the nurse they are worried that their child is hanging out with the wrong type of friends. What can the nurse advise the parents to do to help the adolescent make better choices? Select all that apply. 1 Provide support and love at home to make the child feel wanted. 2 Bring the adolescent to an inpatient psychiatric facility. 3 Establish clear and concise boundaries, rules, and expectations. 4 Talk to the child and allow the child to make her own decisions. 5 Ground the child until she shows appropriate behavior with friends.

1, 3, 4 In order to be an effective parent, the family should convey four external assets to the child so that the child can learn to make the correct choices. The parents should provide support, care, and love at home and in the community. It is also important to establish clear and concise boundaries and expectations both at home and in the community. It is also important for parents to discuss good decision-making strategies with their children to empower them to make correct choices. The adolescent is not displaying any behaviors that warrant an inpatient psychiatric admission, nor does she need to be grounded.

Burns occur in ages...

1-14 years

When is the head circumference and chest circumference usually equal?

1-2 Years

Age that lateral incisor teeth come in/fall out (bottom teeth)

10-16 mos/ 7-8 yrs

How many hours of sleep do toddlers need?

11-12 Hours

When should infants be standing

11-12 mos

Break down the motor development of a toddler:

12 Months- walk alone with wide stance 18 Months- try to run and fall easily Age 2- can walk up and down stairs 18 Months- throws a ball

The nurse finds that a newborn infant weighs approximately 3 kg (7 lb). Approximately how much would the child weigh when he reaches 2.5 years of age? 1 9 kg (20 lb) 2 12 kg (27 lb) 3 15 kg (33 lb) 4 17 kg (38 lb)

12 kg (27 lb)

Adolescent age range

12-18 years

what age is the "terrible twos"

12-36 months

How hot should water be

120 degrees or below

Age that first molar teeth come in/fall out (top teeth)

13-19 mos/ 9-11 yrs

when can a child retain urine for up to 2 hours longer?

14 to 18 months

Age that first molar teeth come in/fall out (bottom teeth)

14-18 mos/ 9-11 yrs

Uses a cup well

15 months

Walks without help

15 months

Homicide is the second leading cause of death in...

15-19 year old

Age that Canine (cuspid) teeth come in/fall out (top teeth)

16-22 mos/ 10-12 yrs

Age that canine (cuspid) teeth come in/fall out (bottom teeth)

17-23 mos/ 9-12 yrs

Jumps in place with both feet

18 months

Manages a spoon without rotation

18 months

Throws a ball overhand

18 months

When does bladder control occur?

18 to 24 months

only ____mL for subcutaneous

1mL

Puts 2-3 words together in a sentence

2 Years

when do children recognize gender differences?

2 years

HOw much weight do preschoolers gain?

2-3kg per year

Can draw a circle

2.5 Years

Good hand-finger coordination

2.5 Years

HOw much growth do preschoolers get?

2.5-3.5 inches/ year (6-9 cm)

The nurse finds that a newborn weighs 3 kg (7 lb). By the time the child reaches 2 years, she weighs 12 kg (26 lb). What would be the child's approximate weight by 6 years of age? 1 20-22 kg (44-48 lb) 2 27-29 kg (59-64 lb) 3 30-32 kg (66-70 lb) 4 36-38 kg (79-84 lb)

20-22 kg (44-48 lb)

what is acceptable visual acuity for this age?

20/40

Age that second molar teeth come in/fall out (bottom teeth)

23-31 mos/ 10-12 yrs

Age that second molar teeth come in/fall out (top teeth)

25-33 mos/ 10-12 yrs

A patient with two children is going through a divorce and does not understand what the term split custody means. What is the most appropriate answer? 1 Custody of both children is given to the grandparents. 2 Custody of both children is given to the parent who brings home the larger salary. 3 Custody of one child is given to the mother, and the father has custody of the other child. 4 Custody of the children is given to the father, and the mother is allowed to visit once a week.

3 Split custody means that custody of one child is given to the mother and custody of the other child is given to the father. This arrangement ensures that both parents have a child, but it separates the siblings. Custody of the children is not given to the grandparents, it is not determined by who has the larger salary, nor is it given solely to the father with visitation privileges given to the mother.

A parent tells a 13-year-old child that he is adopted. What could happen as a result of telling the child at this age? 1 Sympathy 2 Happiness 3 Depression 4 Excitement

3 The earlier the child knows of his adoption status, the better. Generally, older children display anger and sadness. This can often be manifested as depression. The child may feel abandoned, but a feeling of sympathy is rare. Similarly, happiness and excitement are not what a child feels after learning about being adopted.

Parents who are divorcing are worried about how the divorce will affect their child. Which symptom indicates unhealthy coping in the child? 1 Body aches 2 Increased sleep 3 Loss of appetite 4 Body rash

3 The most common manifestation of distress in children is loss of appetite. The child is emotionally distressed by the parents' separation, and this stress can be manifested by a loss of appetite. Body aches, increased sleep, and rash over the body are physical symptoms that are very rarely seen in emotional distress. These symptoms may be caused by a viral infection.

Combines several words and uses grammatical rules

3 Years

How many inches should a toddler grow each year?

3 inches

Accidents account for more than...

3 times as many teen deaths as any other cause

when do children take a gender identity?

3 years old

How developed is a toddler's speech?

3-5 word sentences, love to talk

What ages are in preschoolers?

3-6

Preschoolers age range

3-6 years

When should a child weigh 4x their birth weight?

30 months

By what age would the nurse expect most children to use sentences of four or five words? 18 months 24 months 3 years 4½ years

4½ years Children ages 4 to 5 years use sentences of four or five words. An 18-month-old child has a vocabulary of approximately 10 words. A 24-month-old child uses two- or three-word phrases. A 3-year-old child uses sentences of three or four complete words.

How much weight do preschoolers typically gain/year?

5 lbs

Which age group of children have lowest rate of death?

5-14 years

A child is 50 cm (20 inches) long in the second month of infancy. The nurse checks the baby 2 months later and finds healthy growth in the child. Approximately how long would the baby be at 4 months? 1 52 cm 2 55 cm 3 57 cm 4 60 cm

55 cm

Infants weight should double by when?

6 mos

Age that central incisor teeth come in/fall out (bottom teeth)

6-10 mos/ 6-7 yrs

School children age range

6-12 years

The nurse is speaking to a group in the community about psychosocial development according to Erikson's life-span approach. The nurse instructs the group not to impose too many expectations on a child because the child may develop an inferiority complex. What age group of children is nurse referring to here? 1 1-3 years 2 3-6 years 3 6-12 years 4 12-18 years

6-12 years

When should infants be crawling

6-7 mos

The Kohlberg moral development theory states that children are concerned with conformity and loyalty at a stage of their growth. When this stage is correlated with the cognitive development of children, what would the age group be? 1 0-2 years 2 2-7 years 3 7-11 years 4 11-15 years

7-11 years

The nurse assesses a child's cognitive development to determine whether the child has mastered the concept of conservation. In which age group is the concept of conservation usually attained? 1 0-2 years 2 2-7 years 3 7-11 years 4 11-15 years

7-11 years

Age that central incisor teeth come in/fall out (top teeth)

8-12 mos/ 6-7 yrs

Age that lateral incisor teeth come in/fall out (top teeth)

9-13 mos/ 7-8 yrs

D (Although growth cannot be definitely predicted, at the time of the beginning of menstruation or the skeletal age of 13 years, most girls have grown to about 95% of their adult height. They may have some additional growth (5%) until the epiphyseal plates are closed. Responding that the pubertal growth spurt last about 1 year does not address the girl's question. Young women usually will grow approximately 5% more after the onset of menstruation.)

A 13-year-old girl asks the nurse how much taller she will become. She has been growing about 2 inches per year but grew 4 inches this past year. Menarche recently occurred. The nurse should base her response on knowing that: a. Growth cannot be predicted. b. The pubertal growth spurt lasts about 1 year. c. Mature height is achieved when menarche occurs. d. Approximately 95% of mature height is achieved when menarche occurs.

C (Because the amputation has not occurred, the patient's reaction is caused by anticipation of a future loss. This is a healthy response to the anticipated loss of the leg. It will help foster healthy grieving. Acute grief is a definite syndrome characterized by psychological and somatic symptoms. It is characterized by emotional distancing in relationships with others, accompanied by erratic responses of irritability, hostility, and anger. Universal loss does not describe the emotions of grieving before an actual loss. Some people feel constantly upset and preoccupied with a person who has died, to the point where their relationships and work suffer for months on end. Such a reaction is known as complicated grief.)

A 14-year-old patient with Ewing's sarcoma is scheduled for an amputation of the right leg. The patient has been grieving about the loss ever since the health care provider prescribed the surgery. What type of grief does the nurse identify in this patient? A. Acute grief B. Universal loss C. Anticipatory grief D. Complicated grief

C (Risk taking, rebelliousness, and lack of cooperation are normal parts of adolescence. If the parents increase the amount of discipline, he will most likely be more rebellious. Socialization with peers should be encouraged as a part of adolescence. It is a normal part of adolescence during which the young adult is establishing independence.)

A 16-year-old boy with a chronic illness has recently become rebellious and is taking risks such as missing doses of his medication. The nurse should explain to his parents that: a. He needs more discipline. b. He needs more socialization with peers. c. This is part of normal adolescence. d. This is how he is asking for more parental control.

D (Bereavement is a process of grief experienced by most people. Examples include feelings of sadness, insomnia, poor appetite, deprivation, and desolation. The grieving person may seek professional help for the relief of symptoms if they interfere with daily activities and do not subside within a few months of the loss. Grief is a normal, appropriate emotional response to an external or consciously recognized loss. Mourning is a term used to describe a person's outward expression of grief. The person experiences emotional detachment from the loved object or person. Acceptance is the stage where the patient has achieved inner and outer peace through a personal victory over fear.)

A 27-year-old patient reports having difficulty sleeping, having a poor appetite, and feeling sad since the death of her spouse. What should the nurse identify in this patient as a normal response to the death of the spouse? A. Grief B. Mourning C. Acceptance D. Bereavement

A, D, E (The adjustment stage is the next phase after shock and is most often characterized by an open admission that the condition exists. This stage is accompanied by responses such as guilt. Many parents may feel responsible for the disability because it was genetically inherited. The mother may also believe she caused the disability by doing something wrong during pregnancy or may believe God is punishing her for previous misdeeds. Acting happy and optimistic despite the revealed diagnosis indicates the parent is still in denial and has not accepted the child's disability. Focusing on new caregiving practices as the condition progresses indicates total acceptance of the condition.)

A baby is diagnosed with Turner syndrome shortly after birth. The parent is showing signs of depression and is finding it difficult to bond with the baby. Which characteristics indicate that the parent is in the adjustment stage? Select all that apply. A. Assumes that the disability is genetically inherited B. Acts happy and optimistic despite the diagnosis C. Focuses on caregiving as the condition progresses D. Believes the disability happened during pregnancy E. Believes the disability is a punishment from God

B, D, E (A nurse should be able to identify parents who tend to be overprotective about their child with disabilities. The parent may continually help the child even when the child is capable of doing the task. Setting very high or low goals without understanding the child's capabilities makes the child feel incapable and inadequate. Putting restrictions on their child's play due to fear of injury indicates that the parent is too concerned about the child. Setting same rules for all children is not suggestive of an overprotective attitude in the parent. A parent who is not overprotective of the child helps the child to learn skills to be independent.)

A child is brought to the clinic for a routine check-up. The parent informs the nurse that the child wants to go to school, but the parent does not want the child to go. What other characteristics in the parent would indicate that the parent is overprotective? Select all that apply. A. Sets same rules for the child and the siblings B. Continually helps child even if the child is capable C. Helps the child to learn new skills to be independent D. Sets high goals without understanding child's abilities E. Puts restrictions on child's play due to fear of injury

D (Large doses may be needed because the child has become physiologically tolerant to the drug, requiring higher doses to achieve the same degree of pain control. Continuing studies report that children are consistently undermedicated for pain. The dose is titrated to relieve pain. Addiction refers to a psychological dependence on the medication, which does not happen in terminal care.)

A child who is terminally ill with bone cancer is in severe pain. Nursing interventions should be based on knowledge that: A. children tend to be overmedicated for pain. B. giving large doses of opioids causes euthanasia. C. narcotic addiction is common in terminally ill children. D. large doses of opioids are justified when there are no other treatment options.

A (The nurse should be very sensitive to the emotions of the family members who are grieving their loss and try to support them as much as possible. The nurse should allow privacy to the family with the child and allow them to hold or rock the child if they want. The nurse should remove the tubes and catheters from the child's body and let the family hold the child. The nurse should allow the family to provide last rites according to their culture rather than following hospital policy. It helps the family cope. The family should be allowed to bathe and dress the child, as per their cultural practice.)

A child who was terminally ill died. What intervention should the nurse provide for the child and the family? A. Allow the family be with and hold or rock the child. B. Do not remove any of the tubes or catheters. C. Follow the hospital policy to administer last rites. D. Instruct the family that the nurse bathes the body.

During a home visit, the parent of a 9-year-old child tells the nurse that after coming in from playing outside, the child does not want to do homework. The child feels feverish. What should the nurse tell the child's mother? 1 "Your child has a fever due to impaired thermoregulation." 2 "Your child should play indoor games for 1 hour daily." 3 "A child's body temperature increases after playing." 4 "Your child should drink milk immediately after playing."

A child's body temperature increases after playing."

D (The most accurate measure of skeletal age is radiologic examination of the growth plates. These are the epiphyseal cartilage plates. Radiographs of the hand and wrist provide the most useful screening to determine skeletal age. Age of tooth eruption varies considerably in children. It would not be a good determinant of skeletal age. Assessment of height over time will provide a record of the child's height, not skeletal age. Facial bone development does not reflect the child's skeletal age, which is determined by radiographic assessment.)

A child's skeletal age is best determined by: a. Assessment of dentition. development. b. Assessment of height over time. c. Facial bone d. Radiographs of the hand and wrist.

A (Parental overprotection is manifested by the parents' fear of letting the child achieve any new skill, avoiding all discipline, and catering to the child's every desire to prevent frustration. The overprotective parents usually do not set limits and or institute discipline, and they usually prefer to remain in the role of total caregiver. They do not allow the child to perform self-care or encourage the child to try new activities.)

A common parental reaction to a child with special needs is parental overprotection. Parental behavior suggestive of this includes: a. Giving inconsistent discipline. b. Providing consistent, strict discipline. c. Forcing child to help self, even when not capable. d. Encouraging social and educational activities not appropriate to child's level of capability.

B (This is a description of difficult children, who compose about 10% of the population. Negative withdrawal responses are typical of this type of child, who requires a more structured environment. Mood expressions are usually intense and primarily negative. These children exhibit frequent periods of crying and often violent tantrums. Easy children are even tempered, regular, and predictable in their habits. They are open and adaptable to change. Approximately 40% of children fit this description. Slow-to-warm-up children typically react negatively and with mild intensity to new stimuli and adapt slowly with repeated contact. Approximately 10% of children fit this description. Fast-to-warm-up children is not one of the categories identified by Chess and Thomas.)

A mother reports that her 6-year-old child is highly active and irritable and that she has irregular habits and adapts slowly to new routines, people, or situations. According to Chess and Thomas, which category of temperament best describes this child? a. Easy child b. Difficult child c. Slow-to-warm-up child d. Fast-to-warm-up child

A 4-year-old child shows a motor response score of 3 on the Glasgow Coma Scale. What clinical finding does this signify? 1 Localized pain 2 Abnormal flexion 3 Flexion withdrawal 4 Abnormal extension

A motor response score of a 3 on the Glasgow Coma Scale indicates abnormal flexion of muscles. Localized pain is indicated as a score of 5. Flexion withdrawal is indicated as a score of 4. An abnormal extension is indicated as a score of 2.

C (Kohlberg* Rationale: Kohlberg developed the theory of moral development sequence for children. It includes how children acquire moral reasoning and is based on cognitive developmental theory. Erikson developed the theory of psychosocial development. Fowler developed the theory of spiritual development. Freud developed the theory of psychosexual development.)

A nurse is discussing various developmental theories at a parenting class. Which individual is associated with the moral development theory? A) Erikson B) Fowler C) Kohlberg D) Freud

B (allow the toddler to start making choices about what to wear.* Rationale: A toddler is developing autonomy and is able to start making some choices about what he or she can wear, focusing on doing things for himself or herself and therefore would not want the mother to feed him or her. The child is at the stage of autonomy versus shame and doubt, as defined by Erikson. At this age, the mother should provide opportunities for the child to be active and learn by experience and imitation. Providing toys the child can control will help achieve this stage. A toddler might easily become overstimulated by images from TV and loud sounds. Toddlers are more interested in manipulating and learning from objects in the environment.)

A nurse is examining a toddler and is discussing with the mother psychosocial development according to Erikson's theories. Based on the nurse's knowledge of Erikson, the most age-appropriate activity to suggest to the mother at this stage is to: A) feed lunch. B) allow the toddler to start making choices about what to wear. C) allow the toddler to pull a talking-duck toy. D) turn on a TV show with bright colors and loud songs.

B (The child can throw a large ball but not a small ball.* Rationale: Development is continuous and proceeds from gross to refined, so children whose development is on target can usually throw large objects before small ones. Not gaining weight for 3 months is an abnormal assessment finding; it would indicate that the child's development may not be on target. In children, the legs are normally the most rapidly growing part of the body; if this is not the case, the child's development may not be on target. A child whose development is on target can sit steadily before pulling herself or himself up to her or his feet.)

A nurse is knowledgeable about both growth and development. Which assessment finding indicates the child's development is on target? A) The child has not gained weight for 3 months. B) The child can throw a large ball but not a small ball. C) The child's arms are the most rapidly growing part of the child's body. D) The child can pull herself or himself to her or his feet before the child is able to sit steadily.

A, D, E (To identify "cautions," all items intersected by the age line are administered. Toddlers and preschoolers should be tested by presenting the Denver II as a game. Because children are easily distracted, perform each item quickly and present only one toy from the kit at a time. Before beginning the screening, ask whether the child was born preterm and correctly calculate the adjusted age. Up to 24 months of age, allowances are made for preterm infants by subtracting the number of weeks of missed gestation from their present age and testing them at the adjusted age. Explain to the parents and child, if appropriate, that the screenings are not intelligence tests but rather are a method of showing what the child can do at a particular age.)

A nurse is preparing to administer a Denver II. Which statement(s) about the Denver II test is (are) accurate (Select all that apply)? a. All items intersected by the age line should be administered. b. There is no correction for a child born prematurely. c. The tool is an intelligence test. d. Toddlers and preschoolers should be prepared by presenting the test as a game. e. Presentation of the toys from the kit should be done one at a time.

B (Nurses should be able to identify family members having anticipatory grief reactions. When death is expected, family members may experience anticipatory grief. Anticipatory grief may be manifested in varying behaviors and intensities and may include denial, anger, depression, and other psychological and physical symptoms. Anticipatory grief lasts while the loved one is preparing to die. There is no standard time frame for anticipatory grief. Complicated grief reactions are seen more than 1 year after the loss, whereas anticipatory grief happens before the death. The patient with complicated grief can display symptoms such as unusual sleep disturbances and feelings of excessive loneliness or emptiness.)

A nursing professor is teaching a group of graduate nurses about anticipatory grief reactions. What information should be included in this presentation? A. It may last for weeks or up to a few months. B. It can happen when the death is expected. C. It happens more than 1 year after the death. D. It can result in feelings of excessive loneliness.

A (The amount of medicine is less.* Rationale: A preschool child does not have the ability to understand the concept of conservation. This concept is not developed until school age. Understanding conservation occurs between 7 to 10 years of age, when a child begins to realize that physical factors, such as volume, weight, and number, remain the same even though outward appearances are changed. Children are able to deal with a number of different aspects of a situation simultaneously. This is not an expected response by a child. A preschool child will not typically believe the glass changed shape to accommodate the medicine but rather that the amount of medicine is less in the short, wide glass.)

A preschool child watches a nurse pour medication from a tall, thin glass to a short, wide glass. Which statement is appropriate developmentally for this age group? A) The amount of medicine is less. B) The amount of medicine did not change, only its appearance. C) Pouring medicine makes the medicine hot. D) The glass changed shape to accommodate the medicine.

C (Preschoolers tend to believe that their thoughts or actions are sufficient to cause death or disease. Therefore, the child is most likely to think that the disease is a punishment for the child's action. This may result in the child feeling guilty. The nurse should help parents to understand this kind of reaction of their child and encourage them to be with the child. The child will not blame the parents or grandparents for the condition. The child is too young to understand the pathophysiology of the disease.)

A preschooler is diagnosed with terminal stage bronchial carcinoma. What would the child consider the most probable reason for the condition? A. The child will blame the parents for acquiring the disease. B. The child will blame the grandparents for acquiring this condition. C. The child would consider it to be a punishment for his or her own actions. D. The child would understand the pathophysiology of the disease.

D (The preschooler can recognize that the pet has died but has difficulties with the permanence. Digging up the bird gives reassurance that the bird is still present. A morbid preoccupation with death and the child looking to see if a ghost took it away are expected responses. If they persist, intervention may be required.)

A preschooler is found digging up a pet bird that was recently buried after it died. The best explanation for this behavior is that: a. He has a morbid preoccupation with death. b. He is looking to see if a ghost took it away. c. The loss is not yet resolved, and professional counseling is needed. d. Reassurance is needed that the pet has not gone somewhere else.

C (The child needs honest and accurate information about the illness, treatments, and prognosis. Children, even at a young age, realize that something is seriously wrong and that it involves them. The nurse should help parents understand the importance of honesty. The child will know that something is wrong because of the increased attention of health professionals. This would interfere with denial as a form of coping. Parents may need professional support and guidance from a nurse or social worker in this process. Children will usually tell others how much information they want about their condition.)

A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. The nurse should explain that: a. This will help the child cope effectively by denial. b. This attitude is helpful to give parents time to cope. c. Terminally ill children know when they are seriously ill. d. Terminally ill children usually choose not to discuss the seriousness of their illness.

D (The toddler playing with sand and water is engaging in sense-pleasure play. This is characterized by nonsocial situations in which the child is stimulated by objects in the environment. Infants engage in skill play when they persistently demonstrate and exercise newly acquired abilities. Dramatic play is the predominant form of play in the preschool period. Children pretend and fantasize. Social-affective play is one of the first types of play in which infants engage. The infant responds to interactions with people.)

A toddler playing with sand and water would be participating in _____ play. a. Skill b. Dramatic c. Social-affective d. Sense-pleasure

Which are appropriate statements the nurse should make to parents after the death of their child (select all that apply)? a. "We feel so sorry that we couldn't save your child." b. "Your child isn't suffering anymore." c. "I know how you feel." d. "You're feeling all the pain of losing a child." e. "You are still young enough to have another baby."

A, D

Which describe avoidance behaviors a parent may exhibit when learning that his or her child has a chronic condition (select all that apply)? a. Refuses to agree to treatment b. Shares burden of disorder with others c. Verbalizes possible loss of child d. Withdraws from outside world e. Punishes self because of guilt and shame

A, D, E

A nurse is admitting a child, in foster care, to the hospital. The nurse recognizes that foster parents care for the child _____ hours a day. (Record your answer as a whole number.)

ANS: 24 The term foster care is defined as 24-hour substitute care for children outside of their own homes. DIF: Cognitive Level: Understand REF: p. 27 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

The nurse is teaching a group of new parents about the experience of role transition. Which statement by a parent would indicate a correct understanding of the teaching? a. "My marital relationship can have a positive or negative effect on the role transition." b. "If an infant has special care needs, the parents' sense of confidence in their new role is strengthened." c. "Young parents can adjust to the new role easier than older parents." d. "A parent's previous experience with children makes the role transition more difficult."

ANS: A If parents are supportive of each other, they can serve as positive influences on establishing satisfying parental roles. When marital tensions alter caregiving routines and interfere with the enjoyment of the infant, then the marital relationship has a negative effect. Infants with special care needs can be a significant source of added stress. Older parents are usually more able to cope with the greater financial responsibilities, changes in sleeping habits, and reduced time for each other and other children. Parents who have previous experience with parenting appear more relaxed, have less conflict in disciplinary relationships, and are more aware of normal growth and development. DIF: Cognitive Level: Understand REF: p. 17 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Health Promotion and Maintenance

A nurse is assessing a family's structure. Which describes a family in which a mother, her children, and a stepfather live together? a. Blended b. Nuclear c. Binuclear d. Extended

ANS: A A blended family contains at least one stepparent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. DIF: Cognitive Level: Understand REF: p. 18 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

A 3-year-old girl was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which guidelines concerning adoption should the nurse use in planning a response? a. Telling the child is an important aspect of their parental responsibilities. b. The best time to tell the child is between ages 7 and 10 years. c. It is not necessary to tell the child who was adopted so young. d. It is best to wait until the child asks about it.

ANS: A It is important for the parents not to withhold information about the adoption from the child. It is an essential component of the child's identity. There is no recommended best time to tell children. It is believed that children should be told young enough so they do not remember a time when they did not know. It should be done before the children enter school to keep third parties from telling the children before the parents have had the opportunity. DIF: Cognitive Level: Understand REF: p. 22 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

When assessing a family, the nurse determines that the parents exert little or no control over their children. What is this style of parenting called? a. Permissive b. Dictatorial c. Democratic d. Authoritarian

ANS: A Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. The parents exert little or no control over their children's actions. Dictatorial or authoritarian parents attempt to control their children's behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. Democratic parents combine permissive and dictatorial styles. They direct their children's behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect the child's individual nature. DIF: Cognitive Level: Remember REF: p. 20 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Health Promotion and Maintenance

Divorced parents of a preschool child are asking whether their child will display any feelings or behaviors related to the effect of the divorce. The nurse is correct when explaining that the parents should be prepared for which types of behaviors? (Select all that apply.) a. Displaying fears of abandonment b. Verbalizing that he or she "is the reason for the divorce" c. Displaying fear regarding the future d. Ability to disengage from the divorce proceedings e. Engaging in fantasy to understand the divorce

ANS: A, B, E A child 3 to 5 years of age (preschool) may display fears of abandonment, verbalize feelings that he or she is the reason for the divorce, and engage in fantasy to understand the divorce. He or she would not be displaying fear regarding the future until school age, and the ability to disengage from the divorce proceedings would be characteristic of an adolescent. DIF: Cognitive Level: Apply REF: p. 24 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Teaching and Learning

Which term best describes a group of people who share a set of values, beliefs, practices, social relationships, law, politics, economics, and norms of behavior? a. Race b. Culture c. Ethnicity d. Social group

ANS: B Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perceptions and judgments. Race is defined as a division of humankind possessing traits that are transmissible by descent and are sufficient to characterize it as a distinct human type. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. A social group consists of systems of roles carried out in groups. Examples of primary social groups include the family and peer groups. DIF: Cognitive Level: Remember REF: p. 29 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity

Parents of a firstborn child are asking whether it is normal for their child to be extremely competitive. The nurse should respond to the parents that studies about the ordinal position of children suggest that firstborn children tend to: a. be praised less often. b. be more achievement oriented. c. be more popular with the peer group. d. identify with peer group more than parents.

ANS: B Firstborn children, like only children, tend to be more achievement oriented. Being praised less often, being more popular with the peer group, and identifying with peer groups more than parents are characteristics of later-born children. DIF: Cognitive Level: Apply REF: p. 29 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance

When discussing discipline with the mother of a 4-year-old child, the nurse should include which instruction? a. Children as young as 4 years old rarely need to be punished. b. Parental control should be consistent. c. Withdrawal of love and approval is effective at this age. d. One should expect rules to be followed rigidly and unquestioningly.

ANS: B For effective discipline, parents must be consistent and must follow through with agreed-on actions. Realistic goals should be set for this age group. Parents should structure the environment to prevent unnecessary difficulties. Requests for behavior change should be phrased in a positive manner to provide direction for the child. Withdrawal of love and approval is never appropriate or effective. Discipline strategies should be appropriate to the child's age, temperament, and severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old. DIF: Cognitive Level: Apply REF: p. 20 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

A parent of a school-age child is going through a divorce. The parent tells the school nurse the child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as which implication? a. Indication of maladjustment b. Common reaction to divorce c. Lack of adequate parenting d. Unusual response that indicates need for referral

ANS: B Parental divorce affects school-age children in many ways. In addition to difficulties in school, they often have profound sadness, depression, fear, insecurity, frequent crying, loss of appetite, and sleep disorders. This is not an indication of maladjustment, suggestive of lack of adequate parenting, or an unusual response that indicates need for referral in school-age children after parental divorce. DIF: Cognitive Level: Apply REF: p. 24 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Psychosocial Integrity

A nurse is conducting a teaching session on the use of time-out as a discipline measure to parents of toddlers. Which are correct strategies the nurse should include in the teaching session? (Select all that apply.) a. Time-out as a discipline measure cannot be used when in a public place. b. A rule for the length of time-out is 1 minute per year. c. When the child misbehaves, one warning should be given. d. The area for time-out can be in the family room where the child can see the television. e. When the child is quiet for the specified time, he or she can leave the room.

ANS: B, C, E A rule for the length of time-out is 1 minute per year of age; use a kitchen timer with an audible bell to record the time rather than a watch. When the child misbehaves, one warning should be given. When the child is quiet for the duration of the time, he or she can then leave the room. Time-out can be used in public places and the parents should be consistent on the use of time-out. Implement time-out in a public place by selecting a suitable area or explain to children that time-out will be spent immediately on returning home. The time-out should not be spent in an area from which the child can view the television. Select an area for time-out that is safe, convenient, and unstimulating but where the child can be monitored, such as the bathroom, hallway, or laundry room. DIF: Cognitive Level: Apply REF: p. 21 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

Dunst, Trivette, and Deal identified the qualities of strong families that help them function effectively. Which qualities are included? (Select all that apply.) a. Ability to stay connected without spending time together b. Clear set of family values, rules, and beliefs c. Adoption of one coping strategy that always promotes positive functioning in dealing with life events d. Sense of commitment toward growth of individual family members as opposed to that of the family unit e. Ability to engage in problem-solving activities f. Sense of balance between the use of internal and external family resources

ANS: B, E, F A clear set of family rules, values, and beliefs that establishes expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families also are able to engage in problem-solving activities and to find a balance between internal and external forces. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs. Strong families also use varied coping strategies. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit. DIF: Cognitive Level: Understand REF: p. 19 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Health Promotion and Maintenance

Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events? a. Interactional theory b. Developmental systems theory c. Family stress theory d. Duvall's developmental theory

ANS: C Family stress theory explains the reaction of families to stressful events. In addition, the theory helps suggest factors that promote adaptation to the stress. Stressors, both positive and negative, are cumulative and affect the family. Adaptation requires a change in family structure or interaction. Interactional theory is not a family theory. Interactions are the basis of general systems theory. Developmental systems theory is an outgrowth of Duvall's theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. Duvall's developmental theory describes eight developmental tasks of the family throughout its life span. DIF: Cognitive Level: Understand REF: p. 16 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Which is the term for a family in which the paternal grandmother, the parents, and two minor children live together? a. Blended b. Nuclear c. Bi-nuclear d. Extended

ANS: D An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. A blended family contains at least one stepparent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children. DIF: Cognitive Level: Remember REF: p. 18 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance

A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, "I want to go back to work, but I don't want Eric to suffer because I'll have less time with him." The nurse's most appropriate answer would be which statement? a. "I'm sure he'll be fine if you get a good babysitter." b. "You will need to stay home until Eric starts school." c. "You should go back to work so Eric will get used to being with others." d. "Let's talk about the child care options that will be best for Eric."

ANS: D Let's talk about the child care options that will be best for Eric is an open-ended statement that will assist the mother in exploring her concerns about what is best for both her and Eric. I'm sure he'll be fine if you get a good babysitter, You will need to stay home until Eric starts school, and You should go back to work so Eric will get used to being with others are directive statements. They do not address the effect of her working on Eric. DIF: Cognitive Level: Apply REF: p. 27 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity

Which is most characteristic of the physical punishment of children, such as spanking? a. Psychological impact is usually minimal. b. Children rarely become accustomed to spanking. c. Children's development of reasoning increases. d. Misbehavior is likely to occur when parents are not present.

ANS: D Through the use of physical punishment, children learn what they should not do. When parents are not around, it is more likely that children will misbehave because they have not learned to behave well for their own sake, but rather out of fear of punishment. Spanking can cause severe physical and psychological injury and interfere with effective parent-child interaction. Children do become accustomed to spanking, requiring more severe corporal punishment each time. The use of corporal punishment may interfere with the child's development of moral reasoning. DIF: Cognitive Level: Understand REF: p. 20 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

A nurse is selecting a family theory to assess a patient's family dynamics. Which family theory best describes a series of tasks for the family throughout its life span? a. Interactional theory b. Developmental systems theory c. Structural-functional theory d. Duvall's developmental theory

ANS: D Duvall's developmental theory describes eight developmental tasks of the family throughout its life span. Interactional theory and structural-functional theory are not family theories. Developmental systems theory is an outgrowth of Duvall's theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. DIF: Cognitive Level: Understand REF: p. 17 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

Which term best describes the emotional attitude that one's own ethnic group is superior to others? a. Culture b. Ethnicity c. Superiority d. Ethnocentrism

ANS: D Ethnocentrism is the belief that one's way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of one's ethnic group are superior to those of others. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serves as a frame of reference for individual perception and judgments. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. Superiority is the state or quality of being superior; it does not include ethnicity. DIF: Cognitive Level: Understand REF: p. 30 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity

Leading cause of death of children from age 1-19...

Accidents

D (Preschoolers are most likely to exhibit characteristics of Kohlberg's preconventional level of moral development. During this stage they are culturally oriented to labels of good or bad, right or wrong. Children integrate these concepts based on the physical or pleasurable consequences of their actions. Obeying rules of correct behavior, showing respect for authority, and knowing that behavior that pleases others is considered good are characteristic of Kohlberg's conventional level of moral development.)

According to Kohlberg, children develop moral reasoning as they mature. What is most characteristic of a preschooler's stage of moral development? a. Obeying the rules of correct behavior is important. b. Showing respect for authority is important behavior. c. Behavior that pleases others is considered good. d. Actions are determined as good or bad in terms of their consequences.

Race with strikingly highest homicide rates are found in... (minority populations) especially in

African American children

Infants most at risk for mortality

African American infants

When should a child switch from whole milk to low-fat milk?

After age two

When age can dental visits begin at?

Age 1

When should a toddler begin brushing their teeth?

Age 1

When is gender identity formed?

Age 3

Children at greatest risk for bike fatalities

Ages 5-9

Toddler: Striving for indepence: how the nurse can help?

Allow choices whenever possible but realize that hcild may still be resistant and negative allow child to participate in care and to help whenever possible (e.g. drink medidcine from a cup, hold a dressing)

A toddler is hospitalized for an upcoming surgical procedure. Which method might provide the best way to inform the child about the surgery? By using anatomical drawings as illustrations and allowing the child to color them with markers. Allowing the child to dress up using surgical gown and mask. Having the child sign his name with an "X" on an actual surgical consent form. Taking the child to the operating theater to view a surgery.

Allowing the child to dress up using surgical gown and mask. The concept of dramatic play is used to provide information to children who are having complex health issues or who have to undergo surgical procedures or therapies. It allows for children to be able to respond and interact with the possibility of puzzling or frightening experiences related to the unknown. The use of anatomical drawings may be too realistic for the toddler even though markers would be allowed for coloring. Having the child sign an "X" on an actual surgical consent would not be understood this developmental level. Taking the child to view a surgery at this age may cause more anxiety.

Gross motor skills for 3 year olds

Alternate feet when going up and down the stairs Ride a TRIcycle Jumps off from bottom step Stands on one foot for a few seconds

A (When death is imminent, care should be limited to interventions for palliative care. Music may be used to provide comfort for the child. Vital signs do not need to be measured frequently. The nurse should speak to the child in a clear, distinct voice.)

An appropriate nursing intervention when providing comfort and support for a child whose death is imminent is to: a. Limit care to essentials. b. Avoid playing music near the child. c. Explain to the child the need for constant measurement of vital signs. d. Whisper to the child instead of using a normal voice.

D (In general birth, weight triples by the end of the first year of life. For an infant who was 7 pounds at birth, 21 pounds would be the anticipated weight at the first birthday. Weights of 14, 16, and 18 pounds are less what would be expected for an infant with a birth weight of 7 pounds.)

An infant who weighs 7 pounds at birth would be expected to weigh how many pounds at age 1 year? a. 14 b. 16 c. 18 d. 21

The nurse is reviewing Erikson's theory about the autonomy versus shame and doubt stage. The nurse is trying to correlate it to Freud's psychosexual theory. Which stage would the nurse review in Freud's theory? 1 Oral 2 Anal 3 Phallic 4 Latency

Anal

__________________________________ ________________________ refers to the best approach to prevention that uses teaching and counseling of parents and others about developmental expectations and that alerts parents to the issues that're most likely to arise at a given age.

Anticipatory guidance

B (The parents who anticipate future problems and seek guidance and answers are demonstrating approach behaviors. They are demonstrating positive actions in caring for their child. Avoidance behaviors include being unable to adjust to a progression of the disease or condition, looking for new cures without a perspective toward possible benefit, and failing to recognize the seriousness of the child's condition despite physical evidence. These behaviors would suggest that the parents are moving away from adjustment or adaptation in the crisis of a child with chronic illness or disability.)

Approach behaviors are coping mechanisms that result in a family's movement toward adjustment and resolution of the crisis of having a child with a chronic illness or disability. What is considered an approach behavior in parents? a. Are unable to adjust to a progression of the disease or condition b. Anticipate future problems and seek guidance and answers c. Look for new cures without a perspective toward possible benefit d. Fail to recognize seriousness of child's condition despite physical evidence

A child with a serious chronic illness will soon be discharged home. The case manager requests that the family provide total care for the child for a couple of days while the child is still hospitalized. Based on the principles of family-centered care, which statement addresses this principle? Appropriate because families are usually eager to get involved. Appropriate because it can be beneficial to the transition from hospital to home. Inappropriate because of legal issues when parents care for their children on hospital property. Inappropriate because the family will have to assume the care soon enough and this may increase their stress unnecessarily.

Appropriate because it can be beneficial to the transition from hospital to home. This is appropriate. At least two family members should be comfortable caring for the child before discharge. Caring for the child with the nurse available to answer questions and provide support and guidance will make the transition home for the parents and child easier. The family needs to learn the skills necessary to care for the child at home. Their eagerness is important, but it is not the reason to provide total care for their child while still hospitalized. The family members will be able to learn to care for their child with the supervision of nursing staff. Legal issues related to caring for their child in the hospital setting are not relevant. Learning to care for their child before discharge is essential to properly prepare the family to assume the care and minimize their stress level as much as possible.

Working with parents in preparation for discharge of a hospitalized child who will need to have wet to dry dressing changes performed at home will require that the nurse include which element in the plan of care? Arrange for home health nurse to change dressings as the parents may not understand the complexity of the task. Arrange for a step by step training sequence for wet to dry dressing changes with the parents of the child with return demonstration to evaluate understanding. Provide the parents with a detailed instruction sheet regarding the dressing change procedure as the method of instruction. Arrange for follow up with the child's pediatrician prior to the next scheduled dressing change so that the parents can receive further instruction.

Arrange for a step by step training sequence for wet to dry dressing changes with the parents of the child with return demonstration to evaluate understanding. Arranging for step-by-step sequenced instructions along with return demonstration should be included in the plan of care for the discharge of this child who requires wet to dry dressing changes. Arranging for home health to provide this service may not be possible in terms of insurance coverage. Providing the parents with a detailed instruction sheet should be given but it not the sole method of instruction as it is important to assess and implement tasks so as to make sure that the parents have a thorough understanding of the process. And while follow up with the pediatrician is part of the discharge process, it is the hospital's responsibility to provide thorough discharge instructions and training.

Injury Concerns

Aspiration, bodily harm, burns, drowning, falls

When does one begin practicing dental hygiene with children?

At first tooth eruption - drink fluoridated water like bottled water - instilling early dental preventative care

B (The death of a patient is one of the most stressful aspects of a critical care or oncology nurse. Nurses experience reactions similar to those of family members because of their involvement with the child and family during the illness. Nurses often have feelings of personal loss when a patient dies. The nurse is experiencing a normal grief response to the death of a patient. There is no implication that the mother's loss is minimized. The nurse is validating the worth of the child.)

At the time of a child's death, the nurse tells his mother, "We will miss him so much." The best interpretation of this is that the nurse is: a. Pretending to be experiencing grief. b. Expressing personal feelings of loss. c. Denying the mother's sense of loss. d. Talking when listening would be better.

A (Toddlerhood is a time of imitative behavior. Children will copy the behavior of others without comprehending any significance or meaning to the activities. During the school-age period most children develop a strong interest in religion. The existence of a deity is accepted, and petitions to an omnipotent being are important. Although adolescents become more skeptical and uncertain about religious beliefs, they do understand the significance of religious rituals.)

At what age do children tend to imitate the religious gestures and behaviors of others without understanding their significance? a. Toddlerhood b. Young school-age period c. Older school-age period d. Adolescence

C (By age 9 or 10 years, children have an adult concept of death. They realize that it is inevitable, universal, and irreversible. Preschoolers and young school-age children are too young to have an adult concept of death. Adolescents have a mature understanding of death.)

At what age do most children have an adult concept of death as being inevitable, universal, and irreversible? a. 4 to 5 years b. 6 to 8 years c. 9 to 11 years d. 12 to 16 years

D (Because of their mature understanding of death, remnants of guilt and shame, and issues with deviations from normal, adolescents have the most difficulty coping with death. Toddlers and preschoolers are too young to have difficulty coping with their own death. They will fear separation from parents. School-age children will fear the unknown, such as the consequences of the illness and the threat to their sense of security.)

At what developmental period do children have the most difficulty coping with death, particularly if it is their own? a. Toddlerhood b. Preschool c. School-age d. Adolescence

Describe the concept of atraumatic care and list the 3 principles that provide a framework for its implementation

Atraumatic care is the provision of care that minimizes or eliminates psychologic and physical distress experienced by children and their families. 3 principles: prevent or minimize child's separation from family, promote a sence of control in the child and family & prevent or minimize bodily injury or pain

A nurse is caring for a child who is near death. Which physical signs indicate the child is approaching death (select all that apply)? a. Body feels warm b. Tactile sensation decreasing c. Speech becomes rapid d. Change in respiratory pattern e. Difficulty swallowing

B, D, E

some medications, such as chemotherapy are more precisely dosed using ____

BSA

A (If an object is hidden, that does not mean that it is gone.* Rationale: Part of learning permanence is learning that although an object is no longer visible, it still exists. At 1 year of age, a child may not be able to understand that an object that changes shape is still the same object. Understanding conservation occurs between ages 7 to 11 years.)

Based on Piaget's theory of cognitive development, what is one basic concept a child is expected to attain during the first year of life? A) If an object is hidden, that does not mean that it is gone. B) He or she cannot be fooled by changing shapes. C) Parents are not perfect. D) Most procedures can be reversed.

Identify the standardized test most commonly used in infants to evaluate cognitive ability.

Bayley Scales of Infant Development HINT for neuromotor testing (motor/cognition) Leiter International Performance Scale good if no english or significant language impairment

What is the major determinant of neonatal death?

Birth weight

Which parameters should the nurse monitor in the infant with hypothermia to ensure effective care? 1 Hemoglobin levels 2 Blood glucose levels 3 White blood cell count 4 Serum potassium levels

Blood glucose levels

Majority of deaths from injuries occur in...

Boys

Fine motor skills for 3 year olds

Builds a tower of 9 - 10 blocks Imitates cross when drawing cannot draw stick figures but draw circles with facial features

B (Industry is the developmental task of school-age children. By age 12 years, children engage in tasks that they can carry through to completion. They learn to compete and cooperate with others, and they learn rules. Identity versus role confusion is the developmental task of adolescence. Integrity and intimacy are not developmental tasks of childhood.)

By the time children reach their twelfth birthday, they should have learned to trust others and should have developed a sense of: a. Identity. b. Industry. c. Integrity. d. Intimacy.

C (Linear growth or height occurs almost entirely as a result of skeletal growth and is considered a stable measurement of general growth. On average most children have doubled their birth length at age 4 years. One year and 2 years are too young for doubling of length.)

By what age does birth length usually double? a. 1 year b. 2 years c. 4 years d. 6 years

The nurse case manager is planning a care conference about a young child who has complex health care needs and will soon be discharged home. Whom should the nurse invite to the conference? a. Family and nursing staff b. Social worker, nursing staff, and primary care physician c. Family and key health professionals involved in child's care d. Primary care physician and key health professionals involved in child's care

C

What should the nurse identify as major fears in the preschool child who is hospitalized with a chronic illness (select all that apply)? a. Altered body image b. Separation from peer group c. Bodily injury d. Mutilation e. Being left alone

C, D, E

Planning

Care plan specific to identified outcomes -outcome is expected change in pt health, condition or behavior after intervention has been put in -careplan must be easablished b4 specific nursing interventions are development & implemented

With regard to separation anxiety displayed in a child who is hospitalized, which behavior would indicates the stage of despair? Child clings to parents for comfort. Child tells nurses and staff to "go away." Child is constantly crying and sobbing. Child demonstrates regressive behavior.

Child demonstrates regressive behavior. Demonstrating regressive behavior is a characteristic of the stage of despair. All of the other options indicate a stage of protest.

How does one define a person with obesity?

Children & adolescents having a BMI at or greater than the 95th percentile for youth of same age & gender

Which group experience more poisonings related to medications?

Children 5 years and under

C (The father is describing a well-adapted child who has learned to accept physical limitations. These children function well at home, at school, and with peers. They have an understanding of their disorder that allows them to accept their limitations, assume responsibility for care, and assist in treatment and rehabilitation. The father is not denying the child's limitations or expressing his own views. This is descriptive of an adaptive coping style.)

Chris, age 9 years, has several physical disabilities. His father explains to the nurse that his son concentrates on what he can rather than cannot do and is as independent as possible. The nurse's best interpretation of this is: a. The father is experiencing denial. b. The father is expressing his own views. c. Chris is using an adaptive coping style. d. Chris is using a maladaptive coping style.

Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety? Inactivity Clinging to the parent Depression and sadness Forming superficial relationships

Clinging to the parent In the protest phase of separation anxiety, the child aggressively responds to separation from a parent by clinging and holding onto the parent and screaming for the parent. Inactivity is a sign of despair in a young child, not protest. A depressed, sad child indicates despair, not the protest phase. The formation of superficial relationships indicates that a young child is in the phase of detachment, not protest.

What is the chief illness of childhood?

Common cold - respiratory illness accounting for 50%

What is the leading cause of infant mortality?

Congenital anomalies

What vaccines should be given for 4-6 years?

DTap, MMR, Varicella, Inactived poliovirus (IPV)

Postneonatal mortality

Death between 28 days to 11 months

Neonatal mortality

Deaths before 28 days of life. ( <28 days of life)

Which best describes Piaget's cognitive stage of formal operations? 1 Deductive and abstract reasoning 2 Inductive reasoning and beginning logic 3 Transductive reasoning and egocentrism 4 Cause-and-effect reasoning and object permanence

Deductive and abstract reasoning

What is the single most chronic disease of childhood?

Dental caries - 1 in 5 children between ages of 2-4 have visible caries - begin before 1st birthday

Goals of atraumatic care

Do no harm - prevent or minimize child's separation from family - Promote sense of control - prevent or minimize bodily injury & pain

A, C, E (toys that pop apart and go back together.* Rationale: Both gross and fine motor skills are becoming more developed and children at this age enjoy toys that can help refine these skills. Children at this age enjoy more colorful toys. Children at this age are less interested in placing toys in the mouth and more interested in toys that can be manipulated.)

During a well-baby visit, the parents of a 12-month-old ask the nurse for advice on age-appropriate toys for their child. Based on the nurse's knowledge of developmental levels, the most appropriate toys to suggest are: (Select all that apply.) A) push-pull toys. B) toys with black-white patterns. C) pop-up toys, such as a Jack-in-the-box. D) soft toys that can be put in the mouth. E) toys that pop apart and go back together.

When do children establish life long eating habits?

During first 3 years of life

infant: Sensorimotor Phase of learning how should the nurse deal?

During procedure, use sensory soothing measures (e.g. stroking skin, talking softly, giving pacifier) Use analgesics (e.g. topical anesthetic, intravenous (IV) opioid) to control discomfort Cuddle and hug infant after stressful procedure, encourage parent to comfort infant

A (concrete operations.* Rationale: Black-and-white reasoning involves a situation in which only two alternatives are considered, when in fact there are additional options. Preoperational thinking is concrete and tangible. During the school-age years, children deal with thoughts and learn through observation. They do not have the ability to do abstract reasoning and learn best with illustration. Thought at this time is dominated by what the school-age child can see, hear, or otherwise experience. School-age rhetoric simply refers to the type of ideas that arise out of the years children attend school. Formal operations are characterized by the adaptability and flexibility that occurs during the adolescent years.)

During their school-age years, children best understand concepts that can be seen or illustrated. The nurse knows this type of thinking is termed as: A) concrete operations. B) preoperational. C) school-age rhetoric. D) formal operations.

In what age group should the nurse expect a child to develop gross motor skills? 1 Birth through infancy 2 Early childhood 3 Later childhood 4 Middle childhood

Early childhood

The nurse is assessing a child and asks the child to climb the chairs to check for motor development. What is the age group of the child that the nurse is assessing? 1 Infancy 2 Early childhood 3 Middle childhood 4 Later childhood

Early childhood

Prevention requires

Early identification & rapid therapeutic intervention by qualified professionals

__________ ____________ _____________ involves questioning why something is effective and whether a better approach exists. The concept also involves analyzing and translating published clinical research into the everday practice of nursing

Evidence-based practice

T/F A child with Down Syndrome's intellectual capacity can be predicted at birth

F placement decisions need not be made at dx

A nurse is presenting a class on injury prevention to parents of preschoolers. Which injuries should the nurse identify as occurring in this age group? Select all that apply. Falls Drowning Poisoning Sports injuries Tricycle and bicycle accidents

Falls Drowning Poisoning Tricycle and bicycle accidents

B (For most families, the adjustment phase is accompanied by several responses that are normally part of the adjustment process. Guilt, self-accusation, bitterness, and anger are common reactions. The initial diagnosis of a chronic illness or disability often is often met with intense emotion and characterized by shock and denial. Social reintegration and acceptance of the child's limitations is the culmination of the adjustment process.)

Families progress through various stages of reactions when a child is diagnosed with a chronic illness or disability. After the shock phase, a period of adjustment usually follows. This is often characterized by: a. Denial. b. Guilt and anger. c. Social reintegration. d. Acceptance of child's limitations.

Childhood eating preferences and attitudes established by:

Family & culture

What is centration?

Focusing on one aspect instead of the whole

C (Critical periods are blocks of time during which children are ready to master specific developmental tasks. The earlier that delays in development are discovered and intervention initiated, the less dramatic their effect will be. Infancy is a dynamic time of development that requires frequent evaluations to assess appropriate developmental progress. Infants in a nurturing environment will develop appropriately and will not necessarily need stimulation specific to their developmental stage. Normal growth and development are orderly and proceed in a predictable pattern on the basis of each individual's abilities and potentials.)

Frequent developmental assessments are important for which reason? a. Stable developmental periods during infancy provide an opportunity to identify any delays or deficits. b. Infants need stimulation specific to the stage of development. c. Critical periods of development occur during childhood. d. Child development is unpredictable and needs monitoring.

Goals & Leading Health Indicators of Healthy People 2020

Goals: -increase quality & length of healthy life -eliminate health disparities Leading health indicators: -physical activity -overweight & obesity -tobacco use -substance abuse -responsible sexual behavior -mental health -injury & violence -environmental quality -Immunization -access to health care

Which observation is associated with nightmares as opposed to sleep terrors? Child has no memory of the event or dream like state. Has a hard time returning to sleep following the event. Thrashing type behaviors continue when the child awakens. Is not comforted by traditional methods of contact.

Has a hard time returning to sleep following the event. Nightmares are associated with difficulty returning to sleep as opposed to sleep terrors where the individual easily goes back to sleep. With the advent of a nightmare, the child has a memory of the dream like state, is comforted by traditional methods of contact and thrashing type behaviors cease upon awakening. In sleep terrors, the child has no memory of the event, continues thrashing behaviors when awaken, and is not comforted by traditional methods of contact.

Types of injuries in crawling infant

Has natural tendency to place objects in mouth leading to risk for aspiration & poisoning

Infant: stranger Anxiety how should the nurse deal?

Have usual caregivers perform or assist with procedure Make advances slowly and in a nonthreatening manner Limit number of strangers entering room during procedure

Prevention of violent crimes by young people lies in better understanding social & psychologic factors that lead to

High rates of homicide & suicide

how to give oral medication

Hold the infant in a semi reclining position, place medication in the mouth from a spoon, plastic cup, dropper, or syringe. Best to place along the side of the infant's mouth in small amounts and slowly, waiting for the child to swallow between deposits.

B (Usually, the pubertal growth spurt begins earlier in girls. It typically occurs between the ages of 10 and 14 years for girls and 11 and 16 years for boys. The average earliest age at onset is 1 year earlier for girls. There does not appear to be a relation to growth during infancy.)

How does the onset of the pubertal growth spurt compare in girls and boys? a. It occurs earlier in boys. b. It occurs earlier in girls. c. It is about the same in both boys and girls. d. In both boys and girls it depends on their growth in infancy.

Parents are concerned about the behavior of their preschool child as he is exhibiting aggressive behavior in interactions with other children. Which information would be relevant in determining if the behavior represents an abnormal pattern? Select all that apply. How many times this type of behavior has occurred in recent weeks? Does the behavior seem to be escalating? How long has this behavior been going on? Do you think that the behavior is warranted considering the situation that has occurred?

How many times this type of behavior has occurred in recent weeks? Does the behavior seem to be escalating? In terms of making an evaluation as to whether or not this aggressive behavior is a problem, the nurse would want to obtain information related to quantity, severity, distribution, onset and duration. Asking the parent if they think the behavior is justified given the situation does not address any of the aforementioned variables of concern but rather reflects a judgment value.

Preferred form of nutrition for all infants

Human milk

Based on Piaget's theory of cognitive development, what is one basic concept a child is expected to attain during the first year of life? 1 If an object is hidden, that does not mean that it is gone. 2 He or she cannot be fooled by changing shapes. 3 Parents are not perfect. 4 Most procedures can be reversed.

If an object is hidden, that does not mean that it is gone.

What is the best way to handle a temper tantrum?

Ignore it

An infant's blood glucose levels are low, and the nurse instructs the mother to perform kangaroo care. Which condition would the nurse have assessed in the child? 1 Irregular sleep patterns 2 Reduced metabolism 3 Improper thermoregulation 4 Impaired maturation

Improper thermoregulation

Group with highest rate of injuries

In children less than 9 years

C (In associative play no group goal is present. Each child acts according to his or her own wishes. Although the children may be involved in similar activities, no organization, division of labor, leadership assignment, or mutual goal exists. Solitary play describes children playing alone with toys different from those used by other children in the same area. Parallel play describes children playing independently but being among other children. Cooperative play is organized. Children play in a group with other children who play activities for a common goal.)

In what type of play are children engaged in similar or identical activity without organization, division of labor, or mutual goal? a. Solitary b. Parallel c. Associative d. Cooperative

What is animism?

Inanimate objects are alive

The nurse is giving anticipatory guidance to the parent of a 5-year-old. What is the most appropriate information to include? Prepare the parent for increased aggression. Encourage the parent to offer the child choices. Inform the parent that he or she can expect a more tranquil period at this age. Advise the parent that this is the age when stuttering may develop.

Inform the parent that he or she can expect a more tranquil period at this age. The end of preschool and the beginning of school age is a more tranquil period. Preparing the parent for increased aggression is anticipatory guidance for 4-year-old children. Encouraging the parent to offer the child choices is anticipatory guidance for 3-year-old children. Advising the parent that this is the age when stuttering may develop is anticipatory guidance for 3-year-old children.

What is the erikson stage a toddler is in?

Initiative vs guilt

Most common cause of death & disability to children

Injuries

Diagnosis

Interpret and make decisions about data -some children have potential heal problems -interventions aimed to reduce risk factors "risk" -signs & symptoms: cluster of cues and defining characteristics -critical defining characteristics help differentiate b/w diagnostic categories

strategies for enhancing compliance in children and families: organizational strategies

Involve the care setting and the therapeutic plan. May involve increasing the frequency of appointments, designating a primary practitioner, reducing the cost of medication by prescribing generic brands, reducing the treatment's disruption of the family's lifestyle, and using "cues" to minimize forgetting.

A 12-year-old child is admitted for an emergency appendectomy and rushed into surgery. The parents tell the nurse that they also have a 4-year-old son at home and wonder if they should tell him about his older brother being in the hospital. The best response by the nurse to this query would be to? Tell the parents to refrain from telling the 4-year-old as he will not be able to understand the concepts of hospitalization and surgery. Have the parents go home and bring their 4-year-old back to the hospital so he can be present throughout this family stress experience. It is important to tell their 4-year-old son about his older brother using words and terms that he can understand at his age. Have the parents bring their son in during visiting hours and arrange for a tour of the hospital unit.

It is important to tell their 4-year-old son about his older brother using words and terms that he can understand at his age. It is important to share a hospitalization experience with siblings, however being mindful of their developmental and cognitive level. And while the 4-year-old can be taken into the hospital setting and even receive a tour of the hospital unit, the experience should not be tied into a "show and tell" event. The 4-year-old child does not have to present throughout the entire hospitalization experience as that may produce unnecessary stress in altering his environment and daily routine.

Gross motor skills for 5 year olds

Jump rope Walks backward with heel to toe (can pass a sobriety test) Moves up and down stairs easily Throws and catches ball with ease

B (Attendance at school is an important part of normalization for Kelly. The school nurse should prepare teachers and classmates about her condition, abilities, and special needs. A visit by the parents can be helpful, but unless the classmates are prepared for the changes, it alone will not prevent teasing. Kelly's school experience should be normalized as much as possible. Children need the opportunity to interact with healthy peers and engage in activities with groups or clubs composed of similarly affected persons. Children with special needs are encouraged to maintain and reestablish relationships with peers and participate according to their capabilities.)

Kelly, age 8 years, will soon be able to return to school after an injury that resulted in several severe, chronic disabilities. What is the most appropriate action by the school nurse? a. Recommending that Kelly's parents attend school at first to prevent teasing b. Preparing Kelly's classmates and teachers for changes they can expect c. Referring Kelly to a school where the children have chronic disabilities similar to hers d. Discussing with Kelly and her parents the fact that her classmates will not accept her as they did before

A child is assessed and categorized in the industry versus inferiority stage according to Erikson's theory. The nurse compares the child with Freud's psychosexual development theory. At what stage would the child be categorized in Freud's theory? 1 Anal 2 Phallic 3 Latency 4 Genital

Latency

Ashley, age 4½ years, is afraid of dogs. What should the nurse recommend to her parents to help her with this fear? Keep her away from dogs. Buy her a stuffed dog toy. Force her to touch a dog briefly. Let her watch other children play with a dog.

Let her watch other children play with a dog. The parents should actively seek ways to deal with fear. By observing other children at play with dogs, the child can adapt. Keeping their child away from dogs avoids the object of fear rather than addressing the fear and finding solutions. Buying a child a stuffed dog toy avoids the object of fear rather than addressing the fear and finding solutions. Forcing the child to touch a dog without working up to it may increase the level of fear.

B (Parenting a child with a chronic illness can be very stressful for parents. There are anticipated times that parental stress increases. One of these identified times is when the child begins school. Nurses can help parents recognize and plan interventions to work through these stressful periods. The parents are not in denial; they are responding to the child's placement in school. The parents are not exhibiting signs of a knowledge deficit or expectations that are too high; this is their first interaction with the school system with this child.)

Lindsey, age 5 years, will be starting kindergarten next month. She has cerebral palsy, and it has been determined that she needs to be in a special education classroom. Her parents are tearful when telling the nurse about this and state that they did not realize that her disability was so severe. The best interpretation of this situation is that: a. This is a sign that parents are in denial. b. This is a normal anticipated time of parental stress. c. The parents need to learn more about cerebral palsy. d. The parents are used to having expectations that are too high.

D (Lymph nodes increase rapidly and reach adult size at approximately age 6 years. They continue growing until they reach maximal development at age 10 to 12 years, which is twice their adult size. A rapid decline in size occurs until they reach adult size by the end of adolescence.)

Lymphoid tissues such as lymph nodes are: a. Adult size by age 1 year. b. Adult size by age 13 years. c. Half their adult size by age 5 years. d. Twice their adult size by age 10 to 12 years.

What kinds of thinking do toddlers have?

Magical thinking Animism Centration Time

Parents of a preschooler relate that their child is having some difficulties falling asleep. This is a recent occurrence and the parents report that they have tried virtually everything to get their child to go to sleep. Based on this self-report, the nurse would advise the parents to? Do not feed the child 2 hours before sleep as food might be causing excess stimulation. Do not let the child watch any television in the evening as this may cause stimulation. Have the child fall asleep on the couch and then transfer the child to the bed. Maintaining a consistent approach to bedtime routine serves as a basis for promoting sleep patterns.

Maintaining a consistent approach to bedtime routine serves as a basis for promoting sleep patterns. Children in this age group often experience changes in their sleep patterns but consistent approaches in bedtime rituals may help to promote sleep patterns. By the parents self-report that they have "tried virtually everything" may have contributed to the child's altered sleep pattern. There is no enough information provided for the nurse to make any other of the provided options.

What is the leading cause of death from injury in infants?

Mechanical suffocation - more boys die from suffocation & aspiration than girls

The nurse is caring for a 2-day-old neonate who is healthy but has a low body temperature. The nurse instructs the infant's mother to place the unclothed infant on her bare chest. Which finding in the infant indicates ineffective management of the infant's condition? 1 Hyperglycemia 2 Metabolic acidosis 3 Body weight of 21 lbs 4 Body weight of 7.5 lbs 00:00:15 Question Answer Confidence ButtonsJust a guessPretty sureNailed it

Metabolic acidosis

How does mental health problems affect children & adolescents?

More likely to engage in risky and thrill seeking behaviors as well as drop out of school - at risk for ADHD and anxiety in adolescence

D (Chronic sorrow is manifested by feelings of sorrow and loss that recur in waves over time. The sorrow is in response to the recognition of the child's limitations. The family should be assessed in an ongoing manner to provide appropriate support as the needs of the family change. The sorrow is not preventable. The chronic sorrow occurs during the reintegration and acknowledgment stage.)

Most parents of children with special needs tend to experience chronic sorrow. This is characterized by: a. Lack of acceptance of the child's limitation. b. Lack of available support to prevent sorrow. c. Periods of intensified sorrow when experiencing anger and guilt. d. Periods of intensified sorrow and loss that occur in waves over time.

Biggest cause of death in children

Motor vehicle accidents including occupant, pedestrian, bike, and motorcycle deaths accounting for MORE THAN HALF of all injury deaths

A 4-year-old child is seen playing with his father while waiting in the clinic area for a well checkup visit. The nurse observing the interaction notes that this behavior as being an example of? Imaginative play Mutual play Dramatic play Avoidance play

Mutual play Children playing with a parent is an example of mutual play. Play can be described as being imaginative or dramatic as a characteristic but there is no specific information given that defines the type of play interaction that is occurring. The concept avoidance play does not exist as a characteristic term describing play behaviors.

What is the corresponding stage of spiritual development of a child who states, "All women with big stomachs have babies"? 1 Mythical-literal 2 Undifferentiated 3 Synthetic-convention 4 Individuating-reflexive

Mythical-literal

Types of injuries in older children and adolescents

Need to conform & gain acceptance compels them to accept challenges & dares - most fatal injuries occur in this group

Infant mortality

Number of deaths during first year of life per 1,000 live births (can be further divided into Neo natal mortality & posteneonatal mortality) -in US it has decreased dramatically

Nursing hours per patient day

Number of hours worked in direct patient care per patient day

Preventative dental care

Number of visits in previous 12 months

D (The presence of a child with special needs in a family will change the family dynamic. Siblings may be asked to take on additional responsibilities to help the parents to care for the child. The parents should show gratitude, such as an increase in allowance, special privileges, and verbal praise. Embarrassment may be associated with having a sibling with a chronic illness or disability. Parents must be able to respond in an appropriate manner without punishing the sibling. The parents may need assistance with the care of the child. Most siblings are positive about the extra responsibilities. The siblings need to be informed about the child's condition before a non-family member does so. The parents do not want the siblings to fantasize about what is wrong with the child.)

Nursing interventions to help the siblings of a child with a complex or chronic condition cope include: a. Explaining to the siblings that embarrassment is unhealthy. b. Encouraging the parents not to expect siblings to help them care for the child with special needs. c. Providing information to the siblings about the child's condition only as they request it. d. Suggesting to the parents ways of showing gratitude to the siblings who help care for the child with a disability or chronic condition.

Choking Foods?

Nuts, grapes, hot dogs, peanut butter, raw carrots, tough meats, popcorn

Progression of childhood caries leads to...

Pain & infection within first 2 years of life

What type of play do these kids exhibit?

Parallel play

B (A child learns to throw a ball overhand.* Rationale: Development is the mental and cognitive attainment of skills. Growth is the increase in physical size—both height and weight.)

Parents are often confused by the terms growth and development and use the terms interchangeably. Based on the nurse's knowledge of growth and development, the most appropriate explanation of development is: A) a child grows taller all through early childhood. B) a child learns to throw a ball overhand. C) a child's weight triples during the first year. D) a child's brain increases in size until school age.

A (Death is seen as a temporary departure. Death is thought of as not permanent; life and death can change places with each other. Personification is typical of school-age children. Children 9 to 10 years old have this understanding of death.)

Parents ask the nurse for advice when telling their 4-year-old about a grandmother's death. The nurse's best response involves teaching the parents that the child's concept of death is: A. temporary. B. permanent. C. personified in various forms. D. inevitable at some age.

When preparing parents to teach their preschool child about human sexuality, what should the nurse emphasize? A parent's words may have a greater influence on the child's understanding than the parent's actions. Parents should determine exactly what the child wants to know before answering a question about sexuality. Parents should avoid using correct anatomic terms because they are confusing to the preschooler. Parents should encourage preschoolers to satisfy their sexual curiosity by playing "doctor."

Parents should determine exactly what the child wants to know before answering a question about sexuality. It is important that the parent answer the question that the child is asking. Actions may have a greater influence because language is not fully developed in the preschool years. Using correct terminology lays the foundation for later discussion of human sexuality. Parents should encourage children to ask questions to provide accurate information at their cognitive level.

Adolescent eating preferences established by:

Peer aceptance & sociability - occasionally these choices are detrimental to adolescents who have chronic illness like : diabetes, obesity, chronic lung disease, Hypertension, cardiovascular risk factors, & renal disease

Weight assessment

Percentage of 3-17 year old patients with BMI assessed & nutrition counseling performed during visit to primary care provider

Hemoglobin A1c testing

Percentage of 5-17 year old diabetic patients receiving HbA1c test during year

Childhood immunization status (CIS)

Percentage of children 2 years old that received appropriate immunizations by second birthday

Blood pressure screening

Percentage of patients receiving blood pressure screening during assessment year

The nurse is caring for a child with a genetic disorder and is instructed to not give the child milk or milk products. What type of disorder does this child probably have? 1 Phenylketonuria 2 Sickle cell disorder 3 Down syndrome 4 Turner syndrome

Phenylketonuria

A child has a long standing history of abuse which has triggered many emotional problems. Which type of therapy would be indicated to possibly help the child explore these emotional problems? Dramatic play Therapeutic play Play therapy Creative expression

Play therapy Play therapy is used for patients who have psychological problems facilitated by trained professionals to encourage expression of feelings. Dramatic play is used as a method of communication and interaction whereby children play with puppets and/or objects to gain understanding. Therapeutic play helps the child to learn to deal with fears and apprehension but is nondirective in nature. Creative expression is a method whereby children can use other media such as drawing and painting to express their feelings.

When the nurse uses a standard nursing care plan as a guide in planning care for a hospitalized child, which should be eliminated? Expected outcome or goal Dependent nursing functions Problems not pertinent to the child and family Potential health problems of the child and family

Problems not pertinent to the child and family To create an individualized care plan, the nurse eliminates the irrelevant material and specific information not pertinent to the child and family in question. Consideration of an expected outcome or goal is an essential component of an individualized nursing care plan. Consideration of dependent nursing functions, or those interventions requiring an order, is an essential component of an individualized nursing care plan. Consideration of potential health problems of the child and family is an essential component of an individualized nursing care plan.

High quality prenatal care

Promising preventive strategy to decrease early delivery & infant mortality

Which intervention should the nurse incorporate to prevent hypothermia in an infant? 1 Give hot milk or hot water to the infant at regular intervals. 2 Place the unclothed, diapered infant in the sun for few hours. 3 Feed the infant formula, which is higher in calories. 4 Put the unclothed, diapered infant on the mother's bare chest.

Put the unclothed, diapered infant on the mother's bare chest.

The nurse finds that an infant with a cleft palate is at risk for obstructive apnea. Which associated findings does the nurse expect? Select all that apply. A Clubfoot B Recessed mandible C Abnormally placed tongue D Congenital amputation E Congenitally sparse hair

Recessed mandible Abnormally placed tongue

New morbidity

Refers to pediatric social illness, such as behavior, social & educational problems that children face.

A nurse has been assigned as the home health nurse for a technologically dependent child. The nurse recognizes that the background of this family differs widely from the nurse's own. The nurse views some of their lifestyle choices as less than ideal. What is the most appropriate nursing intervention? Assign the nurse a different family to follow. Respect the differences Assess why the family is different Determine whether the family is dysfunctional

Respect the differences The nurse must respect the family's culture and background. The family is the constant in the child's life, and cultural awareness and sensitivity are critical to a nurse's care of a child and family. The nurse may have some influence on care necessary for the child, but it is inappropriate to assign the nurse to a different family. Nurses must be able to work with families from all cultural groups and respect the differences between the families' cultural norms and those of the nurse's own culture. The nurse will assess the differences, but respecting these differences is what is important. Cultural differences do not make a family dysfunctional, unless the cultural practices are putting the child at risk.

The nurse is assessing a child. The nurse asks the parents, "Has your child started sleeping less lately?" Which attribute of temperament is the nurse assessing? 1 Adaptability 2 Distractibility 3 Rhythmicity 4 Activity

Rhythmicity

Why limit juice consumption?

Risk for obesity

B (Nurses should attend the funeral of a child if they felt closeness with the family. This will help the nurses grieve and gain closure. Families may or may not expect this expression of concern. The behavior is appropriate if a relationship existed between the nurses and family. This may prevent burnout.)

Several nurses tell their nursing supervisor that they want to be able to attend the funeral of a child for whom they had cared. They say they felt especially close to both the child and the family. The supervisor should recognize that attending the funeral is: A. appropriate because families expect this expression of concern. B. appropriate because it can assist in the resolution of personal grief. C. inappropriate because it is unprofessional. D. inappropriate because it increases burnout.

The nurse is assessing an infant with delayed motor development. The nurse finds that the infant is able to move her neck without support. The ability to perform which activity should develop next in this child? 1 Crawling 2 Creeping 3 Sitting 4 Standing

Sitting

Gross motor skills for 4 year olds

Skips and hops on one foot Throw ball overhead Catches ball reliably

Epiglottits

Sudden illness that typically follows symptoms of a cold

Leading cause of injury mortality in children

Suicide

The nurse instructs a child's parent to be cautious because the child is hyperactive and difficult. What assessment would the nurse have performed to confirm the child's behavior? 1 Restlessness 2 Temperament 3 Hypothermic conditions 4 Neurological maturation

Temperament

A preschool child watches a nurse pour medication from a tall, thin glass to a short, wide glass. Which statement is appropriate developmentally for this age group? 1 The amount of medicine is less. 2 The amount of medicine did not change, only its appearance. 3 Pouring medicine makes the medicine hot. 4 The glass changed shape to accommodate the medicine.

The amount of medicine is less.

A nurse is knowledgeable about both growth and development. Which assessment finding indicates the child's development is on target? 1 The child has not gained weight for 3 months. 2 The child can throw a large ball but not a small ball. 3 The child's arms are the most rapidly growing part of the child's body. 4 The child can pull herself or himself to her or his feet before the child is able to sit steadily.

The child can throw a large ball but not a small ball.

Prior to returning to school, an individualized home care plan (IHCP) needs to be developed for which child? The child recently identified with a penicillin allergy. The child being treated for pediculosis capitis (head lice). The child out of school for two week due to mononucleosis. The child recently diagnosed with insulin-dependent diabetes mellitus.

The child recently diagnosed with insulin-dependent diabetes mellitus. An IHCP is needed for the insulin-dependent child to ensure appropriate management of health care needs is in place. The child allergic to penicillin will not receive this medication anymore and a medication alert ID is necessary. An IHCP is not needed. The child treated for pediculosis capitis (head lice) can return to school and does not need an IHCP. The child who missed two weeks of school will need arrangements made for make-up work and an IHCP is not needed.

During assessment of a 7-month-old child, the nurse checks the child's height and weight and compares them with previous assessment records. The nurse finds that the child's height has increased by 1.25 cm, and the weight is 140 g more than in the previous month. What does the nurse infer from this observation? 1 The child is displaying symptoms of Down syndrome. 2 The child's weight is not ideal in relation to height. 3 The child's height and weight are ideal. 4 The child has a calcium deficiency due to malnutrition.

The child's height and weight are ideal.

B (Preschoolers are most likely to be affected by feelings of guilt that they caused the illness/disability or are being punished for wrongdoings. Toddlers are focused on establishing their autonomy. The illness will foster dependency. The school-age child will have limited opportunities for achievement and may not be able to understand limitations. Adolescents are faced with the task of incorporating their disabilities into their changing self-concept.)

The feeling of guilt that the child "caused" the disability or illness is especially critical in which child? a. Toddler b. Preschooler c. School-age child d. Adolescent

A (The first pattern of development is the head-to-tail, or cephalocaudal, direction. The head end of the organism develops first and is large and complex, whereas the lower end is smaller and simpler, and development takes place at a later time. Proximodistal, or near-to-far, is the second pattern of development. Limb buds develop before fingers and toes. Postnatally the child has control of the shoulder before achieving mastery of the hands. Mass to specific is not a specific pattern of development. In all dimensions of growth, a definite, sequential pattern is followed.)

The head-to-tail direction of growth is referred to as: a. Cephalocaudal. b. Proximodistal. c. Mass to specific. d. Sequential.

C (Amniotic bands are a congenital anomaly known as a "disruption" that occurs with the breakdown of previously normal tissue. Congenital amputations caused by amniotic bands are not the result of a teratogen. Other agents include Dilantin, warfarin, cytomegalovirus, radiation, and maternal PKU.)

The intrauterine environment can have a profound and permanent effect on the developing fetus with or without chromosome or gene abnormalities. Most adverse intrauterine effects are the result of teratogens. The nurse is cognizant that this group of agents does not include: a. Accutane b. Rubella c. Amniotic bands d. Alcohol

B (This person is male because his sex chromosomes are XY. He has one extra copy of chromosome 21 (for a total of 47 instead of 46), resulting in Down syndrome. A normal male would have 46 chromosomes. A normal female would have 46 chromosomes and XX for the sex chromosomes. A female with Turner syndrome would have 45 chromosomes; the sex chromosomes would have just one X.)

The karyotype of a person is 47, XY, +21. This person is a: a. Normal male. b. Male with Down syndrome. c. Normal female. d. Female with Turner syndrome.

The nurse assesses a child born to a patient with epilepsy and notices teratogenic effects in the baby. Which factors should the nurse assess to determine the cause of the teratogenic effects? 1 The medication history of the patient 2 The presence of environmental triggers 3 Abnormal CCR5 gene found in the patient 4 A family history of genetic abnormalities

The medication history of the patient

C (A multidisciplinary conference is necessary for coordination of care for children with complex health needs. The family and key health professionals who are involved in the child's care are included. The nursing staff can address the nursing care needs of the child with the family, but other involved disciplines must be included. The family must be included in the discharge conferences, which allow them to determine what education they will require and the resources needed at home. A member of the nursing staff must be included to review the nursing needs of the child.)

The nurse case manager is planning a care conference about a young child who has complex health care needs and will soon be discharged home. Whom should the nurse invite to the conference? a. Family and nursing staff b. Social worker, nursing staff, and primary care physician c. Family and key health professionals involved in child's care d. Primary care physician and key health professionals involved in child's care

B (Parental anger after the diagnosis of a child with a chronic disability is a common response. One of the most common targets for parental anger is members of the staff. The nurse should recognize the common response of anger to the diagnosis and allow the family to ventilate. "What is really wrong?" "Yelling at me will not change things," and "I will come back when you settle down" are all possible responses, but they are not the likely reasons for this anger.)

The nurse comes into the room of a child who was just diagnosed with a chronic disability. The child's parents begin to yell at the nurse about a variety of concerns. The nurse's best response is: a. "What is really wrong?" b. "Being angry is only natural." c. "Yelling at me will not change things." d. "I will come back when you settle down."

A (Parents may be in a state of shock when first hearing about the terminal illness of their child. The parent's abnormal optimism about the child's condition indicates that the parent is in denial and has not accepted the child's illness. It is unlikely that the parent believes that the diagnosis is wrong. The diagnosis of a terminally ill condition in a child is depressing for any parent, even one with a cheerful nature. Being optimistic when there is no cure indicates the stage of shock and denial.)

The nurse finds that the parent of a terminally ill child is unusually optimistic about the child's condition. What should the nurse interpret from this? The parent: A. Is in the denial stage of grief. B. Believes the diagnosis is wrong. C. Normally has a cheerful nature. D. Is optimistic about the treatment

B (In the final hours of life the respiratory pattern may become labored, with periods of apnea. The pulse becomes weak and slowed. There is a sensation of heat, although the body feels cold. Hearing is the last sense to fail.)

The nurse is caring for a child dying from cancer. Physical signs that the child is approaching death include: A. rapid pulse. B. change in respiratory pattern. C. sensation of cold, although body feels hot. D. loss of hearing followed by loss of other senses.

A (The parents should be allowed to remain with their child after the death. The nurse can remove all of the tubes and equipment and offer the parents the option of preparing the body. This is an important part of the grieving process and should be allowed if the parents desire it. It is important for the nurse to ascertain if the family has any special needs.)

The nurse is caring for a child who has just died. The parents ask to be left alone so that they can rock their child one more time. The nurse should: a. Grant their request. b. Assess why they feel that this is necessary. c. Discourage this because it will only prolong their grief. d. Kindly explain that they need to say good-bye to their child now and leave.

D (Acknowledging grief is often the first step toward facing the reality of the child's illness. It is important to have the parents spend the time that is left with their child. Such acceptance may help parents focus on the quality of the child's remaining life. The nurse should not be so blunt as to say that births and deaths are normal. It is not showing compassion. Even though the child will be at peace when the child dies, this is not the best response because it does not provide comfort. The nurse should not ask the parents to stay away from their child in their final stages of life.)

The nurse is caring for a child who is in the final stages of death. What can the nurse do to provide comfort for the parents? A. Explain to the parents that births and deaths are normal. B. Inform the family that their child will soon be at peace. C. Ask the parents to stay away from the child at this time. D. Have the parents focus on the quality of the child's remaining life.

B, C, E (Palliative care focuses on relieving pain and managing symptoms related to a terminal disease. It also addresses the psychological, social, and spiritual problems of children living with terminal conditions. The goal of palliative care is to achieve the best quality of life for patients and their families, consistent with their values. Palliative care seeks to improve the quality of life for a patient with a terminal condition. The nurse will assess the severity of the child's symptoms, but this is not the goal of palliative care. The nurse should encourage family members to participate in the child's care but should not mandate their help.)

The nurse is caring for a child who is in the terminal stage of acute lymphocytic leukemia. What should be the goals of palliative care in the child? Select all that apply. A. To assess the severity of disease symptoms B. To provide effective pain management C. To strive for the best possible quality of life D. To mandate that the family join in the care E. To support the family and the child

C (Because these parents care for this child with complex health needs at home, they are most familiar with the care requirements and routine. The nurse's role includes assessment and evaluation, not just the implementation phase. The nurse recognizes that the philosophy of family-centered care states that the parents are the experts in the care of their child. The nurse functions collaboratively with the family.)

The nurse is caring for an 8-year-old child who has a chronic illness. The child has a tracheostomy, and a parent is rooming-in during this hospitalization. The parent insists on providing almost all of the child's care and tells the nurses how to care for the child. When planning the child's care, the primary nurse should recognize that the parent is: A. controlling and demanding. B. assuming the nurse's role. C. the expert in care of the child. D. not allowing nurses to function independently.

A (Object permanence is the realization that items that leave the visual field still exist. When the infant searches for the toy under the blanket, it is an indication that object permanence has developed. Returning blocks to the same spot on a table is not an example of object permanence. Recognizing a ball of clay is the same when flat is an example of conservation, which occurs during the concrete operations stage from 7 to 11 years. Banging cubes together is a simple repetitive activity characteristic of developing a sense of cause and effect.)

The nurse is observing parents playing with their 10-month-old daughter. What should the nurse recognize as evidence that the child is developing object permanence? a. She looks for the toy the parents hide under the blanket. b. She returns the blocks to the same spot on the table. c. She recognizes that a ball of clay is the same when flattened out. d. She bangs two cubes held in her hands.

A (Diagnosis is one of the anticipated stress points for parents. The parents may not hear or remember all that is said to them. The nurse should continue to provide the kind of information that they desire. This is a particularly stressful time for the parents; the nurse can play a key role in providing necessary information. Parents should be provided with oral and written information. The nurse needs to work with the family to ensure understanding of the information. The parents require information at the time of diagnosis. Other questions will arise as they adjust to the information.)

The nurse is providing support to parents at the time their child is diagnosed with chronic disabilities. The nurse notices that the parents keep asking the same questions. The nurse should: a. Patiently continue to answer questions. b. Kindly refer them to someone else to answer their questions. c. Recognize that some parents cannot understand explanations. d. Suggest that they ask their questions when they are not upset.

D (A parent who states that the child's illness is a trial sent by God to test religious faith is expressing a self-accusatory feeling that indicates a lack of understanding of the condition. Crohn's disease is an autoimmune disorder that affects the gastrointestinal tract, causing inflammation that can result in excessive diarrhea, abdominal pain, and other symptoms. Crohn's disease can stunt growth and weaken bones in children who are going through puberty. Parents are advised to refrain from serving fiber-rich food to such children because these foods are difficult to digest and may block the intestine.)

The nurse is reviewing the plan of care with the parent of a child with Crohn's disease. Which statement made by the parent indicates a need for further education? A. "This illness is why my child has delayed puberty." B. "This illness is caused by the intake of fiber-rich food." C. "This illness has impaired my child's growth and development." D. "This illness is God's way of testing our religious faith."

D ("Cooperative play is organized, and children play in a group with other children."* Rationale: Cooperative play is play that is organized; children play in a group with other children and plan activities for purposes of accomplishing an end. Play in which children borrow and lend play materials and attempt to control who plays in the group is known as associative play. Parallel play occurs when children play independently but among other children. Onlooker play is described as play in which children watch but make no attempt to enter into play with other children.)

The nurse is talking to a group of parents about different types of play in which children engage. Which statement made by a parent would indicate a correct understanding of the teaching? A) "Parallel-play children borrow and lend play materials and sometimes attempt to control who plays in the group." B) "In associative play, children play independently but among other children." C) "During onlooker play, children play alone with toys different from those used by other children in the same area." D) "Cooperative play is organized, and children play in a group with other children."

D (This question will provide information about the marital relationship (does the parent speak to the spouse?), alternate support systems, and ability to communicate. These are very important data for the nurse to obtain and an appropriate part of an accurate assessment. By assessing these areas, the nurse can facilitate the identification and use of community resources as needed. The nurse is obtaining information to help support the parent through the diagnosis. The parent is not in need of additional parenting help at this time.)

The nurse is talking with the parent of a child newly diagnosed with a chronic illness. The parent is upset and tearful. The nurse asks, "With whom do you talk when something is worrying you?" This should be interpreted as: a. Inappropriate, because parent is so upset. b. A diversion of the present crisis to similar situations with which parent has dealt. c. An intervention to find someone to help parent. d. Part of assessing parent's available support system.

A (These are normal grief responses. The process of grief work is lengthy and resolution of grief may take years, with intensification during the early years. The child will never be forgotten by the parents.)

The nurse is talking with the parents of a child who died 6 months ago. They sometimes still "hear" the child's voice and have trouble sleeping. They describe feeling "empty" and depressed. The nurse should recognize that: a. These are normal grief responses. b. The pain of the loss is usually less by this time. c. These grief responses are more typical of the early stages of grief. d. This grieving is essential until the pain is gone and the child is gradually forgotten.

B (The parents' reaction of detaching themselves from the child and constantly rebuking the child indicates rejection. However, even though the parents are rejecting the child, they may still meet the child's physical needs. When parents do not let their children learn new skills for fear of injury, this indicates overprotection. Pretending that the child does not have a problem indicates denial. Placing necessary restrictions on the child indicates gradual acceptance.)

The nurse is working with a family who has a child with a chronic illness. The nurse notices that the parents watch television and play on their electronic devices instead of spending time with the child. The parents are frequently reprimanding the child. What should the nurse interpret from these findings? The parents: A. Are being overprotective. B. Are displaying rejection. C. Are in denial of the illness. D. Have gradual acceptance.

B (An example of parallel play is when both children are engaged in similar activities in proximity to each other; however, they are each engaged in their own play, such as Brian and Kristina playing with their own trucks side by side. Sharing clay is characteristic of associative play. A group of children playing a board game is characteristic of cooperative play. Playing alone on the mother's lap is an example of solitary play.)

The nurse observes some children in the playroom. Which play situation exhibits the characteristics of parallel play? a. Kimberly and Amanda sharing clay to each make things b. Brian playing with his truck next to Kristina playing with her truck c. Adam playing a board game with Kyle, Steven, and Erich d. Danielle playing with a music box on her mother's lap

C (Often, parents ask health care providers not to reveal the prognosis to the terminally ill child. This is a difficult situation for health care providers. Although children do not understand that they are going to die, they are in a position to understand that something is seriously wrong with them. Therefore the nurse should make the parents understand that being honest with the child is important. Being honest creates an open environment where feelings may be shared by the entire family. This often encourages the parents to communicate openly with the child. The nurse is not required to report to the child welfare organization at this stage. The parents' decision should not be ignored; rather, the parents should be encouraged to talk openly with the child. The nurse cannot withhold treatment.)

The parents of a 10-year-old child diagnosed with terminal cancer ask the nurse not to inform their child about the condition. What would be the most appropriate response of the nurse? A. Report the situation to the appropriate child welfare organization. B. Ignore the parents' request and tell the child about the condition. C. Inform the parents that being honest with the child is important. D. Tell the parents that treatment cannot be initiated until the child is informed.

A, B, C, E (The initial diagnosis of a terminal illness in a child is met with shock or denial. Parents experience this reaction, and it can last for days, weeks, or months. If the parents ask questions about the child's treatment or prognosis, this indicates that they have accepted the diagnosis. Parents in denial may want the child to be admitted for more medical treatment. They may feel the terminal diagnosis is wrong and refuse to believe the test results. People are usually not pleased to receive a terminal diagnosis; they are upset and angry. Insisting that nobody is telling them the truth is also an indicator of denial.)

The parents of a 12-year-old child are informed that the child is in the terminal stages of osteosarcoma. The nurse explains to the parents about the care that needs to be provided for the child. Which characteristics in the parents indicate that they are in denial? Select all that apply. A. Want the child to be admitted for more treatment B. Refuse to believe the results of the tests C. Pleased to receive the medical diagnosis D. Ask questions about treatment or prognosis E. Insist that nobody is telling them the truth

D (Grief reactions vary from person to person and it is required for the healing to occur. It is important for the nurse to inform the husband that hearing the dead person talk and distancing from others is very common reaction. It does not indicate any impending mental breakdown, poor coping, or psychiatric problem. Therefore, the husband should be reassured that his wife is trying to cope with the grief and she is normal.)

The parents of a child are grieving the loss of their child. The mother of the child has disturbed sleep. The father informs the nurse that the mother can hear their child talk. The mother wants to be left alone and does not speak to any of the family members. What should be the most appropriate response of the nurse? A. Tell the father that his wife may have mental breakdown in near future. B. Tell the father that his wife is coping very poorly and needs professional help. C. Inform the father that his wife has hallucinations and needs psychiatric referral. D. Inform the father that it is a normal part of grief and would subside over time.

A (Discipline is essential for the children with disabilities. It provides boundaries within which to test their behavior and teaches them socially acceptable behaviors. It is not too difficult to implement discipline with a special-needs child. The nurse should teach the parents ways to manage the child's behavior before it becomes problematic. Punishment is not effective in managing behavior.)

The parents of a child born with disabilities ask the nurse for advice about discipline. The nurse's response should be based on knowledge that discipline is: a. Essential for the child. b. Too difficult to implement with a special-needs child. c. Not needed unless the child becomes problematic. d. Best achieved with punishment for misbehavior.

D (The nurse should be very sensitive to the feelings of a grieving family. The nurse should also provide the child and family with the opportunity to review special experiences or memories in their lives. This helps the family members share their emotions and bond with each other. Parents and family members should be advised to seek professional counseling or work with each other to handle grief. The nurse should never encourage people to use alcohol or drugs to escape grief. The nurse can refer the family to a self-help group, but this is not always an effective way to help grieving parents. They may need a professional counselor to help guide them through the grieving process. The nurse should emphasize to the family that acute grieving only lasts for a few weeks to months, but the entire grieving process is a painful process that often takes years to resolve.)

The parents of a child who is dying of leukemia are grieving their impending loss. What intervention should the nurse perform to provide effective care for the family? A. Encourage the use of alcohol and drugs as a way to escape grief. B. Refer the family to a self-help group to manage their grief. C. Emphasize that acute grieving is a process that lasts for years. D. Provide the child and family with time to share memories.

B (To minimize stress on parents, the family should designate one family member or friend to relay information to others. Open visiting hours would increase the workload of the staff and interfere with care. In addition, the parents would not get any rest because of the continual need to entertain friends and family. Suggesting that the family create a website to post updates or asking parents to answer calls to keep busy may not be helpful. The parents do not need more work to do while dealing with the child's condition.)

The parents of a terminally ill child are overwhelmed with the volume of telephone calls asking about the child's condition. What suggestion should the nurse give to the family to make communication easier? A. "Allow open visiting hours for all family members and the child's friends." B. "Designate one family member or friend to relay information to everyone else." C. "Instruct the family to create a website for information and to post updates." D. "Tell the parents that answering calls and e-mails will help keep them busy."

C (The terms palliative care and hospice care are associated with end-of-life care. Palliative care may be provided when no cure is available. Palliative care seeks to prevent, relieve, reduce, or soothe the symptoms of disease or disorder without effecting cure. Hospice care supports the patient and the family during the dying process (medical prognosis of 6 months or less) and the surviving family members through the process of bereavement. It provides total care for the patient in the hospital, home, and nursing home when the patient's disease is unresponsive to the curative treatment. To qualify for hospice care, the patient does not need to be a Medicare recipient. Most insurance programs cover hospice care. However, for palliative care, the patient needs to be a Medicare recipient. Palliative care can be provided to patients in a variety of settings, including hospitals. Both palliative care and hospice care include spirituality in order to provide holistic care. Nurses need to familiarize themselves with the attitudes and needs of various religious groups so that they can address the spiritual needs of their patients, families, and other members.)

The parents of a terminally ill child are speaking with the nurse to learn about palliative care and how it differs from hospice care. What should the nurse tell them? "Palliative care: A. Requires that a patient be a Medicare recipient." B. Does not provide care for hospitalized patients." C. Is provided when no effective cure is available." D. Does not provide spiritual support to the family."

A, B, E (Nurses should offer information about hospice care to the parents of a terminally ill child. Hospice is a community health care organization which specializes in caring for a dying child. It combines principles of hospice care and palliative care. The client is taken care of at home in the final stages of life. The concepts that make it different from hospital care include: no extraordinary efforts are made to prolong the child's life, and pain and control of symptoms are the primary concerns of treatment. The family members are usually the principal caregivers supported by a team of professionals, and the family's needs are given the same importance as the child's needs.)

The parents of a terminally ill child ask the nurse how hospice care is different from hospital care. What information should the nurse give them? Select all that apply. A. No extraordinary efforts would be made to prolong the child's life. B. Pain and control of symptoms are the primary concerns of treatment. C. The child's needs are considered to be the priority over the family's needs. D. Hospice professionals are solely responsible for providing care to the child. E. Family members are the principal caregivers supported by the hospice team.

D (According to Piaget, this age child is in the preoperational stage of development. Children interpret objects and events not in terms of their general properties but in terms of their relationships or their use to them. This egocentrism does not allow children of this age to put themselves in another's place. Selfishness, self-centeredness, and preferring to play alone do not describe the concept of egocentricity.)

The predominant characteristic of the intellectual development of the child ages 2 to 7 years is egocentricity. What best describes this concept? a. Selfishness b. Self-centeredness c. Preferring to play alone d. Inability to put self in another's place

Which is descriptive of the nutritional requirements of preschool children? The quality of the food consumed is more important than the quantity. Nutritional requirements for preschoolers are different from requirements for toddlers. The requirement for calories per unit of body weight increases slightly during the preschool period. The average daily intake of preschoolers should be about 3000 calories.

The quality of the food consumed is more important than the quantity. It is essential that the child eat a balanced diet with essential nutrients; the amount of food is less important than the quality of the food. Requirements are similar for both toddlers and preschoolers. The caloric requirement decreases slightly for preschoolers. The average intake is about 1800 calories each day for preschoolers.

Which statement helps explain the growth and development of children? 1 Development proceeds at a predictable rate. 2 The sequence of developmental milestones is predictable. 3 Rates of growth are consistent among children. 4 At times of rapid growth, there is also acceleration of development.

The sequence of developmental milestones is predictable.

D, E (The nurse should encourage child's parents to accept the truth and spend the remainder of the time left making memories with the sick child. The nurse should encourage the child's parents to ask for help when they need it and not try to handle everything alone. The child should not be asked to manage her own care. During terminal illness the child needs to depend on her parents and family more than ever. The nurse should not advise the child's parents to pray to God because it is unethical to force religion on a family. The nurse should not get involved in the family's emotional distress. Instead, the nurse should teach them about ways to manage the child's condition.)

The student nurse is caring for a 10-year-old child in the terminal stages of acute lymphocytic leukemia. Which instructions should the nursing instructor provide to the student nurse when caring for the child? Select all that apply. "You should: A. Challenge the child to learn ways to manage her own care." B. Advise the child's parents to pray to God for recovery." C. "Not involve yourself in the family's emotional distress." D. "Urge the parents to accept the truth and spend time together." E. "Encourage the child's parents to ask for help when they need it."

A (Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving the child emotionally disabled. Sigmund Freud proposed a psychosexual theory of development. He proposed that certain parts of the body assume psychological significance as foci of sexual energy. The foci shift as the individual moves through the different stages (oral, anal, phallic, latency, and genital) of development. Lawrence Kohlberg described moral development as having three levels (preconventional, conventional, and postconventional). His theory closely parallels Piaget's. Jean Piaget's cognitive theory interprets how children learn and think and how this thinking progresses and differs from adult thinking. Stages of his theory include sensorimotor, preoperations, concrete operations, and formal operations.)

The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is: a. Erikson. b. Freud. c. Kohlberg. d. Piaget.

The nurse is caring for two children. The younger child creates complex imaginary stories using dolls and toys. The older child is engaged in building a model airplane. Which stages of development are the children likely in, according to Erikson? 1 The younger child is in the trust versus mistrust stage; the older child is in the initiative versus guilt stage. 2 The younger child is in the industry versus inferiority stage; the older child is in the identity versus role confusion stage. 3 The younger child is in the initiative versus guilt stage; the older child is in the industry versus inferiority stage. 4 The younger child is in the identity versus role confusion stage; the older child is in the trust versus mistrust stage.

The younger child is in the initiative versus guilt stage; the older child is in the industry versus inferiority stage.

Types of injuries in growing child

Their absorption with play makes them oblivious to environmental hazards such as street traffic or water

The nurse is caring for a newborn who weighs 3 kg (7 lb). The nurse assesses the child 4 years later and notes that the child weighs 13 kg (30 lb). What should the nurse do with this information? 1 This finding is normal; continue to monitor. 2 Instruct the parents to provide supplements. 3 Assess the child for nutritional deficiencies. 4 Talk to the police about parental neglect.

This finding is normal; continue to monitor.

What is magical thinking?

Thoughts can cause events to happen ex: it is their fault they are sick

D (Using a board game requires cooperative play. The children must be able to play in a group and carry out the formal game. In solitary, parallel, and associative play, children do not play in a group with a common goal.)

Three children playing a board game would be an example of: a. Solitary play b. Parallel play c. Associative play d. Cooperative play

Fine motor skills for 5 year olds

Ties shoelaces Use pencil well Print some letters Draws most stick figure

The nurse is assessing a newborn who weighs 3 kg (7 lb). At what growth stage would the child weigh 12 kg (26 lb)? 1 Infancy 2 Toddlerhood 3 Preschool age 4 School age

Toddlerhood

D (The epiphyseal cartilage plate is the area of active growth. Bone injury at the epiphyseal plate can significantly affect subsequent growth and development. Trauma or infection can result in deformity. The matrix, connective tissue, and calcified cartilage are not areas of active growth. Trauma in these sites will not result in growth problems for the long bones.)

Trauma to which site can result in a growth problem for children's long bones? a. Matrix b. Connective tissue c. Calcified cartilage d. Epiphyseal cartilage plate

The nurse is teaching a student nurse about a child who only has one X chromosome. What abnormality does the child have? 1 Down syndrome 2 Turner syndrome 3 Fragile X syndrome 4 Contiguous gene syndrome

Turner syndrome

Obesity is associated with...

Type 2 diabetes

Fine motor skills for 4 year olds

Uses scissors Laces shoes Copies square, traces cross and diamond

What happens with weight gain during this time period?

Weight gain slows down because they are on the move all the time.

A, B, E (Factors indicating that parents should seek genetic counseling for their child include an abnormal newborn screen, family history of a hereditary disease, and a metabolic disorder. A history of hypertension or severe colic as an infant is not an indicator of a genetic disease.)

What factors indicate that parents should seek genetic counseling for their child (Select all that apply)? a. Abnormal newborn screen b. Family history of a hereditary disease c. History of hypertension in the family d. Severe colic as an infant e. Metabolic disorder

A, B, C (Children with terminal illness experience some amount of pain in the last stage of their illness. Nurses should follow the analgesic stepladder framed by World Health Organization (WHO) for pain management in children. It outlines the use of adjunctive therapy depending on the severity of the pain as mild or severe/persistent. It outlines the principles of analgesic selection such as administration of nonnarcotic analgesics to ease mild pain and administration of narcotic analgesics (opioids) to ease severe or persistent pain. It outlines the use of combination therapy to counteract adverse effects, not side effects. A patient with a terminal illness will require increased levels of pain medication to manage pain. The patient will not become dependent or addicted.)

What information should the nurse provide to a group of nursing students when teaching them about the analgesic stepladder for pain management in children with terminal illness? Select all that apply. A. "It was implemented by the World Health Organization (WHO)." B. It provides for the use of adjunctive drug therapy to ease pain." C. It outlines the principles of analgesic selection and titration." D. "It describes the use of combination therapy to decrease side effects." E. It was created to prevent drug dependence and drug addiction."

A (This is the priority nursing diagnosis that is appropriate for the majority of chronic illnesses. Pain is not associated with the majority of chronic illnesses. A chronic illness is one that does not have a cure. It does not mean the child will die prematurely. Frequent hospitalizations are not necessarily required for many chronic illnesses.)

What is a priority nursing diagnosis for the preschool child with chronic illness? a. Risk for Delayed Growth and Development related to chronic illness or disability b. Chronic Pain related to frequent injections c. Anticipatory Grieving related to impending death d. Anxiety related to frequent hospitalizations

B (Preoperational thinking is concrete and tangible. Children in this age group cannot reason beyond the observable, and they lack the ability to make deductions or generalizations. Increasingly logical thought, inductive reasoning, and the ability to make generalizations are characteristic of the concrete operations stage of development, ages 7 to 11 years.)

What is characteristic of the preoperational stage of cognitive development? a. Thinking is logical. b. Thinking is concrete. c. Reasoning is inductive. d. Generalizations can be made.

A (The school-age child is very interested in postdeath services and may be inquisitive about what happens to the body. School-age children have an established concept of forever and have a deeper understanding of death in a concrete manner. Toddler may imagine the deceased person to still be alive. Adolescents may respond to death with an idealistic view of the world and criticize funerals as barbaric.)

What is most descriptive of a school-age child's reaction to death? a. Is very interested in funerals and burials b. Has little understanding of words such as forever c. Imagines the deceased person to be still alive d. Has an idealistic view of the world and criticizes funerals as barbaric

A (Nutrition is the single most important influence on growth. Dietary factors regulate growth at all stages of development, and their effects are exerted in numerous and complex ways. Adequate nutrition is closely related to good health throughout life. Heredity, culture, and environment all contribute to the child's growth and development; however, good nutrition is essential throughout the life span for optimal health.)

What is probably the single most important influence on growth at all stages of development? a. Nutrition b. Heredity c. Culture d. Environment

D (Hearing is the last sense to cease before death. Talking to the dying child is important both for the child and for the family. There is no evidence that the dying process decreases hearing acuity; therefore, the sister should speak at a normal volume. The sibling should be encouraged to speak to the child, as well as sit close to the bed and hold the child's hand.)

What is the most appropriate response to a school-age child who asks if she can talk to her dying sister? a. "You need to speak loudly so she can hear you." b. "Holding her hand would be better because at this point she can't hear you." c. "Although she can't hear you, she can feel your presence so sit close to her." d. "Even though she will probably not answer you, she can still hear what you say to her."

Types of injuries in small infants

When they begin to roll over or propel themselves, they can fall from unprotected surfaces

B (Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs demonstrate developmental appropriateness. Parents need to foster appropriate developmental behavior in the 4-year-old child. Dressing and feeding the child do not encourage independent behavior. A 4-year-old child cannot be expected to cognitively understand the reason for hospitalization. Expecting the child to verbalize an understanding for hospitalization is an inappropriate outcome. Parents staying with the child throughout a hospitalization is an inappropriate outcome. Although children benefit from parental involvement, parents may not have the support structure to stay in the room with the child at all times.)

Which "expected outcome" would be developmentally appropriate for a hospitalized 4-year-old child? a. The child will be dressed and fed by the parents. b. The child will independently ask for play materials or other personal needs. c. The child will be able to verbalize an understanding of the reason for the hospitalization. d. The child will have a parent stay in the room at all times.

A, B, C (Nurses play an important role in helping the grieving family cope with their loss. The nurse should plan regular follow-ups through phone calls or meetings to assess whether they are coping well. Support groups and bereavement counseling may help the family vent their feelings and learn coping skills. The nurse should initiate contact by sending cards. The nurse should not expect the family to come in for a visit. The nurse should ask permission to make a home visit to make it easier on the family. This helps the family feel cared for.)

Which approaches should the nurse adopt to provide support and guidance to a grieving family? Select all that apply. A. Follow up regularly with telephone calls. B. Provide a referral to a support group. C. Recommend bereavement counseling. D. Refrain from sending them cards. E. Ask the family come for an office visit.

C (During the concrete operations stage of development, which occurs approximately between ages 7 and 11 years, increasingly logical and coherent thought processes occur. This is characterized by the child's ability to classify, sort, order, and organize facts to use in problem solving. The progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage of development. The inability to put oneself in another's place is characteristic of the preoperational stage of development. The ability to think in abstract terms and draw logical conclusions is characteristic of the formal operations stage of development.)

Which behavior is most characteristic of the concrete operations stage of cognitive development? a. Progression from reflex activity to imitative behavior b. Inability to put oneself in another's place c. Increasingly logical and coherent thought processes d. Ability to think in abstract terms and draw logical conclusions

A, B, E (Coping reactions to stressors include those that indicate avoidance. Avoidance includes behaviors that help the person deny the truth or escape from it. Refusing to agree to treatment, being angry toward the staff, and seeking nontraditional medical treatments such as faith healing are examples of avoidance behavior. Expressing feelings of sorrow and planning realistically for the future are approach behaviors that indicate acceptance of the condition.)

Which behaviors of the family members indicate avoidance coping behavior? Select all that apply. A. Refuses to agree to the treatment B. Demonstrates anger and hostility C. Expresses deep feelings of sorrow D. Makes realistic plans for the future E. Seeks cures from the faith healers

C, D, E (There are two ways of coping with the illness. Children with healthy coping mechanisms accept their limitations and assume responsibility for their care. These children may also identify with other similarly affected people. Maladaptive coping is evident in behavior problems at home and school. These children may also have a negative attitude toward the illness and begin acting out.)

Which behaviors would characterize a child adequately coping with a chronic illness? Select all that apply. A. Behavior problems at home and school B. Negative attitudes about his or her condition C. Acceptance of his or her limitations and coping accordingly D. Taking responsibility for his or her own physical care E. Identification with other similarly affected people

A (Deductive and abstract reasoning* Rationale: Piaget's cognitive stage of formal operations occurs between the ages of 11 and 15; deductive and abstract reasoning are developed. Inductive reasoning and beginning logic begin in the concrete operations stage between the ages of 7 and 11. Transductive reasoning and egocentrism occur in the preoperational stage at age 2 to 7. Cause-and-effect and object permanence occur during the sensorimotor stage from birth to 2 years.)

Which best describes Piaget's cognitive stage of formal operations? A) Deductive and abstract reasoning B) Inductive reasoning and beginning logic C) Transductive reasoning and egocentrism D) Cause-and-effect reasoning and object permanence

A, B, C (Children with negative and declining attitudes toward their chronic illness use maladaptive coping patterns. These maladaptive coping patterns are characterized by irritability at home and school. The child has a pessimistic outlook toward the disease and feels inadequate in managing it. The child may feel different, withdrawn, and less worthy than others. The child who has healthy coping skills may expresses appropriate emotions, such as anxiety, sadness, and anger, during periods of illness exacerbations. Demonstrating confidence during remissions indicates healthy coping skills)

Which child behaviors indicate maladaptive coping toward chronic illness? Select all that apply. A. Is irritable both at home and during school B. Demonstrates feelings of pessimism and inadequacy C. Expresses feelings of worthlessness to others D. Expresses anxiety during remissions E. Demonstrates confidence during an exacerbation

D (Sensorimotor activity is a major component of play at all ages. Active play is essential for muscle development and allows the release of surplus energy. Through sensorimotor play, children explore their physical world by using tactile, auditory, visual, and kinesthetic stimulation. Creativity, socialization, and intellectual development are each functions of play that are major components at different ages.)

Which function of play is a major component of play at all ages? a. Creativity b. Socialization c. Intellectual development d. Sensorimotor activity

B (Encouraging the toddler to be independent encourages a sense of autonomy. The child can be given choices about feeding, dressing, and diversional activities, which will provide a sense of control. Avoiding separation from family during hospitalizations, and helping parents learn special care needs of their child should be practiced as part of family-centered care. It does not necessarily foster autonomy. Exposing the child to pleasurable experiences, especially sensory ones, is a supportive intervention. It does not promote autonomy.)

Which intervention will encourage a sense of autonomy in a toddler with disabilities? a. Avoid separation from family during hospitalizations. b. Encourage independence in as many areas as possible. c. Expose child to pleasurable experiences as much as possible. d. Help parents learn special care needs of their child.

B (Encouraging the toddler to be independent encourages a sense of autonomy. The child can be given choices about feeding, dressing, and diversional activities, which will provide a sense of control. Avoiding separation from family during hospitalizations and helping parents learn special care needs of their child should be practiced as part of family-centered care. They do not particularly foster autonomy. Exposing the child to pleasurable experiences, especially sensory ones, is a supportive intervention. It does not particularly support autonomy.)

Which intervention will encourage a sense of autonomy in a toddler with disabilities? a. Avoiding separation from family during hospitalizations b. Encouraging independence in as many areas as possible c. Exposing child to pleasurable experiences as much as possible d. Helping parents learn special care needs of their child

A (The school-age child who is ill may be forced into a period of dependency. To foster normalcy, the child should be given as much control as possible. It is unrealistic to expect one individual to make the child feel normal. The child has a chronic illness. It would be unacceptable to convince the child that nothing is wrong. The family rules should be similar for each of the children in a family. Resentment and hostility can arise if different standards are applied to each child.)

Which is the most appropriate nursing intervention to promote normalization in a school-age child with a chronic illness? a. Give child as much control as possible. b. Ask child's peer to make child feel normal. c. Convince child that nothing is wrong with him or her. d. Explain to parents that family rules for the child do not need to be the same as for healthy siblings.

B (Normalization refers to behaviors and interventions for people with disabilities to integrate into society by living life as people without a disability would. For children, normalization includes attending school and being integrated into regular classrooms. This affords the child the advantages of learning with a wide group of peers. Care is necessarily focused on the child's developmental age. Home care by the family is considered best practice. The nurse can assist families by assessing social support systems, coping strategies, family cohesiveness, and family and community resources.)

Which represents a common best practice in the provision of services to children with chronic or complex conditions? a. Care is focused on the child's chronologic age. b. Children with complex conditions are integrated into regular classrooms. c. Disabled children are less likely to be cared for by their families. d. Children with complex conditions are placed in residential treatment facilities.

B (The sequence of developmental milestones is predictable.* Rationale: *There is a fixed, precise order to development. There are periods of both accelerated and decelerated growth and development.* Each child develops at his or her own rate. Physical growth and development proceed at differing rates.)

Which statement helps explain the growth and development of children? A) Development proceeds at a predictable rate. B) The sequence of developmental milestones is predictable. C) Rates of growth are consistent among children. D) At times of rapid growth, there is also acceleration of development.

B (The BMR is the rate of metabolism when the body is at rest. At all ages the rate is slightly higher in boys than in girls. The rate is increased by fever. The BMR is highest in infancy and then closely relates to the proportion of surface area to body mass. As the child grows, the proportion decreases progressively to maturity.)

Which statement is true about the basal metabolic rate (BMR) in children? a. It is reduced by fever. b. It is slightly higher in boys than in girls at all ages. c. It increases with the age of child. d. It decreases as proportion of surface area to body mass increases.

B (Adults should be involved in the selection of toys for children to ensure that they are safe and age appropriate. Once the child is using a toy, the adult should be alert to manufacturer recalls. The child and adult should be involved in the joint process of toy selection. Government agencies do not inspect all toys for sale. The U.S. Consumer Products Safety Commission does keep track of potentially dangerous and recalled toys. Children do not have the ability to determine the safety of a toy. It is the adult's responsibility.)

Which statement is true about toy safety? a. Adults should be the only ones who select toys. b. Adults should be alert to notices of recalls by manufacturers. c. Government agencies inspect all toys on the market. d. Evaluation of toy safety is a joint effort between children and adults.

C (Children respond to everyday stress by trying to change the circumstances or adjust to the circumstances the way they are. Strategies that provide relaxation and other stress-reduction techniques should be used. An inappropriate response would be for the parents to solve the problems. Some children develop socially unacceptable strategies such as lying, stealing, or cheating. Learning problem solving, listening to music, and using relaxation techniques are positive approaches for coping in children.)

Which strategy would be the least appropriate for a child to use to cope? a. Learning problem-solving b. Listening to music. c. Having parents solve problems d. Using relaxation techniques

A (Sensitive periods are limited times during the process of growth when the organism will interact with a particular environment in a specific manner. These times make the organism more susceptible to positive or negative influences. The sequential period, terminal points, and differentiation points are developmental times that do not make the organism more susceptible to environmental interaction.)

Which term refers to those times in an individual's life when he or she is more susceptible to positive or negative influences? a. Sensitive period b. Sequential period c. Terminal points d. Differentiation points

Types of injuries in mobile toddler

With the instinct to explore & investigate as well as ability to run and climb may experience falls, burns, & collisions with objects

Are toddlers egocentric?

Yes

Is object permanence fully developed?

Yes

A common parental reaction to a child with special needs is parental overprotection. Parental behavior suggestive of this includes: a. Giving inconsistent discipline. b. Providing consistent, strict discipline. c. Forcing child to help self, even when not capable. d. Encouraging social and educational activities not appropriate to child's level of capability.

a

A cure is no longer possible for a young child with cancer. The nursing staff recognizes that the goal of treatment must shift from cure to palliation. Which is an important consideration at this time? a. The family is included in the decision to shift the goals of treatment. b. The decision must be made by the health professionals involved in the child's care. c. The family needs to understand that palliative care takes place in the home. d. The decision should not be communicated to the family because it will encourage a sense of hopelessness.

a

An appropriate nursing intervention when providing comfort and support for a child whose death is imminent is to: a. Limit care to essentials. b. Avoid playing music near the child. c. Explain to the child the need for constant measurement of vital signs. d. Whisper to the child instead of using a normal voice.

a

The nurse is caring for a child who has just died. The parents ask to be left alone so that they can rock their child one more time. The nurse should: a. Grant their request. b. Assess why they feel that this is necessary. c. Discourage this because it will only prolong their grief. d. Kindly explain that they need to say good-bye to their child now and leave.

a

The nurse is providing support to parents at the time their child is diagnosed with chronic disabilities. The nurse notices that the parents keep asking the same questions. The nurse should: a. Patiently continue to answer questions. b. Kindly refer them to someone else to answer their questions. c. Recognize that some parents cannot understand explanations. d. Suggest that they ask their questions when they are not upset.

a

The nurse is talking with the parents of a child who died 6 months ago. They sometimes still "hear" the child's voice and have trouble sleeping. They describe feeling "empty" and depressed. The nurse should recognize that: a. These are normal grief responses. b. The pain of the loss is usually less by this time. c. These grief responses are more typical of the early stages of grief. d. This grieving is essential until the pain is gone and the child is gradually forgotten.

a

The parents of a child born with disabilities ask the nurse for advice about discipline. The nurse's response should be based on knowledge that discipline is: a. Essential for the child. b. Too difficult to implement with a special-needs child. c. Not needed unless the child becomes problematic. d. Best achieved with punishment for misbehavior.

a

What is a priority nursing diagnosis for the preschool child with chronic illness? a. Risk for Delayed Growth and Development related to chronic illness or disability b. Chronic Pain related to frequent injections c. Anticipatory Grieving related to impending death d. Anxiety related to frequent hospitalizations

a

Which is the most appropriate nursing intervention to promote normalization in a school-age child with a chronic illness? a. Give child as much control as possible. b. Ask child's peer to make child feel normal. c. Convince child that nothing is wrong with him or her. d. Explain to parents that family rules for the child do not need to be the same as for healthy siblings.

a

The major determinant of neonatal death in technologically developed countries is: a) birth weight b) short gestation c) long gestation d) HIV infection

a) birth weight

Two basic concepts in philosophy of family-centered nursing care are: a) enabling and empowerment b) empowerment and bias c) enabling and curing d) empowerment and self-control

a) enabling and empowerment

Children 12 years of age and older who are victims of homicide tend to be killed by: a) firearms b) family members c) stabbing d) poor safety devices on firearms

a) firearms

Another term for "the new morbidity" is a) pediatric social illness b) pediatric noncompliance c) learning disorder d) autism spectrum disorder

a) pediatric social illness

The nurse then identifies a possible human response pattern to further classify the data. Which one of the following functional health patterns would be best for the nurse to select? a) role-relationship pattern b) nutritional-metabolic pattern c) coping-stress tolerance pattern d) self-perception/self-concept pattern

a) role-relationship pattern

At Sara's next well-baby visit, what information will be most important to document in the chart? a) written evidence of progress toward outcomes b) the standard plan of care c) broad-based goals d) interventions applicable to patients like Sara

a) written evidence of progress toward outcomes

What is most descriptive of a school-age child's reaction to death? a. Is very interested in funerals and burials b. Has little understanding of words such as forever c. Imagines the deceased person to be still alive d. Has an idealistic view of the world and criticizes funerals as barbaric

a. Is very interested in funerals and burials

Assent

ability of the pediatric pt to approve the guardian's decision in a health care matter

4 causes: Congenital anomalies, disorders relating to short gestation & unspecified LBW, sudden infant death syndrome, & newborn affected by maternal complications of pregnancy

accounted for about half 52% of all deaths of infants under 1 year of age

A ventilator-dependent child is being discharged home from the hospital. Prior to discharge, the home health care nurse discusses the development of an emergency plan with the family. The most essential component of the plan is acquisition of a backup generator. designation of an emergency shelter. notifying the power company that the child is on life support. provision for alternate heating and cooling source if power is lost. notifying emergency medical services that child is on life support.

acquisition of a backup generator. It is essential that the family have a backup generator in place prior to discharge so that the child's life support is not interrupted should power be lost. Designation of an emergency shelter, notifying the power company that the child is on life support, provision for alternate hearing and cooling source if power is lost and notifying the emergency medical services that the child is on life support are important concerns but are not considered to be the most essential component of the discharge plan.

when do children use multiword sentences of two/three words?

age 2

when do children us simple sentences and begin to master grammatical rules?

age 3

What methods are used to calculate medication dosages

age, weight, and body surface area (BSA)

school age child: striving for industry how the nurse should deal with this?

allow responsiblity for simple tasks (collecting specimens) include child in decion making (e.g. time of day to perform procedure, preferred site) encourage active participation (e.g. removing dressings, handling equipment opening packages )

A nurse is examining a toddler and is discussing with the mother psychosocial development according to Erikson's theories. Based on the nurse's knowledge of Erikson, the most age-appropriate activity to suggest to the mother at this stage is to: 1 feed lunch. 2 allow the toddler to start making choices about what to wear. 3 allow the toddler to pull a talking-duck toy. 4 turn on a TV show with bright colors and loud songs.

allow the toddler to start making choices about what to wear.

Lazy eye; reduced visual acuity in one eye

amblyopia

drowning and burns are

among the top five leading causes of death for males and females throughout/ child hood

Different refractive strength in each eye

anisometropia

strategies for enhancing compliance in children and families: Behavioral strategies

are designed to modify behavior directly. Nurses can use several effective strategies with children to encourage the desired behavior. Positive reinforcement can strengthen behavior. Such as a child earning something like a gold star or tokens that can be exchanged for special privileges or a gift. Negative reinforcement or disciplinary techniques may be needed to improve compliance.

causes of violence against children & self inflicted behavior:

are not fully understood

Preschoolers of low-income families

are twice as likely to develop tooth decay and only half as likely to visit the dentist as other children

A home health nurse is caring for a 2-week-old infant and notes on assessment that the infant has a string tied around the wrist. The nurse checks for adequate circulation. The most appropriate nursing intervention by the nurse is to ask the parents to remove the string. report the parents to Social Services for child endangerment. remove the string and inform the parents that the string is dangerous. ask the parents the meaning of the string and leave the string in place.

ask the parents the meaning of the string and leave the string in place. Families of various cultural backgrounds have specific beliefs about health care. These beliefs may differ from the nurse's beliefs and the nurse needs to honor the practices and seek clarification of the cultural practice. The nurse should honor the practices of the family. For the nurse to do otherwise would lead to loss of trust from the family. The nurse needs to provide education to the family that includes safety principles as the infant grows.

Pediatric nurses can :**

assess children and adolescents for risk factors related to violence

first thing to assess when trying to enhance compliance within children and families

assess level of compliance

Make food what so kids eat it more

attractive and different. use a cookie cutter food with cool straws etc

Describes Erikson

autonomy vs. shame and doubt

what should you do before mealtime and afterwards

avoid procedures before and after meals, make sure the child is well rested and pain free

Approach behaviors are coping mechanisms that result in a family's movement toward adjustment and resolution of the crisis of having a child with a chronic illness or disability. What is considered an approach behavior in parents? a. Are unable to adjust to a progression of the disease or condition b. Anticipate future problems and seek guidance and answers c. Look for new cures without a perspective toward possible benefit d. Fail to recognize seriousness of child's condition despite physical evidence

b

At the time of a child's death, the nurse tells his mother, "We will miss him so much." The best interpretation of this is that the nurse is: a. Pretending to be experiencing grief. b. Expressing personal feelings of loss. c. Denying the mother's sense of loss. d. Talking when listening would be better.

b

Families progress through various stages of reactions when a child is diagnosed with a chronic illness or disability. After the shock phase, a period of adjustment usually follows. This is often characterized by: a. Denial. b. Guilt and anger. c. Social reintegration. d. Acceptance of child's limitations

b

Kelly, age 8 years, will soon be able to return to school after an injury that resulted in several severe, chronic disabilities. What is the most appropriate action by the school nurse? a. Recommending that Kelly's parents attend school at first to prevent teasing b. Preparing Kelly's classmates and teachers for changes they can expect c. Referring Kelly to a school where the children have chronic disabilities similar to hers d. Discussing with Kelly and her parents the fact that her classmates will not accept her as they did before

b

Lindsey, age 5 years, will be starting kindergarten next month. She has cerebral palsy, and it has been determined that she needs to be in a special education classroom. Her parents are tearful when telling the nurse about this a. This is a sign that parents are in denial. b. This is a normal anticipated time of parental stress. c. The parents need to learn more about cerebral palsy. d. The parents are used to having expectations that are too high.

b

The nurse comes into the room of a child who was just diagnosed with a chronic disability. The child's parents begin to yell at the nurse about a variety of concerns. The nurse's best response is: a. "What is really wrong?" b. "Being angry is only natural." c. "Yelling at me will not change things." d. "I will come back when you settle down."

b

Which intervention will encourage a sense of autonomy in a toddler with disabilities? a. Avoiding separation from family during hospitalizations b. Encouraging independence in as many areas as possible c. Exposing child to pleasurable experiences as much as possible d. Helping parents learn special care needs of their child

b

Which represents a common best practice in the provision of services to children with chronic or complex conditions? a. Care is focused on the child's chronologic age. b. Children with complex conditions are integrated into regular classrooms. c. Disabled children are less likely to be cared for by their families. d. Children with complex conditions are placed in residential treatment facilities.

b

During the evaluation phase, which one of the following responses by Sara's mother would indicate that the expected outcomes have been met? a) "I will have to go through all the boys' things when we get home to be sure there aren't any other small objects that could hurt Sara." b) "I had forgotten how curious babies are. It has been many years since the boys were babies, and they didn't have an older child's toys around." c) "I will have to start to discipline Sara now so that she knows not to play with the older children's belongings." d) "I am afraid she cannot receive her immunizations. She had a fever after her last one."

b) "I had forgotten how curious babies are. It has been many years since the boys were babies, and they didn't have an older child's toys around."

The incidence of accidental drowning is highest in both boys and girls in what age-group? a) <1 year b) 1-4 years c) 5-14 years d) 15-24 years

b) 1-4 years

According to "Healthy People 2020," strategies that address leading health indicators for the nation would include all of the following EXCEPT: a) decreasing tobacco use b) increasing innovative Tx for cancer c) decreasing substance abuse d) increasing immunization rates

b) increasing innovative Tx for cancer

Which one of the following statments about injuries in childhood is FALSE? a) developmental stage partially determines prevalence of injuries at a given age b) most fatal injuries occur in children <9 years old c) developmental stage helps to direct preventative measures d) children aged 5-9 years are at greatest risk for bicycle fatalities

b) most fatal injuries occur in children <9 years old

The nurse and a new nurse are caring for a child who will require palliative care. Which statement made by the new nurse would indicate a correct understanding of palliative care? a. "Palliative care serves to hasten death and make the process easier for the family." b. "Palliative care provides pain and symptom management for the child." c. "The goal of palliative care is to place the child in a hospice setting at the end of life." d. "The goal of palliative care is to act as the liaison between the family, child, and other health care professionals."

b. "Palliative care provides pain and symptom management for the child."

Which best describes how preschoolers react to the death of a loved one? a. The preschooler is too young to have a concept of death. b. A preschooler is likely to feel guilty and responsible for the death. c. Grief is acute but does not last long at this age. d. Grief is usually expressed in the same way in which the adults in the preschooler's life are expressing grief.

b. A preschooler is likely to feel guilty and responsible for the death.

A nurse is planning palliative care for a child with severe pain. Which should the nurse expect to be prescribed for pain relief? a. Opioids as needed b. Opioids on a regular schedule c. Distraction and relaxation techniques d. Nonsteroidal antiinflammatory drugs

b. Opioids on a regular schedule

The feeling of guilt that the child "caused" the disability or illness is especially critical in which child? a. Toddler b. Preschooler c. School-age child d. Adolescent

b. Preschooler

Testing of the parents is necessary to identify the carrier and offer genetic counseling when Down syndrome is caused by: a. mosaicism. b. translocation. c. maternal age over 40. d. paternal age over 40

b. translocation.

Infants age range

birth to 1 year

By 2.5 what is expected for weight

birth weight should be quadrupled by 2.5

The psychosexual conflicts of preschool children make them extremely vulnerable to separation anxiety. loss of control. bodily injury and pain. loss of identity.

bodily injury and pain. Intrusive procedures, whether or not they are perceived as painful, are threatening to the preschooler because of the poorly developed concept of body integrity. Separation anxiety is more of a characteristic of infancy. Loss of control is a characteristic fear of school-age children. Loss of identity is a concern of adolescents because illnesses are conceptualized as the effect on the individual.

Most calculations for medications are often expressed in units of measure per____

body weight

A 16-year-old boy with a chronic illness has recently become rebellious and is taking risks such as missing doses of his medication. The nurse should explain to his parents that: a. He needs more discipline. b. He needs more socialization with peers. c. This is part of normal adolescence. d. This is how he is asking for more parental control.

c

A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. The nurse should explain that: a. This will help the child cope effectively by denial. b. This attitude is helpful to give parents time to cope. c. Terminally ill children know when they are seriously ill. d. Terminally ill children usually choose not to discuss the seriousness of their illness.

c

Chris, age 9 years, has several physical disabilities. His father explains to the nurse that his son concentrates on what he can rather than cannot do and is as independent as possible. The nurse's best interpretation of this is: a. The father is experiencing denial. b. The father is expressing his own views. c. Chris is using an adaptive coping style. d. Chris is using a maladaptive coping style.

c

Infant mortality decreased significantly in the 1990s for which of the following? a) Low birth weight b) congenital heart defects c) HIV infection d) SIDS

c) HIV infection

Which one of the following statements is true about infant mortality in the US? a) There has been a recent dramatic increase in infant mortality in the US b) US is currently a world leader in reducing infant mortality c) In 2001 the US ranked last in infant mortality rate among nations w/similar-sized populations d) The US has a lower infant mortality rates than most other developed countries

c) In 2001 the US ranked last in infant mortality rate among nations w/similar-sized populations

Which one of the following patient outcomes is individualized for Sara? a) Sara will receive her immunizations on time b) Sara will demonstrate adherence to the nurse's recommendations c) Marisa Gutierrez will verbalize the need to keep small objects away from Sara to avoid aspiration d) Sara's brothers will verbalize the need to stop playing with small objects

c) Marisa Gutierrez will verbalize the need to keep small objects away from Sara to avoid aspiration

Case Study: Marisa Gutierrez arrives with her infant, Sara, in the well-baby clinic. Sara, who is 15 mos old, is the youngest of 3 children. Her mother has brought her to the clinic for well-child care. Sara's 2 bros, who are 7 and 8, have come as well. As the nurse interviews the mother, Sara explores the exam room. She reaches for her older brother' coins and put one in her mouth. After organizing the data into similar categories, the nurse correctly makes which one of the following decisions? a) no dysfunctional health problems are evident b) high risk for dysfunctional health problems exists c) actual dysfunctional health problems are evident d) potential complications are evident

c) actual dysfunctional health problems are evident

An example of atraumatic care would be to: a) eliminate all traumatic procedures b) restrict visiting hours to adults only c) allow parents to "room in" with the child d) remove parents from the room during painful procedures

c) allow parents to "room in" with the child

The disease that continues to be a leading cause of death in all age-groups of children is: a) Type 1 DM b) AIDS c) cancer d) infectious diseases

c) cancer

Mental health problems in children: a) affect 1/20 adolescents b) make the children less likely to drop out of school than those w/other disabilities c) include ADHD d) are more common in children living in large urban centers

c) include ADHD

Which of the following differences is seen when infant death rates are categorized according to race? a) disparities among races have continued to increase dramatically in the USA b) infant mortality for Hispanic infants is much higher than for any other groups c) infant mortality for African-Americans is 2x the rate of Caucasians d) infant mortality for Caucasian infants is the same as for other races

c) infant mortality for African-Americans is 2x the rate of Caucasians

The role of the nurse in the parent-professional partnership is to: a) decide what is most important for the family b) decide what is most important for the child c) strengthen the family's ability to nurture d) manipulate the available resources

c) strengthen the family's ability to nurture

As the movement for providing care based on evidence continues, nurses will be using methods to evaluate research such as: a) Agency for Health Care Policy and Research (AHCPR) guidelines in place of guidelines developed locally b) guidelines that are based on traditional practice c) the GRADE criteria d) guidelines that reflect current research but decrease job satisfaction

c) the GRADE criteria

After a child reaches the age of 1 year, the leading cause of death is from: a) HIV b) congenital anomolies c) unintentional injuries d) heart disease

c) unintentional anomolies

At what age do most children have an adult concept of death as being inevitable, universal, and irreversible? a. 4 to 5 years b. 6 to 8 years c. 9 to 11 years d. 12 to 16 years

c. 9 to 11 years

Another name for trisomy 21 is: a. phenylketonuria. b. Turner syndrome. c. Down syndrome. d. galactosemia.

c. Down syndrome.

Which of the following statements about stuttering is correct? a. Stuttering is normal in the school-age child. b. Stuttering occurs because children do not know what they want to say. c. Undue emphasis on a stutter may cause an abnormal speech pattern. d. Chances for reversal of stuttering are good until about age 3 years.

c. Undue emphasis on a stutter may cause an abnormal speech pattern. they know what they want to say

Opacity of crystalline lens

cataract

1 out of 5 adolescents has a mental health problem & 1 out of 10 has a serious emotional problem that affects daily functioning

children and adolescents with mental health problems are more likely to engage in risky and thrill seeking behaviors & drop out than those with other disabilities

A 4-year-old child is scheduled for cardiac surgery in a week. The child's parents call the hospital to ask how to prepare the child for the upcoming hospitalization and surgical procedure. The nurse's reply should be based on the knowledge that preparation at this age will only increase the child's stress. preparation needs to be at least 2 to 3 weeks before hospitalization to be effective. children who are prepared experience less fear and stress during hospitalization. children who are prepared experience overwhelming fear by the time hospitalization occurs.

children who are prepared experience less fear and stress during hospitalization. Preparing the child for the hospitalization will reduce the number of unknown elements. Taking tours, handling some of the equipment, or being told stories about what to expect will increase the familiar items. Timing of the preparation must also be considered. Four- to 7-year-olds can be prepared up to 1 week in advance of the hospitalization. Preparation of a 4-year-old will reduce stress by having the child incorporate and assimilate the information more slowly. Children between the ages of 4 and 7 years should be prepared about 1 week before hospitalization. A reduction in fear is usually observed when children are prepared appropriately for hospitalization.

preschooler: illness and hospitalization viewed as punishment how should the nurse deal with this?

clarify why each procedure is performed: Child will find it difficult to understand how medicine can make him or her feel better and can taste bad at the same time ask child thoughts regarding why a procedure is performed state directly that procedures are never a form of punishment

toddler: Limited language deals. how should the nurse deal?

communicate using gestures or demonstrations use few simple terms familiar to child give child one direction at a time (lie down and then hold my hand) use small replicas of equipment; allow child to handle equipment use play:demonstrate on doll but avoid childs favorite doll because child may think doll is really feeling procedure prepare parents separately to avoid childs misinterpreting words

clinical reasoning

complex developmental process based on rational and deliberate thought

During their school-age years, children best understand concepts that can be seen or illustrated. The nurse knows this type of thinking is termed as: 1 concrete operations. 2 preoperational. 3 school-age rhetoric. 4 formal operations.

concrete operations.

Assessment

consider info about pt biophysical, psychologic, sociocultural and spiritual background

Therapeutic care

covers prevention, diagnosis, treatment or palliation of actor or chronic conditions

A mother tells the nurse that her daughter's favorite toy is a large, empty box that contained a stove. She plays "house" in it with her toddler brother. Based on the nurse's knowledge of growth and development, the nurse recognizes that this is unsafe play that should be discouraged. creative play that should be encouraged. suggestive of limited family resources. suggestive of limited adult supervision.

creative play that should be encouraged. This type of play should be encouraged. After children create something new, they can then transfer it to other situations. There should be some supervision to prevent injury or accidents. As long as the play is supervised, it should be encouraged. This is not considered unsafe play. There is no indication of limited resources. There is no indication of limited adult supervision.

A preschooler is found digging up a pet bird that was recently buried after it died. The best explanation for this behavior is that: a. He has a morbid preoccupation with death. b. He is looking to see if a ghost took it away. c. The loss is not yet resolved, and professional counseling is needed. d. Reassurance is needed that the pet has not gone somewhere else.

d

Most parents of children with special needs tend to experience chronic sorrow. This is characterized by: a. Lack of acceptance of the child's limitation. b. Lack of available support to prevent sorrow. c. Periods of intensified sorrow when experiencing anger and guilt. d. Periods of intensified sorrow and loss that occur in waves over time.

d

Nursing interventions to help the siblings of a child with a complex or chronic condition cope include: a. Explaining to the siblings that embarrassment is unhealthy. b. Encouraging the parents not to expect siblings to help them care for the child with special needs. c. Providing information to the siblings about the child's condition only as they request it. d. Suggesting to the parents ways of showing gratitude to the siblings who help care for the child with a disability or chronic condition.

d

The nurse is talking with the parent of a child newly diagnosed with a chronic illness. The parent is upset and tearful. The nurse asks, "With whom do you talk when something is worrying you?" This should be interpreted as: a. Inappropriate, because parent is so upset. b. A diversion of the present crisis to similar situations with which parent has dealt. c. An intervention to find someone to help parent. d. Part of assessing parent's available support system.

d

What is the most appropriate response to a school-age child who asks if she can talk to her dying sister? a. "You need to speak loudly so she can hear you." b. "Holding her hand would be better because at this point she can't hear you." c. "Although she can't hear you, she can feel your presence so sit close to her." d. "Even though she will probably not answer you, she can still hear what you say to her."

d

Obesity in children and adolescents is defined as: a) BMI >/= 90th percentile for age & height b) BMI </= 90th percentile for age & gender c) BMI >/= 95th percentile for age and height d) BMI >/= 95th percentile for age & gender

d) BMI >/=95th percentile for age and gender

Which of the following accounts for the most deaths in infants <1 year of age? a) pneumonia/influenza b) congenital heart defects c) HIV infection d) Sudden infant death syndrome

d) Sudden infant death syndrome

The current trend toward EBP practice involves: a) questioning whether a better approach exists b) analyzing published clinical research c) increased emphasis on measurable outcomes d) a, b, and c are correct

d) a, b, and c are correct

Based on the data collected, which one of the following nursing diagnoses would be most appropriate? a) altered family process b) altered family coping c) altered individual coping d) altered parenting

d) altered parenting

50% of all acute conditions of childhood can be accounted for by: a) injuries and accidents b) bacterial infections c) parasitic disease d) respiratory illness

d) respiratory illness

At what developmental period do children have the most difficulty coping with death, particularly if it is their own? a. Toddlerhood b. Preschool c. School-age d. Adolescence

d. Adolescence

Which term best describes a multidisciplinary approach to the management of a terminal illness that focuses on symptom control and support? a. Dying care b. Curative care c. Restorative care d. Palliative care

d. Palliative care

quality of care

degree of which health services for people and populations inc the likelihood of desired health outcomes & are consistent with current professional knowledge -better care- -Health people/healthy communities- -Affordable care-

Nurses counseling parents regarding the home care of the child with a cardiac defect before corrective surgery should stress the importance of reducing caloric intake to decrease cardiac demands. importance of relaxing discipline and limit-setting to prevent crying. need to be extremely concerned about cyanotic spells. desirability of promoting normalcy within the limits of the child's condition.

desirability of promoting normalcy within the limits of the child's condition. The child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be encouraged to promote as normal a life as possible for their child. The child needs increased caloric intake after cardiac surgery. The child needs discipline and appropriate limit setting, as would be done with any other child his or her age. Because cyanotic spells will occur in children with some defects, the parents need to be taught how to assess for and manage them appropriately, thereby decreasing their anxiety and concern.

bw 50 & 70 % of adolescents with anxiety disorders & implies control disorders

develop these during adolescence

adolescent: Developing identity and abstract thought

discuss why procedure is necessary or beneficial explain long term consequences of procedures; include information about body systems working together relaize adolescent may fear deathk ,disablity or other potential risks encourage questioning regarding fears, options, and alternatives

95 % of medication related emergency room visits in children under five are

due to ingesting medication while unsupervised

The most dramatic time of physical, motor, cognitive, emotional, and social development occur

during Infancy

Match each role of pediatric nurse to it's description a) family advocacy and caring b) disease prevention and health promotion c) health teaching d) support e) counseling f) therapeutic relationship g) coordination & collaboration h) ethical decision making i) research & EBP __ a mutual exchange of ideas and opinions __ health maintenance strategies __ working together as a member of the health team __ establishing relationships w/children and families, yet remaining separate __ systematically recording and analyzing observation __ attention to emotional needs (listening, physical presence) __ transmitting info __ using pt, family, and societal values in care __ acting in the childs best interest

e) counseling: mutual exchange of ideas and opinions b) disease prevention and health promotion: health maintenance and strategies g) coordination & collaboration: working together as a member of the health team f) therapeutic relationship: establishing relationships w/children and families, yet remaining separate i) research and EBP: systematically recording and analyzing observation d) support: attention to emotional needs (listening, physical presence) c) health teaching: trasmitting info h) ethical decision making: using pt, family & societal values in care a) family advocacy and caring: acting in the child's best interes

Duvall's developmental theory

emphasizes the developmental stages that all families go through, beginning with marriage; the longitudinal career of the family is also known as the family life cycle

Professionals

enable families by creating opportunities & means for all family members to display their current abilities and competencies and to acquire new ones to meet needs of child and fam

therapeutic relationship

essential foundation for providing high quality nursing care (meaningful relationships with boundaries)

In helping a child to adapt to a hospitalization experience, the best approach would be to allow the child to bring in all of his favorite toys to the hospital so as to represent a more familiar environment. let the parents bring in food from home that the child is used to eating for all meals. establish a daily routine and schedule with the child and parent to help maintain consistency. allow the child to select his room on the unit.

establish a daily routine and schedule with the child and parent to help maintain consistency. By providing a daily routine and schedule, the nurse helps to support consistency. It is not realistic for the child to bring in all of his favorite toys or allow the child to make a room selection on the unit. Bringing food in from home for all meals is not realistic and may not be advised based on therapeutic treatment.

infant: Increased muscle control how should the nurse deal?

expect old infants to resist restrain adequately keep harmful objects out of reach

Toddler: Negative Behavior how should the nurse deal?

expect treatments to be resisted, child may try to run away use firm, direct approach ignore temper tantrums use distraction techniques(e.g.singing a song with child) restrain adequately

toddler: egocentric thought how should the nurse deal?

explain procedure in relation to what child will see ,hear, taste, smell and feel emphasized aspects of procedure that require cooperation tell child it is okay to cry, yell or use other means to express discomfort berbally designate one health care provider to speak during procedure. hearing more than one can be confusing to a child ex: Black nurse giving the shot on youtube

Preschoolers: developing initiative and preoperational thought EGOCENTRIC

explain procedure in simple terms and in relation to how it affects childs (as with toddler, stress sensory aspects) demonstrate use of equipment allow child to play with miniature or actual equipment encourage "playing out" experience on a doll both before and after procedure to clarify misconceptions use neutral words to describe the procedure

school age child" developing industry and concrete thought how the nurse should deal with this?

explain procedure using correct scientific and medical terminology explain procedure using simple diagrams and photographs discuss why porcedure is necesaary explain function and operation of equipment in concrete terms allow child to manipulate equipment allow time before and after procedure for questions and discussion

What are the clinical manifestations of Fragile X syndrome?

extremely varied in females; psychosocial deficits (anxiety, withdrawal, depression) in males, long face + prominent jaw, large protruding ears, big balls

The nurse working in an outpatient surgery center for children should understand that children's anxiety is minimal in such a center. waiting is not stressful for parents in such a center. accurate and complete discharge teaching is the responsibility of the surgeon. families need to be prepared for what to expect after discharge.

families need to be prepared for what to expect after discharge. Discharge instructions should be provided in both written and oral form and in the primary language of the patient and family. Instructions need to include normal responses to the procedure and when to notify the practitioner if untoward reactions occur. Although anxiety may be reduced because of the lack of an overnight stay, the child will still experience the stress associated with a medical procedure. The waiting period while the child is having the procedure is a stressful time for families in both outpatient and inpatient settings. Discharge instructions are a responsibility of both the surgeon and the nursing staff.

Family Stress Theory

family response to & coping with stressful events

characteristics associated with good compliance includes

family support, family reminders, good communication and expectations for successful completion of the therapeutic regimen

The preschooler's body image has developed to include a well-defined body boundary. knowledge about his or her internal anatomy. fear of intrusive procedures. fear of looking different from his or her friends.

fear of intrusive procedures. Preschoolers fear that their insides will come out with intrusive procedures. Preschoolers have poorly defined body images. Preschoolers have little or no knowledge of their internal anatomy. The fear of looking different is a concept that occurs in later school-aged children and adolescents.

The two rules used to provide sensitive information to a preschooler focus on describing the information in a succinct way and answering any questions. ask the child if he/she understands what you have told them and then clarify any additional questions. find out what they know and think and then be honest. use the opportunity to provide minimal information and keep the level of interaction simple.

find out what they know and think and then be honest. It is important to find out what they know and think before providing any information and then equally important is to be honest in your communication. The method of providing information may vary based on the type of information being provided and the level of understanding of the child.

provide what kind of food for younger children

finger foods and involve them in the selection and prep

Prehensile grasp

fingers (not including thumb) are able to grasp an object

What kind of food should you give children

foods that they like and avoid foods that are NOT highly seasoned, strong smell or are mixed together unless typical of cultural practices

Cephalocaudal

from head to tail

Proximodistally

from medial structures to distal structures

school age child: increased self control how the nurse should deal with this

gain childs cooperation tell child what is expected suggest several ways of maintaing control the child may select from (e.g. deep breathing, relaxation, counting)

Evaluation

gather sort and analyzes data to determine if outcome was met, intervention was appropriate, plan req modification, or alternatives needed

Increased intraocular pressure

glaucoma

How many calories should a preschooler consume?

half amount of adults (1800 kcals)

The parents of a 4½-year-old girl are worried because she has an imaginary playmate. Based on the nurse's knowledge of the preschooler, the most appropriate response is a psychosocial evaluation is indicated. an evaluation of possible parent-child conflict is indicated. having imaginary playmates is normal and useful at this age. having imaginary playmates is abnormal after age 2 years.

having imaginary playmates is normal and useful at this age. Imaginary playmates are a part of normal development at this age and serve many purposes, including being a friend in times of loneliness, accomplishing what the preschooler is still attempting, and experiencing what the preschooler wants to forget or remember. Because an imaginary playmate is part of normal development, a psychosocial evaluation is not warranted. Because an imaginary playmate is part of normal development, an evaluation of the parent-child relationship is not warranted. Imaginary playmates are commonly present during the preschool years; therefore, they are not abnormal after the age of 2 years.

what happens in regards to height in toddlers?

height increases 2.5- 3.5 inches/years

Recent concern focused on:

highest risk, premature children or low birth weight, children in daycare, poverty/homeless, immigrant, children with chronic medical & psychiatric illness and disabilities

what do you do when Regression occurs?

ignore it while praising existing patterns of appropriate behavior

Acute Illness

illness with symptoms severe enough to limit activity or require medical attn

Describe Pagets final sensory motor

imitation of behaviors with limited attention span

preschoolers: limited concept of time and frustration tolerance how to deal with this?

implement same appraoches as for toddlers but may plan longer teaching session (10 -15 minutes) may divide information into more than one session

Presence of gun in household

increases risk of suicide by about fivefold & risk of homicide by about threefold

List five causes of cognitive impairment and cite one example of each.

infection/intoxication (rubella, syphillis, prenatal smoking, lead) trauma/physical agents (hypozia, radiation) metabolic/nutritional abnormalities gros postnatal brain disease (neurofiromatosis) gestational disorders (premie, LBW) psychiatric disorders (autism)

A, C, D (A common statement is that play is the work of childhood. Intellectual development is enhanced through the manipulation and exploration of objects. Self-awareness is the process of developing a self-identity. This process is facilitated through play. In addition, creativity is developed through the experimentation characteristic of imaginative play. Physical development depends on many factors; play is not one of them. Temperament refers to behavioral tendencies that are observable from the time of birth. The actual behaviors but not the child's temperament attributes may be modified through play.)

inform them that play serves the following function (Select all that apply): a. Intellectual development b. Physical development c. Self-awareness d. Creativity e. Temperament development

According to Erikson, the primary psychosocial task of the preschool period is developing a sense of identity. intimacy. initiative. industry.

initiative. Preschoolers focus on developing initiative. The stage is known as initiative versus guilt. Identity versus role confusion is associated with adolescence. Intimacy versus isolation is associated with young adulthood. Industry versus inferiority is associated with the school-aged child.

List five physical features that are found in the infant with Down syndrome.

intelligence (visual better than auditory processing, weak grammar/expressive language, motor dvp delay) social dvp (2-3yr beyond mental age, easy-child pattern) congenital heart disease (septal defects) in 40-45% sensory problems (hearing loss common, strabisum/nystagmus/myopia) URIs common, leukemia, reduced wt/ht growth delayed/incomplete sexual dvp hypotonicity of muscles and hyperextensibility of joints

Implementation

intervention into action & accumulate feedback -main concerns are pts physical safety & psychologic comfort in terms of Atraumatic care

The ratio of BSA to weight varies _____ with ___

inversely with length So, an infant who is shorter and weighs less than an older child or adult has relatively more BSA than would be expected from the weight.

preschooler: striving for initiative how should the nurse deal with this?

involve child in care whenever possible (e.g. hold equipment, remove dressing) give choices whenever possible but avoid excessive delays

Infant: How to deal with attachment to parent how should the nurse deal?

involve parent in procedure if desired keep parent in infants line of vision if parent is unable to be with infant, place familiar object with infant(eg: stuffed toy)

adolescent: Striving for independence

involved adolescent in decision making and planning impose few restrictions explore coping strategies accept regression to more childish methods of ocping difficulty accepting new authority figures and may resist complying with procedures

organizational strategies

involves the care setting and the therapeutic plan. increasing appointments, designating a primary practioner, reducing the cost of medication by prescribing generic brands, reducing the treatments disruption of the fams lifestyle.

preschooler: Animism how to deal with this?

keep equipment out of sight except when shown to or used on child

toddler:Animism how should the nurse deal?

keep frightening objects out of view (young children believe objects have lifelike qualities and can harm them)

A home health nurse is assigned to an adolescent with recently acquired tetraplegia. The adolescent's mother tells the nurse, "I'm sick of providing all the care while my husband does whatever he wants and whenever he wants." Based on the nurse's knowledge of family-centered care, the most appropriate nursing intervention is to listen and reflect the mother's feelings. refer the mother for psychological counseling. suggest ways the mother can get the husband to help with care. meet with the adolescent's father in private and ask why he does not help.

listen and reflect the mother's feelings. It is appropriate for the nurse to reflect with the mother about her feelings and explore avenues for additional home health assistance and provide respite care for the mother. A support group for caregivers is more appropriate at this time, not counseling. It is inappropriate for the nurse to agree with the mother that the husband is not helping enough. The nurse is making a judgment that is beyond the role of the nurse in addition to undermining the family relationship. It is inappropriate to meet with the father privately because the meeting is based on the mother's assumption of the father's minimal involvement with the adolescent's care. The father may be working two jobs to support the family's additional expenses.

Initiative vs Industry

magical thinking, superego, oedipal and electa complex, modeling, social awareness, concrete thinking, time relation

Morbidity

measurement of the prevalence of a specific disease in the pop at a specific time

________ is the best way to administer medication for older children that can drink from a cup

medicine cup. do not add to formula because then the child might start rejecting the formula

infant: imitation of gestures how should the nurse deal?

model desired behavior (e.g. opening mouth)

child hood obesity:

most common nutritional problem among American children (increasing in epidemic proportions)

the ___route of medication administration is preferred because of the ease of administration

most medications are dissolved or suspended in liquid preperations'

A patient who is undergoing stem cell therapy asks the nurse about undifferentiated cells. Which response given by the nurse is most appropriate? "These cells:" 1 are able to divide at a very rapid rate." 2 multiply to form any part of the body." 3 can perform specialized functions." 4 are similar to all other cells in the body."

multiply to form any part of the body."

Infant mortality

number of deaths during the first year of life per 1000 births

Frued's Psychosexual Stages

oral stage, anal stage, phallic stage, latency stage, genital stage

What should be done/reviewed when a CI child is admitted to the hospital?

parent should visit interview with special focus on self-care abilities and special devices used, usual routines, and behaviors that may require intervention placed with roommate at same dvp stage explain procedures in concrete, emphasize what the child will physically experienced; DEMONSTRATION

How should feedings in children with Down Syndrome be approached?

parents need to know tongue thrusting is a phys response, not rejection use small, long, straight-handled spoon to push food to back and side of the mouth hypotonia puts infant at risk for constipation

Encourage who to feed the child or be present during meal times

parents or family members

What is considered partial sight? Legal blindness?

partial sight: 20/70 to 20/200 legal blindness: <20/200

Childhood Health Problems

pediatric social illness, low birth weight, obesity, type 2 diabetes, childhood injuries, violence, substance abuse, and mental health problems (etc)

What are the 3 s/sx of SC compression?

persistent necl pain, loss of established motor/bladder/bowel control, changes in sensation

School age child: Improved concept of time how should the nurse deal with this ?

plan for longer teaching session (20 mins) prepare up to 1 day in advance of procedure to allow for processing of information

The best approach for effective communication with a preschooler is through speech. play. drawing. actions.

play. Preschoolers' most effective means of communication is through play. Play allows preschoolers to understand, adjust to, and work out life's experiences through their imagination and ability to invent and imitate. Speech is not effective, because preschoolers assume that everyone thinks as they do and that a brief explanation of their thinking makes them understood by others, which is often not true. Also, preschoolers often do not understand the meaning of words and often take statements literally. Drawing is still being developed as a fine motor skill; therefore, it is not the most effective means of communication. Actions are not an appropriate means of communication for a preschooler.

preschooler: Fears of bodily harm, intrusion and castration

point out on drawing, doll or child where procedure is performed emphasize that no other child part will be involved use nonintrusive procedures whenever possible (e.g. axillary temperatures, oral medication) apply an adhesive bandage over puncture site encourage parental presence realize that procedures involving genitailia provoke anxiety allow child to wear underpants with gown explain unfamiliar situations,especially noises or lights

Pincer grasp

pointer finger and thumb squeeze to grasp an object

problems that negatively impact a child's development include:

poverty, violence, aggression, noncompliance, school failure & adjustment to parental separation and divorce

when kids finish their food what should you do? What to do if they dont?

praise children for what they do eat and do not punish. Dont punish by not giving dessert

school age child: Developing relationships

prepare 2 or more children for same procedure or encourage one to help prepare another provide privacy from peers durign procedure to maintain self-esteem

Toddlers: limited concept of time how to deal with this?

prepare child shortly or immediately before procedure keep teaching session short (5-10 minutes) have preparations completed before involving child in procedure Have extra equipment nearby (alcohol swabs, new needle adhesive bandages) to avoid delays tell child when procedure is cimpleted

adolescent: consciousness of appearance

procide privacy: describe how the body will be covered and what will be exposed discuss how procedure may affect appearace scar) and what can be done to minimize it emphasize any physical benefits of procedure

pediatric nurse

promotes health & well being of child and family

An adolescent is admitted to the hospital for a fractured femur. The most appropriate nursing intervention(s) in caring for this adolescent is/are to Select all that apply. provide written material about the hospital. provide an opportunity for the adolescent to try on surgical attire. explain the upcoming surgery to the adolescent using anatomically correct models. provide an opportunity for the adolescent to talk with peers who have had a similar experience. provide education for the parents of what to teach so they can share with their adolescent.

provide written material about the hospital. explain the upcoming surgery to the adolescent using anatomically correct models. provide an opportunity for the adolescent to talk with peers who have had a similar experience. Adolescents benefit from written material about hospitalization. This material offers information and services provided in the hospital that the adolescent can access that gives a sense of control. The use of anatomically correct models to explain surgical procedures offers the adolescent opportunities to ask questions and decrease fear and anxiety. The opportunity for the adolescent to talk with peers who have had a similar experience to facilitate communication on their level. Dressing up in surgical attire is appropriate for the younger child, not the adolescent. The adolescent should be taught firsthand about the hospitalization and what to expect.

Informed consent

pt's right to receive sufficient information to make an informed health care decisions

A case manager is assigned to coordinate the care of a child with a complex medical condition. The family is told that one of the goals is to control costs. This goal should be recognized as unsafe. realistic. impossible. inappropriate.

realistic. Management of costs is one part of case management. With a case manager providing coordination and continuity across care settings and facilitating access to needed medical services, cost control is a realistic outcome. Cost management will only be unsafe if treatment and equipment necessary for the child's care are denied. Cost management is a realistic goal for the case manager, not an impossible one. Cost management is not an inappropriate one, unless treatment or equipment necessary for the child's care is denied.

adolescent: Concern more with present than with future how the nurse should deal with this?

realize tha immediate effects of procedure are more significant than future benefits

infants: memory for past experiences how should the nurse deal?

realizes that older infants may associate objects, places, or persons with prior painful experiences and will cry and resist at the sight of them. keep frightening objects out of view perform painful procedures in a separate room, not in crib (or bed) use nonintrusive procedures whenever possible (e.g. axillary or tmpanic temperatures, oral medications)

Family Centered Care

recognizes the family as the constant in child's life, -approach to planning, delivery, and evaluation of health care grounded in mutually beneficial partnerships among providers, fam, pts

A 4½-year-old boy has been having increasingly frequent angry outbursts in preschool for approximately 8 to 10 weeks. In addition, he is aggressive toward the other children and teachers. His parents ask the nurse for advice. The most appropriate nursing intervention is to explain that this is normal in preschoolers, especially boys. refer the child for counseling. talk to the preschool teacher to obtain validation for the behavior the parent reports. encourage the parent to try more consistent and firm discipline.

refer the child for counseling. This is not expected behavior. The child should be referred to a competent professional to deal with his aggression so that an accurate assessment can be made and a care plan determined. Outward aggression to others is not normal behavior and should be evaluated. The validation will be helpful for the referral, but the referral is the priority action. This may be recommended by the professional once an accurate assessment is made.

During a well-child visit, the father of a 4-year-old child tells the nurse that he is not certain if his child is ready for kindergarten. The child's birthday is close to the cutoff date, and the child has not attended preschool. The most appropriate recommendation by the nurse is to encourage the father to have the child start kindergarten. recommend to the father that he postpone kindergarten and send the child to preschool. refer the child for developmental screening and make a recommendation based on the results. have the father observe a kindergarten class and then decide if his child would enjoy the experience.

refer the child for developmental screening and make a recommendation based on the results. A developmental screening will provide the necessary information to help the family determine readiness. Encouraging the father to have the child start kindergarten does not address the father's concern about readiness and suggests that his concerns are not warranted. Recommending to the father that he postpone kindergarten and send the child to preschool assumes that the child is not ready for kindergarten, but the recommendation is not based on any data or facts. Recommending to the father that he simply place his child in preschool may lead to the child's boredom with school. Having the father observe a kindergarten class and then decide if the child would enjoy the experience will provide information about kindergarten but not about whether his child is ready to begin and thrive there.

strategies for enhancing compliance in children and families:treatment strategies

relate to the child's refusal or inability to take the prescribed treatment regimen. The family may also have difficulty following a prescribed treatment regimen. Assess the reason for refusal. Assess the treatment and medication schedule to determine whether it is reasonable for a home situation. Basically a strategy to ensure the patient is getting treatment the best and easiest way possible.

how to incorporate play into nursing procedures and activities

selecting non threatening words or phrases, can facilitate learning and adjustments to the new situation for the hospitalized child

Suicide

self chosen death & is 3rd leading cause of death in children 10-19

____ ___increase autonomy in adolescents

self esteem

What kind of play do CI children need?

sensorimotor for extended period; expose to sounds/sights/sensations outings, visitations may enjoy indiv/dual sports more than team sports

Piaget's stages of cognitive development

sensorimotor, preoperational/preconceptual, concrete operational, formal operational

what kind of protions should you give children

serve small portion serve each course separately and ensure a variety of foods, textures and colors

serve ____ meals with a nutritious between meal snack

serve small, frequent meals with nutrition snacks in between

How can a CI child be disciplined?

simple, consistent limit-setting if not cognitively able to, moral lessons are of little value reinforcement and time-outs best, avoid aversive strategies

Kimberly, age 4 years, sometimes wakes her parents up at night, screaming, thrashing, sweating, and apparently frightened. Yet she is not aware of her parents' presence when they check on her. She lies down and sleeps without any parental intervention. This most likely scenario is nightmares. sleep terrors. seizure activity. sleep apnea.

sleep terrors. In sleep terrors, the child is only partially aroused; therefore, she does not remember her parents' presence. A nightmare is a frightening dream followed by full awakening; therefore, the child would realize that her parents are present. The description of the child's experience does not indicate the presence of seizure activity. Sleep apnea is a cessation of breathing during sleep.

S3 and S4 heart sounds

soft sounds, blood flow into ventricles and atrial contraction

Define the term fading.

specifically taking the child through each sequence of the desired activity and gradually fading out phys assistance so child becomes more independent

Squint or cross-eye; malalignment of eyes

strabismus

Medication is not added to the infants formula feeding because the child my

subsequently refuse the formula.

Play can be used to ....

teach, express feelings, or achieve a therapeutic goal. Consequently it should be included in preparing children for and encouraging their cooperation during procedures.

Describe Erikson's Autonomy vs. shame and doubt

the Childs behavior is their own and they strongly express their emotions

Describe Paige's sensorimotor /cognitive development

the child cannot transfer past knowledge to new situations ex: need to investigates light switch function every time they see it

Describe Negativism

the child likes to say no or me do , don't give choice where there is not one

Prior to accepting an assignment as a home health nurse, the nurse must realize that the family is in charge. all decisions are made by the health care provider. the family will adapt their lifestyle to the needs of the nurse. independent decisions regarding emergency care of the child are made by the nurse.

the family is in charge. The nurse must realize that the family is in charge. The family is in charge and the health care providers must realize this matter. The nurse must be flexible and adaptable to the family's lifestyle. Informed consent must be provided by the family for emergency care-any care.

Describe Ritualism

the idea of sameness provides comfort to the child

patients who are more knowledgeable about their condition are more likely to comply;how should the nurse incorporate this?

the nurse should incorporate teaching principles known to enhance understanding retention of material

Describe the Preconceptual phase

theres a transition between self satisfying behavior and socialized relationships. - also there is mental symbolism resulting in fear of things like dentist or uniforms

what is going on with toddlers in regards to Psychosocial development?

they differentiate themselves from others and can tolerate separation from parents

why are ear infections common in toddlers?

they're ear canals are short and straight

What age does parallel play?

toddlers

Parallel play

toddlers play next to each other but not with each other

violence permeates American households thru

tv, commercials, games, movies , that all desensitize child towards violence'

when do children prefer using their fingers?

until 18 months

toddler: developing anatomy and sensorimotor to preoperational thought how should the nurse deal?

use same approaches as for infant plus the following

Preschooler: increased language skills how to deal with this?

use verbal explanation but avoid oversestimating childs comprehenion of words encourage child to verablize ideas and feelings

Research and EBP: GRADE criteria-

used to evaluate the quality of research articles used to develop practice guidelines

Family Systems Theory

views the family as a functioning unit that solves problems, makes decisions, and achieves collective goals

Ecomaps

visual representation of the relations between social network members. Members of the network are represented by points, and lines are drawn between pairs of points to demonstrate a relationship between them; also called a sociogram

Define the term shaping.

waiting for the child to give a response that approximates the desired behavior, then reinforcing successive approximations of the end goal

what happens in regards to weight in toddlers

weight gain slows to 4.5-6.5 pounds/year

What vaccines should be given for 3-6 years?

yearly seasonaly influenza vaccine

On assessing a large family, the nurse finds one of the adolescents is less peer-oriented, lacks autonomous inner controls, and does not tend to participate democratically in family interactions or depend on parents for advice. Which behavior of the adolescent will the nurse think to be uncharacteristic of an adolescent belonging to a large family? 1 Less peer orientation 2 Democratic participation 3 Autonomous inner controls 4 Depending on parents for advice

1 Peer orientation is typically seen in adolescents from large families. Democratic participation, developed autonomous inner controls, and depending on parents for advice are not normal behavioral patterns seen in adolescents from large families.

A couple who is going through a divorce asks the nurse how to disclose this news to their 4-year-old child. What would be the nurse's best response? 1 "You should sit down and calmly explain the situation to your child." 2 "You should not discuss it with the child until after the divorce is final." 3 'You should ask the grandparents or another relative to break the news." 4 "You should take your child to see a psychiatrist to break the news."

1 The parents should set aside time and explain the separation to their child. They should answer the child's questions and give the child time to absorb the information. The parents should not hide the information from the child because it can damage trust between the parents and the child. It is healthier when the child finds this out from parents rather than somebody else, whether it is the grandparents or a psychiatrist.

The community health nurse is performing an assessment of an adolescent. Which group does the nurse ask the adolescent about when assessing the primary social group? 1 Peers 2 Church group 3 Work colleagues 4 Professional seniors

1 There are two types of social groups, primary and secondary. The primary group consists of peers and family who have a direct contact with and influence on the person. Secondary groups are indirectly related to the person. The examples include social organizations such as the church group, and professional groups such as office colleagues and professional seniors. Test-Taking Tip: Read carefully and answer the question asked; pay attention to specific details in the question.

A camp nurse is assessing a group of children attending summer camp. Based on the nurse's knowledge of special parenting situations, which group of children is at risk for a sense of belonging? 1 Children adopted as infants 2 Children recently placed in foster care 3 Children whose parents recently divorced 4 Children who recently gained a stepparent

2 Children placed in foster care are at greater risk to have problems perceiving a sense of belonging. Children adopted at birth have fewer problems with acceptance when parents follow preadoption counseling about disclosure. Children of divorced parents often fear abandonment. Children who gain a stepparent are at risk for having trust problems with the new parent.

Detecting communication disorders during early childhood: a. adversely affects the child's social relationships. b. increases the child's difficulty with academic skills. c. increases the child's ability to correct deficit skills. d. adversely affects the child's emotional interactions.

c. increases the child's ability to correct deficit skills.

Which type of language development is seen in 4-year-olds? 1 Names four or more colors 2 Knows simple songs 3 Has vocabulary of about 2100 words 4 Uses sentences of six to eight words, with all parts of speech

2, a 4-year-old knows simple songs. A 5-year-old can name four or more colors, has a vocabulary of about 2100 words, and uses sentences of six to eight words with all parts of speech.

After giving a bed bath and cleaning the feet of a 2-year-old boy, an intravenous line is inserted into a small area by shaving the scalp. His Jewish parents are upset with this procedure. What could be the most probable reason behind the parents' discontent? 1 Intravenous infusions are against Jewish culture. 2 Scalp vein insertions are against the Jewish culture. 3 Cutting the hair before 3 years of age is not permitted in Jewish culture. 4 Touching the head after touching the foot is disrespectful in Jewish culture.

3 In Jewish culture, first haircut is done for boys at age 3 years. This is called the "upsherenish ceremony." Therefore, the nurse should have gotten consent from the parents before shaving the scalp of the boy. Intravenous infusions and scalp vein insertion are allowed in the Jewish culture. Touching the head after touching the foot is considered disrespectful in the Vietnamese culture.

A family presents to the emergency room with a child with enuresis. They tell the nurse that they have tried their traditional cure of burning to alleviate the problem. What can the nurse expect as a physical sign of this practice? 1 Reddened blotches on the skin 2 Rash covering the child's body 3 Small blisters on the child's body 4 Small welt-like lesions on the skin

3 Many communities follow the practice of burning. As the name suggests, small burns are made on the child's body in an attempt to cure disorders such as enuresis and temper tantrums. The nurse is most likely to find blisters on the child's body. Reddened blotches, rashes, and welt-like lesions may be signs of an allergic reaction.

A single working parent says that caring for a child and managing work is becoming difficult. The nurse determines that the patient is exhausted by these responsibilities. Which is the most appropriate service that would benefit the patient? 1 Hospital 2 Change of job 3 Adoption service 4 Respite child care

4 Respite child care is a service available to help parents to relieve exhaustion and avoid burnout. Therefore, the patient should seek respite child care services. Hospitals are for patients who need medical attention. It would not be appropriate to change jobs because the stress of working would still be there. Adoption services are inappropriate in this situation.

In regard to Fragile X syndrome, the fragile site is caused by: a. 5 to 40 repeats of nucleotide base pairs. b. gene mutation. c. infection. d. advanced maternal age.

b. gene mutation. 5-40 repeat nucleotide pairs normal 55-200 is carrier 200-2000 is full mutation, occurs when base pair repeats expand from genetic heritage

The parents of a child who is stuttering should be encouraged to: a. have the child start again more slowly. b. give the child plenty of time. c. show concern for the hesitancy. d. reward the child for proper speech.

b. give the child plenty of time. chances of reversal good if done <5y.o. undue stress may result in abnormal speech pattern

What are the unique features of a primary social group as part of social and cultural roles? Select all that apply. 1 The members of the social group are intimate with each other. 2 The members of the social group are mutually supportive. 3 The members of the social group a part of professional association. 4 The member of the social group has less concern for other member's behavior. 5 The behaviorof the individual member of a social group is constrained

1, 2, 5 Primary and secondary are the two types of social groups. The primary group includes family and peer, and is characterized by intimate and face-to-face contacts. The features of primary social group are intimacy, mutual support, and constraint of individual members' behavior. Professional association and less concern for members' behavior are features of a secondary social group. STUDY TIP: Avoid planning other activities that will add stress to your life between now and the time you take the licensure examination. Enough will happen spontaneously; do not plan to add to it.

What are the ways the nurse may help a family meet its needs based on family strength and functioning styles? Select all that apply. 1 Providing individualized support 2 Strengthening the family resources 3 Helping to delineate the individualized work 4 Training the family members to avoid stressful events 5 Building on qualities that make family function in a better manner

1, 2, 5 Providing individualized support, strengthening the family resources, and building on qualities that makes the family work better are the ways a nurse may help the family to meet its demands. Efforts should be made to share work in groups rather than delineating work. Families actually cope and respond to stressful events, which has to be identified and appreciated.

Children are taught the values of their culture through observation and feedback on their own behavior. A nurse teaching a class on cultural awareness-competence should be aware of which factor(s) that may be culturally determined? Select all that apply. 1 Social roles 2 Racial variation 3 Degree of competition 4 Determination of status 5 Geographic

1, 3, 4 Social roles are influenced by culture. Cultures that value individual resourcefulness/competition of status is acceptable. Determination of status is culturally determined and varies according to each culture. Racial variation refers to transmissible traits. Culture is composed of beliefs, values, practices, and social relationships that are learned. Cultural development may be limited by geography. The geographic boundaries are not culturally determined.

What instructions should the nurse give to parents who have adopted a child? Select all that apply. 1 "You should reveal the adoption information as soon as possible." 2 "You should ask a third party to reveal the adoption information." 3 "You should always be honest and open toward the child." 4 "You should never reveal to the child that the child is adopted." 5 "Revealing adoption information causes concern and anxiety in children."

1, 3, 5 Discussing adoption with the adopted child requires utmost care. The parents should always be honest with their children. This strengthens the relationship between the parents and the adopted child. Revealing information early leads to less chance of misunderstanding and better continuance of relationship. Adoption information causes concern and anxiety in children but should not be avoided. Information about the adoption has to be revealed before any third party reveals it. Adoption information should not be withheld; the child has the right to know about the parents.

A female patient tells the nurse, "I am well educated and would like to start working full-time like my husband." How should the nurse respond? Select all that apply. 1 "You might potentially get really stressed with work and house chores." 2 "You may at times direct your stress toward children." 3 "Dual income would help you to lead a joyous life." 4 "You may not have adequate time for social activities." 5 "You may have problems fulfilling time demands."

1, 4, 5 Work overload is a common source of stress in a dual-earner family as both partners need to share the household chores. Social activities are significantly curtailed as most time is devoted in meeting the responsibilities of the household. Time demands and scheduling are major problems for all individuals who work. Dual income provides more economic stability rather than making them happy. It is usually an indirect stress to the child.

The nurse is planning care for the family of a preschool-age child who has a chronic illness. Which activities should the nurse recommend to decrease the risk for compassion fatigue? Select all that apply. 1 Exercising 2 Moving away 3 Developing a hobby 4 Fostering social relationships 5 Sleeping more than twelve hours each night

1,3,4 The nurse should recommend exercising, developing a hobby, and fostering social relationships as activities that can decrease the risk for compassion fatigue. Moving away is avoidance behavior that does not address exhaustion from overwhelming caregiving responsibilities. Sleeping more than the body requires is also an avoidance behavior.

How should the nurse obtain cultural knowledge? 1 By interacting with people of different cultures 2 By seeking formal and informal education about various cultures and cultural practices 3 By learning to appreciate different cultural values 4 By seeking training in various nursing interventions

2 Cultural competence has five components. Cultural knowledge is formal and informal education about various cultures and cultural practices. It does not involve interacting with people from different cultures -- this is a cultural encounter. It also does not involve cultural appreciation by the nurse; this is cultural awareness. It does not consist of knowledge of nursing interventions.

The nurse is caring for a dying boy whose religion is Islam (Muslim/Moslem). An important nursing consideration related to his impending death and religion is that: 1 there are no special rites. 2 there are specific practices to be followed. 3 the family is expected to "wait" away from the dying person. 4 baptism should be performed if it has not been done previously.

2 Islam has specific rituals for bathing and wrapping the body in cloth before it is to be moved. The nurse should contact someone from the person's mosque to assist. Family may be present. No baptism is performed at this time. Test-Taking Tip: Attempt to select the answer that is most complete and includes the other answers within it. For example, a stem might read, "A child's intelligence is influenced by:" and three options might be genetic inheritance, environmental factors, and past experiences. The fourth option might be multiple factors, which is a more inclusive choice and therefore the correct answer.

The nurse is assessing a traditional Hindu woman. What should the nurse ask in order to learn about the patient's health traditions? 1 "Do you have an advance directive for medical decisions?" 2 "What are your beliefs about health and illness?" 3 "How often do you pray or visit a place of worship?" 4 "Can you tell me when you developed the symptoms?"

2 Many cultures have health practices and traditions different from those of the Western world. The nurse can ask questions about their health and illness beliefs. These include all the health practices, medicines, and food of the patient's culture. This can help the nurse and patient develop mutually acceptable goals. Asking a patient whether he or she had an advance directive is important but will not provide information about cultural health practices. How often the patient prays is not related to cultural health practices. The nurse should ask questions about when the symptoms developed, but this does not relate to cultural health practices.

The nurse is caring for a traditional Chinese patient. The patient avoids direct eye contact with the nurse. What should the nurse conclude from this behavior? 1 The patient has major depression. 2 The behavior is acceptable and normal. 3 The patient demonstrates low self-esteem. 4 The nurse should get a psychiatric referral.

2 Many traditional Chinese people avoid direct eye contact as a sign of respect. It may be normal for this patient. The nurse cannot conclude that the patient has major depression or low self-esteem just from this behavior. Other assessment data are needed. There is also no evidence that this patient needs a psychiatric referral because he or she does not make eye contact. Test-Taking Tip: Pace yourself during the testing period and work as accurately as possible. Do not be pressured into finishing early. Do not rush! Students who achieve higher scores on examinations are typically those who use their time judiciously.

The nurse is assessing a 14-year-old child who has recently discovered he or she is adopted. What may be a sign that the child is not handling this information well? 1 Nausea and vomiting 2 Decline in school grades 3 Increased thirst and polyuria 4 Changes in elimination

2 Teenagers do not always verbalize their feelings, so one sign may be a decline in school grades. The child's temper and social behaviors may also be altered. Nausea and vomiting may be a sign of a viral infection. Increased thirst and polyuria are signs diabetes mellitus. Disturbances in elimination are common in infants after stress; however, they are uncommon in adolescence. Test-Taking Tip: The computerized NCLEX exam is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer will present the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass.

The nurse is caring for a Buddhist patient. The nurse finds that the patient has not touched the food tray. The food tray holds chicken, bread, soup, and fruits. What is the most appropriate action by the nurse? 1 Start an intravenous (IV) infusion because the patient is not eating. 2 Advise the patient to eat the food because it is essential for health. 3 Ask the patient whether there is a problem with the food provided. 4 Ignore the behavior.

3 Many Buddhists are strictly vegetarian. This may explain why the patient does not touch the meal tray. The nurse should ask the patient what his or her dietary preferences are and provide what the patient wants. However, the nurse should not provide food choices that go against any dietary restrictions placed by the health care provider. It is inappropriate to start an IV line because IV fluids do not provide nutrition. The nurse should not force the patient to eat or ignore the patient.

The nurse is caring for a Mexican patient with severe febrile seizures. As a part of the care, the nurse removes the child's clothing and provides a bath while maintaining privacy. The nurse also takes off an amulet and necklace worn by the child. Later in the day, the child's parents refuse to speak to the nurse. What is the likely cause for their behavior? 1 They oppose treatments in conventional medicine. 2 They did not like the nurse touching and bathing their child. 3 They did not want the amulet and necklace to be removed. 4 Their spiritual healer forbids them to talk to the nurse

3 Many religions believe in supernatural causes and cures of diseases. Many Mexican people wear amulets and necklaces, which they believe ward off evil and protect a person from evil eye and diseases. The nurse took off the amulet and necklace without speaking to the parents or asking their permission. This is the most likely cause of the parents' displeasure. The parents brought the child to the hospital, which suggests they have no objection to modern medicine or nursing care.

Which statement describes a reconstituted family? 1 A child who lives with another family that has legal guardianship 2 A child staying with grandparents, away from the parents 3 A child staying with the father and the new stepmother 4 A child living in a family with both parents working for a living

3 Reconstituted families are families made up of stepfathers or stepmothers with or without their respective children. Children staying with another family with legal guardianship are in foster care. Children staying with their grandparents are in kinship care. Families where both parents work are called dual-earner families.

Before transporting a 16-year-old American Indian female for a magnetic resonance imaging (MRI) scan, the nurse notices the girl is wearing a decorated amulet necklace. The nurse's next best action is to: 1 remove the necklace and place it at the nurse's station. 2 explain the risks of wearing the necklace during the MRI. 3 ask the patient if there is a special reason for wearing the necklace. 4 place tape around the neck covering the necklace.

3 The nurse should first ask the patient the purpose of wearing the necklace. The amulet may be worn as a religious ritual or simply as an accessory. After assessing why the necklace is worn, the nurse can explain the reason for having to remove the necklace for the procedure. The first step is to assess. Placing tape around the neck is not an appropriate action and could be unsafe. The necklace should be left with family members if possible or in a locked cabinet, rather than at the nurse's station. Test-Taking Tip: Many times the correct answer is the longest alternative given, but do not count on it. NCLEX item writers (those who write the questions) are also aware of this and attempt to avoid offering you such "helpful hints."

The nurse is caring for a 7-year-old child. The child wears an amulet because the family believes that it will protect the child from the evil eye. For a diagnostic procedure, the nurse has to take this amulet off. What should the nurse do? 1 Allow the child to continue to wear the amulet for comfort during all aspects of the procedure. 2 Do not perform the prescribed procedure because removing the amulet will hurt the family's feelings. 3 Get permission from the family to remove it for the procedure and replace it afterwards. 4 Ask the family to remove the amulet and not to let the child wear it because it obstructs medical care.

3 The nurse should try to avoid hurting the family's feelings. If the amulet is an obstacle to medical care, the nurse should explain that to the family and obtain their permission to remove the amulet for the procedure. The nurse should replace it as soon as the procedure is over. Continuing the procedure without taking off the amulet may interfere with the procedure or hurt the child. The nurse should not cancel the procedure because it is essential for the child's care. The nurse should not ask the family to remove the amulet permanently because it does not impede all medical care; affects only this procedure.

The nurse should expect to possibly incorporate which religious and cultural practices into the plan of care when caring for a 35-year-old Jewish mother who just gave birth to a healthy baby boy? Select all that apply. 1 Circumcision in hospital 2 Ordering house diet lunch tray of roasted pork with mashed potatoes 3 Allowing family, friends, and rabbi to visit patient often 4 Ask males to remove shawl and yarmulke while visiting 5 Ordering house diet with the exception of shellfish

3, 5 Family, friends, and rabbi should be allowed to visit. Individuals of the Jewish faith generally are prohibited from eating pork or shellfish. Ritual circumcision of male infants is custom on the eighth day and performed by a mohel. Asking males to remove shawls or yarmulkes is inconsistent with acceptance of religious values.

A 14-year-old boy learns about his adoption from his relatives and wants to know his identity. He appears angry, embarrassed, and anxious. What should the nurse advise his parents to help resolve the conflict? 1 "Don't forget to obtain the boy's birth certificate." 2 "Don't reveal the information regarding the adoption." 3 "Don't encourage the boy to search for his identity in this situation." 4 "Don't forget to inform the child about the availability of a birth certificate."

4 Adoptive parents should inform the boy about the availability of a birth certificate. Open and honest communication between the boy and the parents is essential for the welfare of the adopted child. Legally, adoptive parents are not permitted to obtain the birth certificate. Parents should understand the need of the child to search for his identity and extend encouragement and support. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer

During the assessment of a 5-year-old child whose parents are from Southeast Asia, the nurse notices small burn injuries on the skin. The nurse learns that the child has a history of temper tantrums. Which is the immediate nursing action? 1 Call the police. 2 Report child abuse. 3 Inform the health care provider. 4 Ask the parents about the injury.

4 Communication is important to avoid wrong diagnosis and interpretations. The nurse should ask the parents about the burn injuries to understand their cultural and religious practices. If the child exhibits temper tantrums, some Southeast Asian cultural groups follow the practice of causing burn injuries on the skin for treatment. These burn injuries are not considered to be abusive by this cultural group even though the dominant culture and legal system may consider this to be child abuse. Therefore, there is no need to call the police or report child abuse. The nurse can inform the health care provider after discussing with the parents.

Unequal curvatures in refractive apparatus

astigmatism

List 5 behavioral features common to children with Fragile X syndrome

Autism-like behavior such as gaze aversion; hyperactivity; potentially aggressive behavior; short attention span; intolerance to changes in routine; mouthing behaviors; mild to severe cognitive impairment

Identify the standardized test most commonly used in infants to evaluate cognitive ability.

Bayley Scales of Infant Dvp HINT for neuromotor testing (motor/cognition) Leiter International Performance Scale good if no english or significant language impairment

The nurse is caring for a young child diagnosed with lead poisoning. Which finding indicates that the client has suffered from high-dose exposure to lead? 1 Blindness 2 Hyperactivity 3 Hearing impairment 4 Mild intellectual deficit

Blindness indicates that the client is suffering from encephalopathy as a result of high-dose exposure to lead. Hyperactivity, hearing impairment, and mild intellectual deficit are indications of low-dose exposure to lead.

Children with Down syndrome may have a number of associated anomalies. List the most common congenital anomalies found in these children

CHD such as septal defect in 40-45% renal agenesis, duodenal atresia, Hirschsprung disease, trancheoesophageal fistula, skeletal defects 15-20% have occipitoatlantal/atlantoaxial instability - if symptomatic, assess for risk of SC compression

A preschool-aged child is about to be admitted to the pediatric intensive care unit after surgery for removal of a brain tumor. The nurse manager should intervene immediately when the child's nurse does what? 1 Places a hypothermia blanket at the bedside 2 Adjusts the bed to the Trendelenburg position 3 Obtains electronic equipment for monitoring of vital signs 4 Secures a pump to administer the ordered intravenous fluids

Raising the foot of the bed increases blood flow to the brain, thereby increasing intracranial pressure. An increase in temperature may occur after a craniotomy as a result of stimulation of the hypothalamus. A hypothermic blanket should be ready if the temperature climbs precipitously. Monitoring of vital signs is a critical component of postoperative care. IV infusions must be regulated precisely to minimize the possibility of cerebral edema.

A 4-year-old child with nephrotic syndrome is admitted to the pediatric unit. What clinical finding does the nurse expect when assessing this child? 1 Severe lethargy 2 Dark, frothy urine 3 Chronic hypertension 4 Flushed, ruddy complexion

Dark, frothy urine is characteristic of a child with nephrotic syndrome; large amounts of protein in the urine cause it to take this appearance. The child may be somewhat, not severely, lethargic. Blood pressure is normal or decreased; hypertension is associated with glomerulonephritis. Children with nephrotic syndrome usually have a pale complexion and are not flushed and ruddy in appearance.

What would the nurse instruct the parent to refrain from doing if a 4-year-old child has nightmares on a routine basis? 1 Keeping the lights on 2 Sleeping with the child 3 Tucking in a favorite soft toy with the child 4 Leaving the room after comforting the child

If a child has nightmares, the parent should avoid sleeping with the child. Sleeping with the child may create a habit of delaying bedtime. In case of nightmares, keeping the lights on may help the child to overcome fear. Tucking in a soft toy gives the feeling of security to the child. The parent should comfort the child and leave the child in his or her own bed so that the child does not use the fear as an excuse to delay bedtime.

List at least four early signs that are suggestive of cognitive impairment.

Nonresponsiveness to contact; poor eye contact during feeding; diminished spontaneous activity; decreased alertness to voice or movement; irritability; slow feeding dysmorphic syndromes (microcephaly, etc) major organ system dysfunction B difficulties fine/gross motor delays language difficulties/delay

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

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

Which age group would the nurse state engages in associative play? 1 Infants 2 Toddlers 3 Adolescents 4 Preschoolers

Preschoolers play with one other child in a cooperative manner in which they make something or play designated roles. Infants do not perform allied play. Parallel play is common among toddlers. In this form of play, each one engages in an independent activity that is similar to, but not influenced by or shared with others. Adolescents spend time with multiple friends at one time.

List at least eight strategies the nurse can use during hospitalization of a child who has lost his or her sight.

Talk to the child about everything that is occurring. Emphasize aspects of procedures that are felt and/or heard. Approach the child with identifying information. Explain unfamiliar sounds. Encourage roomingin for parents. Encourage parents to participate in the care. Bring familiar objects from home. Orient the child to the immediate surroundings. If the child has sight on admission, use this opportunity to point out significant aspects of the room and to have the child practice ambulating with the eyes closed.

What does the nurse state the average weight of a preschooler at the age of 5 years old? 1 32 pounds (14.51 kg) 2 37 pounds (16.78 kg) 3 41 pounds (18.59 kg) 4 45 pounds (20.41 kg)

The weight of an average 5-year-old preschooler is 41 pounds (18.59 kg). The average weight at 3 years of age is 32 pounds (14.51 kg). At the age of 4 years, the average weight is 37 pounds (16.78 kg). Forty-five pounds (20.41 kg) is not the average weight of a 5-year old.

A 4-year-old child is admitted to the pediatric unit for a tonsillectomy. During preoperative planning a nurse reviews the child's laboratory report. Which lab value is of most significance in this situation? 1 Potassium level 2 Coagulation studies 3 Red blood cell (RBC) count 4 Erythrocyte sedimentation rate (ESR)

Tonsillectomy may result in hemorrhage because of the vascularity of the oropharynx; clotting function must be adequate. The potassium level, RBC count, and ESR are not significant in this type of surgery if the child is otherwise healthy. Test-Taking Tip: Eat breakfast or lunch before an exam. Avoid greasy, heavy foods and overeating. This will help keep you calm and give you energy.

Delayed Development is any significant lag in physical, cognitive, behavioral, emotional, or social development when compared against developmental norms Cognitive Impairment encompasses intellectual and adaptive functioning significantly below average

What is the difference between CI and developmental disabilities?

In assessing a child for the development of a hearing impairment, the nurse would look for: a. a loud monotone voice. b. stuttering. c. unusual shyness. d. attentiveness, especially when someone is talking

a. a loud monotone voice. * evident in conductive hearing loss ID of hearing loss <3mo and intervention no later than 6mo is essential to facilitate language/edu dvp

The method of communication used with combined auditory and visual impairments that involves spelling into the child's hand is called: a. finger spelling. b. the Tadoma method. c. blindism. d. the tapping method.

a. finger spelling. Tadoma is when child places a hand over speaker's face/neck to monitor facial movements associated with speech production

One of the clinical manifestations associated with the speech sounds known as articulation errors is the: a. omission of consonants at the end of words. b. deviation in pitch or quality of the voice. c. pauses within a word. d. frequent use of circumlocutions.

a. omission of consonants at the end of words.

The American Association on Intellectual and Developmental Disabilities definition of intellectual disability includes: a. significant limitations in intellectual functioning and adaptive behavior. b. an emphasis on function. c. only intelligence and no other criteria. d. an age limit of 16.

a. significant limitations in intellectual functioning and adaptive behavior. must be <18 y.o.

When teaching a child with a cognitive impairment, the nurse's best strategy to present symbols in an exaggerated, concrete form is: a. singing. b. memorizing. c. verbal explanation. d. ignoring the child.

a. singing. understand learning abilities/deficits concrete ideas easier to learn than abstract; DEMONSTRATION over verbal explanation (but if so, use one-step directions b/c they have hard time remembering) repetition important difficulty discriminating b/w 2+ stimuli unless in exaggerated concrete form void of extraneous stimulion

Care for the hearing-impaired child who is hospitalized should include: a. supplementing verbal explanations with tactile and visual aids. b. communicating only with parents to ensure accuracy. c. discouraging parents from rooming in. d. sending nonvocal communication devices home to avoid loss.

a. supplementing verbal explanations with tactile and visual aids. constantly reassure kid's understanding assign nurses without accents, ensure hearing aid is working, to awaken gently shake or turn on hearing aid, make sure nurse is visible before procedure

Fragile X syndrome is: a. the most common inherited cause of cognitive impairment. b. the most common inherited cause of cognitive impairment next to Down syndrome. c. caused by an abnormal gene on chromosome 21. d. caused by a missing gene on the X chromosome.

a. the most common inherited cause of cognitive impairment. more common in females, but male carriers more affected expansion cannot be passed down from father to daughter but trait can be

Which one of the following examples would be most indicative of a language disorder? a. A 22-month-old child who has not uttered his first word b. A 38-month-old who has not uttered his first sentence c. An 18-month-old who uses short "telegraphic" phrases d. A 4-year-old who stutters

b. A 38-month-old who has not uttered his first sentence

Which of the following situations would be considered abnormal? a. A neonate who lacks binocularity b. A toddler whose mother says he looks cross-eyed c. A 5-year-old who has hyperopia d. Presence of a red reflex in a 7-year-old

b. A toddler whose mother says he looks cross-eyed in infants: lack of eye contact; binocularity at 2-4mo childhood:

Which of the following statements is correct about eye care and sports? a. Glasses may interfere with the child's ability in sports. b. Face mask and helmet should be required gear for softball. c. Contact lenses provide less visual acuity than glasses for sports. d. It is usually difficult to convince children to wear their glasses to play sports

b. Face mask and helmet should be required gear for softball.

The mutual participation model of care for the child who is cognitively impaired and needs hospitalization would include: a. isolating the child from others to avoid conflicts. b. allowing parents to room in and participate in the care. c. having the parents perform all activities of daily living. d. having the nurse perform all activities of daily living.

b. allowing parents to room in and participate in the care. don't pressure parent into feeling all ADLs are their responsibility

One behavior associated with hearing impairment in the infant is: a. a monotone voice. b. consistent lack of the startle reflex to sound. c. a louder than usual cry. d. inability to form the word "da-da" by 6 months

b. consistent lack of the startle reflex to sound. * look for head turning, eye blinking, and cessation of body movement variability in response intensity is normal, but complete absence is sus inability to say well-formed syllables (da, na, yaya) by 11mo requires immediate referral

To help families with children who are hearing and vision impaired, the nurse should teach the parents to establish communication by: a. always placing the child in the same place in the room to help identify surroundings. b. selecting a cue that is always used to help the child discriminate one person from another. c. limiting the cues that are sent and received. d. limiting stimulation to allow the child to feel safe.

b. selecting a cue that is always used to help the child discriminate one person from another. discuss with parents behaviors that signal the infant's recognition of them (quieting, blinking, RR change) consistent tactile cues used to associate change of position/activities so that movement is experienced positively and non-threateningly

Which of the following strategies would best help the intellectually disabled child acquire social skills? a. Use discipline and negative reinforcement. b. Provide information about the importance of socialization skills. c. Use active rehearsal with role-playing and practice sessions. d. Use all of the above.

c. Use active rehearsal with role-playing and practice sessions.

Decreased muscle tone in the infant with Down syndrome: a. indicates inadequate parenting. b. is a sign of infant detachment. c. compromises respiratory expansion. d. predisposes the infant to diarrhea.

c. compromises respiratory expansion. * must become mouth breathers, dries oropharyngeal airway and more susceptible to URI and otitis media lack of physical molding is a phys characteristic, not a sign of detachment/rejection

Strategies to use when caring for the hospitalized child with autism include: a. maintaining direct eye contact when explaining procedures. b. using holding and touch to comfort the child. c. decreasing stimulation. d. all of the above.

c. decreasing stimulation. eye and physical contact often upsets these children may startve themselves or eat anything in sight (edible or not)

Following assessment and detection of a language problem, the nurse should advise the family to: a. wait and see what happens. b. wait because the child will grow out of it. c. obtain a specialized evaluation. d. repeat words so that the child will learn more language.

c. obtain a specialized evaluation. direct observation (spontaneous language interaction and word-imitative procedure), indirect assessment via parental info from hx, screening tests (DASE test) waiting and seeing often detrimental

The correct term to use for a person whose hearing disability precludes successful processing of linguistic information through audition without the use of a hearing aid is: a. deaf-mute. b. slight to moderate hearing loss. c. severe to profound hearing loss. d. deaf and dumb

c. severe to profound hearing loss. slight-moderate: residual hearing sufficient to process linguistic info, usually with hearing aid

At what decibel level would a hearing loss be considered profound? a. Less than 30 dB b. 41-60 dB c. 61-80 dB d. More than 81 dB

d. More than 81 dB very loud brief noise or long exposure to hazardous noise can produce hearing loss exact sound level that produces hearing loss unknown slight is 26-40; moderate is 41-60; severe is 61-80dB

Diagnostic criteria for autism spectrum disorders (ASD) include symptoms related to: a. social interactions. b. impairments in communication. c. repetitive behavior patterns. d. all of the above

d. all of the above difficulties adjusting behavior to suit different social contexts, fixed interest, repetitive behaviors communicative impairment (extended humming/grunting, inappropriate laughing, echolalia) gold standard dx is Autism Dianostic Interview

Sensorineural hearing loss occurs as a result of: a. kernicterus. b. use of tobramycin and gentamicin. c. congenital defects of inner ear structures. d. all of the above.

d. all of the above. involves damage to inner ear structures/auditory nerve results in distortion of sound and problems in auditory discrimination may respond to cochlear implants

Acquiring social skills for the child who is intellectually disabled includes: a. learning acceptable sexual behavior. b. being exposed to strangers. c. learning to greet visitors appropriately. d. all of the above.

d. all of the above. teach social behaviors early (waving, thank you, sitting modestly) acceptable sexual B to avoid exploitation need stranger exposure b/c no learning transfer between situations, so practice is needed

The primary purpose of record keeping for 7 days before toilet training an intellectually disabled child is to: a. determine the child's patterns of behavior and parents' response. b. determine the amount of urinary output and usual times the child urinates. c. assess the child's physical and psychologic readiness to use the toilet. d. determine all of the above.

d. determine all of the above. usually begins after self-feeding review past attempts at toilet training and offer positive alternative to negative reinforcers (waking in middle of night, withholding fluid, spanking)

To best promote socialization for the child with a hearing aid, teachers should: a. discourage hearing-impaired children from playing together. b. use frequent group projects to promote communication. c. use audiovisual-assisted instruction as much as possible. d. minimize background noise.

d. minimize background noise. exaggerating pronunciation lessens comprehension audiovisual teaching aids not always suitable sit in semi-circle in front of hearing-impaired kid when in a group; point out next speaker

All of the following strategies will enhance communication with a child who is hearing impaired except: a. touching the child lightly to signal the presence of a speaker. b. speaking at eye level or moving to a 45-degree angle. c. using facial expressions to convey the message better. d. moving and using animated body language to communicate better.

d. moving and using animated body language to communicate better. most common hearing aid problem is acoustic feedback d/t improper fit

Conductive hearing loss in children is most often a result of: a. the use of tobramycin and gentamicin. b. the high noise levels from ventilators. c. congenital defects d. recurrent serous otitis media

d. recurrent serous otitis media conductive/middle hearing loss results from interference with transmission of sound to/by middle ear mainly involves interference in loudness of a sound very responsive to surgery/hearing aid

If a child has a penetrating injury to the eye, the nurse should: a. apply an eye patch. b. attempt to remove the object. c. irrigate the eye. d. use strict aseptic technique to examine the eye.

d. use strict aseptic technique to examine the eye. trauma is most common cause of visual impairment in children removal usually by opthomologist

Define task analysis and describe its use when teaching a child who is intellectually disabled.

the process of breaking down a task into its smallest components allows child to gain independence and take one step at a time

Describe the conditions necessary for a child with cognitive impairment to begin learning how to dress.

they can sit quietly for 3-5 minutes while working on a task can watch what they are doing while working on a task can follow phys gestures/cues and verbal commands can relate clothing articles to appropriate body part

How is play different for visually impaired children?

they can't imitate others or actively explore environment, so depend on others to sitmulate them and teach them how to play discourage the self-stimulatory activities (body rocking, finger flicking, or arm twirling) that they may have dvp to encourage social acceptance