Peds 2
A parent is worried that a child is not eating well. What does the nurse teach the parent to address this problem? a. Limit sports and team events that occur over the dinner hour. b. Pack a nutritious lunch to take to school every day. c. Teach about healthy snacks available at school. d. Ensure the child gets 2 cups of milk products a day.
ANS: A Sports and team schedules often disrupt mealtime, especially dinner, and families often find themselves eating fast food on the way to practices and games. The family's best option is to limit activities that occur during this time. The child may not eat a packed lunch and may choose unhealthy foods from the schools' vending machines. Children in this age group need 3 cups of milk and dairy products per day.
Which activity does the nurse recommend to help develop fine motor skills in the school-age child? a. Drawing b. Singing c. Soccer d. Swimming
ANS: A Activities such as drawing, building models, and playing a musical instrument increase the school-age child's fine motor skills. Activities such as soccer or swimming help develop gross motor skills. Singing does not increase motor skills.
The ability to mentally understand that 1 + 3 = 4 and 4 - 1 = 3 occurs in which stage of cognitive development? a. Concrete operations b. Formal operations c. Intuitive thought d. Preoperations
ANS: A By 7 to 8 years of age, the child is able to retrace a process (reversibility) and has the skills necessary for solving mathematical problems. This stage is called concrete operations. The formal operations stage deals with abstract reasoning and does not occur until adolescence. Thinking in the intuitive stage is based on immediate perceptions. A child in this stage often solves problems by random guessing.
An 8-year-old girl tells the nurse that she has cancer because God is punishing her for "being bad." She shares her concern that if she dies, she will go to hell. What action by the nurse is most appropriate? a. Reassure the child that she is not being punished. b. Share concerns about development with the parents. c. Request a child-life specialist to intervene. d. Have the chaplain console the child.
ANS: A Children at this age may view illness or injury as a punishment for a real or imagined transgression. The nurse should reassure the child that she is not being punished. Since this is a common belief at this age, there are no concerns to share with parents. A child-life specialist or chaplain visit may be appropriate, but the nurse needs to respond to this statement him- or herself.
The nurse is presenting information on burn safety to a toddler and preschool parenting group at a local community center. To avoid the most common cause of fire death in children this age, what information does the nurse provide? a. Practice family fire drills often. b. Cover outlets with plastic covers. c. Turn the water heater temperature to 110° F (43.3° C). d. Keep children out of the kitchen when cooking.
ANS: A Children younger than 5 years are at the greatest risk for burn deaths in a house fire. They often panic and hide in closets or under beds rather than escape safely. Parents need to practice fire drills with their children to teach them what to do in the event of a house fire. Covering outlets, turning the water heater down, and keeping children out of the kitchen when cooking are more appropriate for younger children.
Which statement, made by a nursing student to the father of a 4-year-old child, warrants correction by the nurse? a. "Because the 'baby teeth' are not permanent, they are not important to the child." b. "Encourage your child to practice brushing his teeth after you have thoroughly cleaned them." c. "Your child's 'permanent teeth' will begin to come in around 6 years of age." d. "Fluoride supplements are needed if you do not have fluoridated water."
ANS: A Deciduous teeth are important because they maintain spacing and play an important role in the growth and development of the jaws and face and in speech development. Toddlers and preschoolers lack the manual dexterity to remove plaque adequately, so parents must assume this responsibility. But encouraging the child to practice will aid in increasing his or her abilities. Secondary teeth erupt at approximately 6 years of age. If the family does not have fluoridated water, the child will need fluoride treatments.
A school nurse is teaching a health class for 5th grade children. The nurse plans to include which statement to best describe growth in the early school-age period? a. Boys grow faster than girls. b. Puberty occurs earlier in boys than in girls. c. Puberty occurs at the same age for all races and ethnicities. d. It is a period of rapid physical growth.
ANS: A During the school-age developmental period, boys are approximately 1 inch taller and 2 pounds heavier than girls. Puberty occurs 1 1/2 to 2 years later in boys, which is developmentally later than puberty in girls (not unusual in 9- or 10-year-old girls). Puberty occurs approximately 1 year earlier in African-American girls than in white girls. Physical growth is slow and steady during the school-age years.
A nurse is interested in preventing injuries to children while they play. What action by the nurse would most likely lead to the biggest impact? a. Volunteering for an organization that gives away bicycle helmets. b. Providing education on the need for knee pads when skating. c. Teaching parents that children too big for child care seats should sit in the front seat. d. Encouraging children to play only on formal, constructed playgrounds.
ANS: A Head injuries from bicycles are a large part of serious injury to children in this age group. They need to be taught to only ride a bike while wearing a helmet. The nurse's best option is to volunteer for an organization that gives away helmets. Knee pads when skating is also a good idea, but that won't have the impact of helmets. Once a child is too big for a child care seat and the seat belt fits appropriately, the child should sit in the back seat. Playing on constructed playgrounds only will not prevent injuries and is unrealistic.
The nurse is assessing a preschool aged child during a well-child checkup. This child has gained 2 pounds in 1 year. What action by the nurse is best? a. Ask the parent to provide a 3-day diet diary. b. Assess the child's teeth and gums. c. Plot the weight gain on the growth chart. d. Instruct the parent on today's needed vaccinations.
ANS: A Preschool children gain an average of 5 pounds a year. A gain of only 2 pounds is less than half of the expected weight gain and should be investigated. The other actions are part of a well-child checkup but are not related to the lack of weight gain.
Which toy is the most developmentally appropriate for an 18- to 24-month-old child? a. A push-and-pull toy b. Nesting blocks c. A bicycle with training wheels d. A computer
ANS: A Push-and-pull toys encourage large muscle activity and are appropriate for toddlers. Nesting blocks are more appropriate for a 12- to 15-month-old child. This child is too young for bicycles or computers.
A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says she is completing her schoolwork satisfactorily, but lately she has been somewhat aggressive and stubborn in the classroom. What action by the school nurse is most appropriate? a. Assess the child for unusual stress. b. Perform a detailed physical exam. c. Call the parents in for a conference. d. Screen the child for developmental delay.
ANS: A Signs of stress include stomach pains or headache, sleep problems, bedwetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors. The nurse should assess the child for stress. The other actions are not warranted although the nurse may want to have a conference with parents after screening the child.
The nurse teaches parents signs that a child might be being bullied or otherwise victimized. What signs does the nurse include in this teaching? (Select all that apply.) a. Spends an inordinate amount of time in the nurse's office b. Belongings frequently go missing or are damaged. c. The child wants to be driven to school. d. School performance improves. e. The child freely talks about his day.
ANS: A,B,C Signs that may indicate a child is being bullied are similar to signs of other types of stress and include nonspecific illness or complaints, withdrawal, depression, school refusal, and decreased school performance. Children express fear of going to school or riding the school bus. Very often, children will not talk about what is happening to them. Improving school performance and talking about the day are not indications of bullying.
Which does the nurse teach as an appropriate disciplinary intervention for the school-age child? a. Time-out periods b. Consequences that are consistent with the behavior c. Physical punishment d. Lectures about inappropriate behavior
ANS: B A consequence that is related to the inappropriate behavior is the recommended discipline. Responsibility can be developed in children through the use of natural and logical consequences related to actions. Time-out periods are more appropriate for younger children. Physical intervention is an inappropriate form of discipline. It does not connect the discipline with the child's inappropriate behavior. Lengthy discussions typically are not helpful.
Which demonstrates the school-age child's developing logic in the stage of concrete operations? (Select all that apply.) a. Recognizes that 1 lb of feathers is equal to 1 lb of metal b. Recognizes that he can be a son, brother, or nephew at the same time c. Understands the principles of adding, subtracting, and reversibility d. Has thinking that is characterized by egocentrism, animism, and centration e. Often solves problems with random guessing instead of logic
ANS: A,B,C The school-age child understands that the properties of objects do not change when their order, form, or appearance does. Conservation occurs in the concrete operations stage. Comprehension of class inclusion occurs as the school-age child's logic increases. The child begins to understand that a person can be in more than one class at the same time. This is characteristic of concrete thinking and logical reasoning. The school-age child is able to understand principles of adding and subtracting, as well as the process of reversibility, which occurs in the stage of concrete operations. Egocentrism, animism, and centration occur in the intuitive thought stage, as does random guessing.
Which play patterns does a 3-year-old child typically display? (Select all that apply.) a. Imaginary play b. Parallel play c. Cooperative play d. Structured play e. Associative play
ANS: A,B,C,E Children between ages 3 and 5 years enjoy parallel and associative play. Children learn to share and cooperate as they play in small groups. Play is often imitative, dramatic, and creative. Structured play is typical of school-age children.
A nurse is assessing a child for toilet training readiness during a home visit. Which behaviors by the child are positive signs? (Select all that apply.) a. Removes own clothing b. Walks into bathroom on own c. Has been walking for 6 months d. Will give up toy when asked to e. Scratches as legs periodically
ANS: A,B,D Signs of readiness for toilet training include being able to remove own clothing, being willing to let go of a toy when asked, is able to sit, squat, and walk well, has been walking for 1 year, noticing if diaper is wet, pulls on diaper or exhibits other behavior indicating diaper needs to be changed, communicating the need to go to the bathroom or goes there by self and wanting to please parent by staying dry.
The nurse is assessing parental knowledge of temper tantrums. Which are true statements about temper tantrums? (Select all that apply.) a. Temper tantrums are a common response to anger and frustration in toddlers. b. Temper tantrums often include screaming, kicking, throwing things, and head banging. c. Parents can effectively manage temper tantrums by giving in to the child's demands. d. Children having temper tantrums should be safely isolated and ignored. e. Parents can learn to anticipate times when tantrums are more likely to occur.
ANS: A,B,D,E Temper tantrums are a common response to anger and frustration in toddlers. They occur more often when toddlers are tired, hungry, bored, or excessively stimulated. A nap before fatigue or a snack if mealtime is delayed will be helpful in alleviating the times when tantrums are most likely to occur. Tantrums may include screaming, kicking, throwing things, biting themselves, or banging their head. Effective management of tantrums includes safely isolating and ignoring the child. The child should learn that nothing is gained by having a temper tantrum. Giving in to the child's demands only increases the behavior.
Which interventions should the nurse teach that are appropriate for preventing childhood obesity? (Select all that apply.) a. Establish consistent times for meals and snacks. b. Sign your child up for sports teams. c. Teach the family and child how to prepare foods in a healthy manner. d. Show the family how to read food labels. e. Limit computer and television time.
ANS: A,C,D,E Preventing obesity includes encouraging families to establish consistent times for meals and snacks, teaching them how to select and prepare healthful foods, and limiting computer and television time. Participating in sports is a great activity, but parents should not sign their kids up for teams without consulting them first.
The nurse plans a teaching session with a toddler's parents on car safety. Which will the nurse teach? (Select all that apply.) a. Secure in a rear-facing, upright car safety seat. b. Place the car safety seat in the rear seat, behind the driver's seat. c. Harness safety straps should fit snugly. d. Place the car safety seat in the front passenger seat equipped with an airbag. e. After the age of 2 years, toddlers can be placed in a forward-facing car seat.
ANS: A,C,E Toddlers should be secured in a rear-facing, upright, approved car safety seat. Harness straps should be adjusted to provide a snug fit. After age 2, the child can sit in a forward-facing car seat. The car safety seat should be placed in the middle of the rear seat. Children younger than 13 years should not ride in a front passenger seat that is equipped with an airbag.
A nurse is assessing an older school-age child recently admitted to the hospital. Which assessment does the nurse perform to determine if child is in an appropriate stage of cognitive development? a. Give the child a collection of similar objects, and ask him or her to organize them. b. Ask the child to perform a series of math problems using subtraction. c. Determine the child's vocabulary and reading comprehension. d. Find out what play activities the child enjoys engaging in.
ANS: B The ability to classify things from simple to complex and the ability to identify differences and similarities are cognitive skills of the older school-age child; this demonstrates use of classification and logical thought processes. The emergency of this ability explains why children of this age enjoy collecting things. Subtraction and addition are appropriate cognitive activities for the young school-age child. Vocabulary is not as valid an assessment of cognitive ability as is the child's ability to classify. Play activity is not as valid an assessment of cognitive function as is the child's ability to classify.
The nursing student has planned teaching for a toddler parent group on poison prevention in the home. In reviewing the presentation with the nurse, what information requires the nurse to provide more instruction to the student? a. Lock all medications away securely. b. Place cleaning supplies in a top cabinet. c. Try not to let your child watch you take pills. d. Call Poison Control right away for an exposure.
ANS: B Anything potentially poisonous including things like medication, cleaning supplies, or personal care items must be stored in places completely inaccessible to children. Toddlers view climbing as a challenge, so a top cabinet is not inaccessible. The other instructions are appropriate.
A school nurse reports to the parents that their child is complaining of frequent headaches. What suggestion does the nurse offer to the parents? a. A complete neurologic workup b. A vision screening exam c. Decreased amount of household stress d. Assessment for seasonal allergies
ANS: B Children often manifest visual problems during the school-age period. These children may squint, move closer to the television or to the front of the class if possible, or complain of headaches. The parents should obtain a visual screening exam for their child. None of the other options is needed at this point.
A nurse has been teaching a parent of a toddler about effective discipline. Which statement by the parent indicates that goals for teaching have been met? a. "I always include explanations and morals when I am disciplining my toddler." b. "I always try to be immediate and consistent when disciplining the children." c. "I believe that discipline should be done by only one family member." d. "My rule of thumb is no more than one spanking a day."
ANS: B Consistent and immediate discipline for toddlers is the most effective approach. Unless disciplined immediately, the toddler will have difficulty connecting the discipline with the behavior. The toddler's cognitive level of development precludes the use of explanations and morals as a part of discipline. Discipline for the toddler should be immediate; therefore the family member caring for the child should provide discipline to the toddler when it is necessary. Discipline is required for unacceptable behavior, and the one-spanking-a-day rule contradicts the concept of a consistent response to inappropriate behavior. In addition, spanking is an inappropriate method of disciplining a child.
Parents tell the nurse that their preschool-age child seems to have an imaginary friend named Bob. Whenever their child is scolded or disciplined, the child in turn scolds Bob. What response by the nurse is most appropriate? a. Ask the child to introduce Bob when the parents are not present. b. Inform the parents that this is normal behavior in this age group. c. Suggest the parents discuss the situation with the provider. d. Refer the child for hearing and vision screening.
ANS: B In the early preschool years, boundaries between reality and fantasy blur. Children at the age may develop imaginary friends who can keep them company or take the blame when the child misbehaves. The nurse informs the parents that this is normal behavior. The child likely will not "introduce" Bob to a stranger. The nurse him- or herself needs to provide this anticipatory guidance and not just suggest the parents talk to the provider. There is no reason for sensory screening.
The parent of a 14-month-old child is concerned because the child's appetite has decreased. The best response for the nurse to make to the parent is, a. "It is important for your toddler to eat three meals a day and no snacks." b. "It is not unusual for toddlers to eat less due to slower growth." c. "Be sure to increase your child's milk consumption, which will improve nutrition." d. "Give your child a multivitamin daily to increase your toddler's nutrition."
ANS: B Physiologically, growth slows and appetite decreases during the toddler period. So the nurse should assure the parent that this is normal behavior. Toddlers need small, frequent meals. Nutritious selection throughout the day, rather than quantity, is more important with this age-group. Milk consumption should not exceed 16 to 24 oz daily. Juice should be limited to 4 to 6 oz per day. Increasing the amount of milk will only further decrease solid food intake. Supplemental vitamins are important for all children, but they do not increase appetite.
The nurse is providing anticipatory guidance for parents of a school-age child. Which behavior does the nurse suggest to best assist the child in negotiating the developmental task of industry? a. Identifying failures immediately and asking the child's peers for feedback b. Structuring the environment so that the child can master tasks c. Completing homework for children who are having difficulty with them d. Decreasing expectations to eliminate potential failures
ANS: B The task of the caring teacher or parent is to identify areas in which a child is competent and to build on successful experiences to foster feelings of mastery and success. Structuring the environment to enhance self-confidence and to provide the opportunity to solve increasingly more complex problems will promote a sense of mastery. Asking peers for feedback reinforces the child's feelings of failure. When parents complete children's homework for them, it sends the message that they do not trust their child to do a good job. Providing assistance and suggestions and praising their best efforts are more appropriate. Decreasing expectations to eliminate failures will not promote a sense of achievement or mastery.
The nurse is assessing a toddler's growth and development. Which statement does the nurse understand about language development in a toddler? a. Language development skills slow during the toddler period. b. The toddler understands more than he or she can express. c. Most of the toddler's speech is not easily understood. d. The toddler's vocabulary contains approximately 600 words.
ANS: B The toddler's ability to understand language (receptive language) exceeds the child's ability to speak it (expressive language). Although language development varies in relationship to physical activity, language skills are rapidly accelerating by 15 to 24 months of age. By 2 years of age, 60% to 70% of the toddler's speech is understandable. The toddler's vocabulary contains approximately 300 or more words.
Which statement is correct about toilet training? a. Bladder training is usually accomplished before bowel training. b. Wanting to please the parent helps motivate the child to use the toilet. c. Watching older siblings use the toilet confuses the child. d. Children should be forced to sit on the toilet when first learning.
ANS: B Voluntary control of the anal and urethral sphincters is achieved some time after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please the parent by holding on rather than pleasing himself or herself by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner.
A nurse is planning care for a hospitalized toddler in the preoperational thinking stage. Which characteristics should the nurse expect in this stage? (Select all that apply.) a. Concrete thinking b. Egocentrism c. Animism d. Magical thought e. Ability to reason
ANS: B,C,D The characteristics of preoperational thinking that occur for the toddler include egocentrism (views everything in relation to self), animism (believes that inert objects are alive), and magical thought (believes that thinking something causes that event). Concrete thinking is seen in school-age children, and ability to reason is seen with adolescents.
The increase in the number of overweight children in this country is addressed in Healthy People 2020. Strategies designed to approach this issue include (Select all that apply.) a. decreased calcium and iron intake. b. increased fiber and whole grain intake. c. decreased use of sugar and sodium. d. increase fruit and vegetable intake. e. decrease the use of solid fats.
ANS: B,C,D,E Along with these recommendations, children at risk for being overweight should be screened beginning at age 2 years. Children with a family history of dyslipidemia or early cardiovascular disease development, children whose body mass index percentile exceeds the definition for overweight, and children who have high blood pressure should have a fasting lipid screen. The nurse should instruct parents that calcium and iron intake should be increased as part of this strategy.
The student nurse learns that which factors place children at risk for malocclusion? (Select all that apply.) a. Sucking the thumb b. Mouth breathing c. Cleft palate d. Early loss of "baby" teeth e. Heredity
ANS: B,C,D,E Factors that contribute to malocclusion include mouth breathing, cleft palate, early loss of deciduous teeth, and heredity. Sucking the thumb is not a contributing factor unless it persists beyond 2 to 4 years.
Which strategies can a nurse teach to parents of a child experiencing uncomplicated school refusal? (Select all that apply.) a. The child should be allowed to stay home until the anxiety about going to school is resolved. b. Parents should be empathetic yet firm in their insistence that the child attend school. c. A modified school attendance may be necessary. d. Parents need to pick the child up at school whenever the child wants to come home. e. Parents need to communicate with the teachers about the situation.
ANS: B,C,E In uncomplicated cases of school refusal, the parent needs to return the child to school as soon as possible. If symptoms are severe, a limited period of part-time or modified school attendance may be necessary. For example, part of the day may be spent in the counselor's or school nurse's office, with assignments obtained from the teacher. Parents should be empathetic yet firm and consistent in their insistence that the child attend school. Parents should not pick the child up at school once the child is there or let the child stay home until this issue is resolved. The principal and teacher should be told about the situation so that they can cooperate with the treatment plan.
In providing anticipatory guidance to parents whose child will soon be entering kindergarten, which is a critical factor to include in this teaching? a. The child needs to be able to sit still. b. The child should be able to count to 25. c. The parent should have interaction and be responsive to the child. d. The child should attend a preschool program first.
ANS: C The earliest interactions between parent and infant lay the foundation for school readiness. Probably the most important factor in the development of academic competency is the relationship between parent and child. Sitting still and counting are important skills but are not as vital as parental involvement and responsiveness. Preschool is a helpful experience but not required to enter kindergarten.
A parent reports getting annoyed with a 6-year-old child who seems to always get cranky and irritable when playing with friends. What suggestion by the nurse is best? a. Maybe he should not play with those friends anymore. b. The parents should monitor the children's play more closely. c. When the child gets cranky he should be told to rest. d. The parents should assess the child's diet for protein.
ANS: C Children often do not recognize that they are becoming fatigued. Six-year-olds in particular are quite bad about this. Signs of fatigue include being cranky. The parent should have the child rest at this point. Forbidding the child's friends, monitoring play more closely, and assessing the diet for protein are not needed for this problem.
Which comments indicate that the mother of a toddler needs further teaching about dental care? a. "We use well water so I give my toddler fluoride supplements." b. "My toddler brushes his teeth with my help." c. "My child will not need a dental checkup until his permanent teeth come in." d. "I use a small nylon bristle brush for my toddler's teeth."
ANS: C Children should first see the dentist 6 months after the first primary tooth erupts and no later than age 30 months. Toddlers need fluoride supplements when they use a water supply that is not fluoridated. Toddlers need supervision with dental care. The parent should finish brushing areas not reached by the child. A small nylon bristle brush works best for cleaning toddlers' teeth.
The nurse teaches the parents that which of the following is the primary purpose of a transitional object? a. It helps the parents with the guilt they feel when they leave the child. b. It keeps the child quiet at bedtime. c. It is effective in decreasing anxiety in the toddler. d. It decreases negativism and tantrums in the toddler.
ANS: C Decreasing anxiety, particularly separation anxiety, is the function of a transitional object; it provides comfort to the toddler in stressful situations and helps make the transition from dependence to autonomy. Decreased parental guilt (distress) is an indirect benefit of a transitional object. A transitional object may be part of a bedtime ritual, but it may not keep the child quiet at bedtime. A transitional object does not significantly affect negativity and tantrums, but it can comfort a child after tantrums.
A parent of a chubby 8-year-old wants to know how to keep the child from gaining more weight. What response by the nurse is best? a. Do not allow your child to snack. b. Make a school lunch every day. c. Model the behaviors you'd like to see. d. Place your child on a restricted diet.
ANS: C One good option for obesity prevention is to model the behaviors the parents want the child to emulate. The parents should set good examples with eating health and engaging in regular exercise. Snacks, if healthy, can be an important part of a nutritious day. Even if the parent makes a lunch for school each day, there is no guarantee the child will eat it. Children will likely rebel against a strict diet.
A group of boys ages 9 and 10 years have formed a "boys-only" club that is open to neighborhood and school friends who have skateboards. This should be interpreted as a. behavior that encourages bullying and sexism. b. behavior that reinforces poor peer relationships. c. characteristic of social development of this age. d. characteristic of children who are at risk for membership in gangs.
ANS: C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. A boys-only club does not have a direct correlation with later gang activity.
Which statement is the most accurate about moral development in the 9-year-old school-age child? a. Right and wrong are based on physical consequences of behavior. b. The child obeys parents because of fear of punishment. c. The school-age child conforms to rules to please others. d. Parents are the determiners of right and wrong for the school-age child.
ANS: C The 7- to 12-year-old child bases right and wrong on a good-boy or good-girl orientation in which the child conforms to rules to please others and avoid disapproval. Children 4 to 7 years of age base right and wrong on consequences. Consequences are the most important consideration for the child between 4 and 7 years of age. Parents determine right and wrong for the child younger than 4 years of age.
The parents of a newborn say that their toddler "hates the baby.... He suggested that we put him in the trash can so the trash truck could take him away." The nurse's best action is to a. assess the older child for signs of child abuse. b. refer the family for psychological counseling. c. assist the family to deal with this response. d. encourage the family to give the toddler extra attention.
ANS: C The arrival of a new infant represents a crisis for even the best prepared toddler. Toddlers have their entire schedule and routines disrupted because of the new family member. This is a normal response. The nurse should work with parents on ways to involve the toddler in the newborn's care and to help focus attention on the toddler. There is no need to assess for child abuse or to refer the family for counseling. Giving the toddler some extra attention and "special time" will probably help, but this is too narrow in scope to be the best answer. The nurse should help brainstorm several different strategies.
The nurse is planning to teach parents of a 15-month-old child. Which is the priority concern the nurse should address? a. Toilet training guidelines b. Guidelines for weaning children from bottles c. Instructions on preschool readiness d. Instructions on a home safety assessment
ANS: D Accidents are the major cause of death in children, including deaths caused by ingestion of poisonous materials. Home and environmental safety assessments are priorities in this age-group because of toddlers' increased motor skills and independence, which puts them at greater risk in an unsafe environment. Although it is appropriate to give parents of a 15-month-old child toilet training guidelines, the child is not usually ready for toilet training, so it is not the priority teaching intervention. Parents of a 15-month-old child should have been advised to begin weaning from the breast or bottle at 6 to 12 months of age. Educating a parent about preschool readiness is important and can occur later in the parents' educational process. The priority teaching intervention for the parents of a 15-month-old child is the importance of a safe environment.
A school-age child got a hand-knitted sweater from a relative as a gift. The child refuses to wear it, and it is causing a great deal of conflict in the family as the relative wants to see the child in it. What information can the nurse provide the family about this issue? a. This is a time when strict discipline is needed and should be enforced. b. It's best to choose your battles carefully or you'll fight over everything. c. Teach the child a polite way of expressing dislike for the sweater. d. Children this age find it painful to be different from their peers.
ANS: D Children at this age do find it very painful to be different in any way from their peers. The sweater may be very different from anything the peers are wearing, which makes the child reluctant to wear it. The nurse can provide this information to the family so they have information they can use in working out a solution to this problem. Strict discipline is not needed. Telling parents to choose their battles does not help them solve this situation. Children should be taught polite ways in which to express themselves, but this also does not help to solve the family conflict.
What do parents of preschool children need to understand about discipline? a. Both parents and the child should agree on the method of discipline. b. Discipline should involve some physical restriction. c. The method of discipline should be consistent with that of the child's peers. d. Discipline should include positive reinforcement of desired behaviors.
ANS: D Effective discipline strategies should involve a comprehensive approach that includes consideration of the parent-child relationship, reinforcement of desired behaviors, and consequences for negative behaviors. Discipline does not need to be agreed on by the child. Preschoolers feel secure with limits and appropriate, consistent discipline. Both parents should be in agreement so that the discipline is consistently applied. Discipline does not necessarily need to include physical restriction. Discipline does not need to be consistent with that of the child's peers.
A school nurse is conducting a class on safety for a group of school-age children. Which statement indicates that the children may need further teaching? a. "My sister and I know two different ways to get out of the house." b. "I can dial 911 if there is a fire or a burglar in the house." c. "If we have a fire, we have to meet at the neighbor's house." d. "If there is a fire I will go back for my cat Fluffy because she will be scared."
ANS: D Fire safety is important at any age, but for this age group children should know two different ways out of the house, how to call 911, and where the family will meet outside the house. Children should be taught never to return to a burning house, not even for a pet.
The nurse is talking to a 7-year-old boy during a well-child clinic visit. The boy states "I am a Power Ranger, so don't make me angry!" What action by the nurse is best? a. Ask the child about other friends he might play with. b. Find out why the child thinks he is a Power Ranger. c. Ask the parents if he has any opposite sex friends. d. Conduct further developmental screening on the child.
ANS: D Magical thinking is developmentally appropriate for the preschooler not a 7-year-old. The nurse should assess this child's development further. Asking about other friends or special powers will not provide information related to development. A 7-year-old does not typically have opposite sex playmates.
In providing anticipatory guidance to parents, which parental behavior does the nurse teach as most important in fostering moral development? a. Telling the child what is right and wrong b. Vigilantly monitoring the child and her peers c. Weekly family meetings to discuss behavior d. Living as the parents say they believe
ANS: D Parents living what they believe gives non-ambivalent messages and fosters the child's moral development and reasoning. Telling the child what is right and wrong is not effective unless the child has experienced what she hears. Parents need to live according to the values they are teaching to their children. Vigilant monitoring of the child and her peers is an inappropriate action for the parent to initiate. It does not foster moral development and reasoning in the child. Weekly family meetings to discuss behaviors may or may not be helpful in the development of moral reasoning.
Which statement made by a mother of a school-age boy indicates a need for further teaching? a. "My child is playing soccer on a team this year." b. "He is always active with his friends playing games." c. "I limit his television watching to about 2 hours a day." d. "I am glad his coach emphasizes winning and discipline in today's society."
ANS: D Team sports are important for the development of sportsmanship and teamwork and for exercise and refinement of motor skills. A coach who emphasizes winning and strict discipline is not appropriate for children in this age-group. Team sports such as soccer are appropriate for exercise and refinement of motor skills. Limiting television to 2 hours a day is an appropriate restriction. School-age children should be encouraged to participate in physical activities.
A 17-month-old child is expected to be in what stage according to Piaget? a. Trust b. Preoperations c. Secondary circular reaction d. Sensorimotor period
ANS: D The 17-month-old is in the fifth stage of the sensorimotor phase, tertiary circular reactions. Learning in this stage occurs mainly by trial and error. Trust is Erikson's first stage. Preoperation is the stage of cognitive development usually present in older toddlers and preschoolers. Secondary circular reactions last from approximately ages 4 to 8 months.
What should the nurse teach a parent who is concerned about preventing sleep problems in a 2-year-old child? a. Have the child always sleep in a quiet, darkened room. b. Provide high-carbohydrate snacks before bedtime. c. Have the child's daytime caretaker eliminate naps. d. Use a nightlight in the child's room.
ANS: D The boundaries between reality and fantasy are not well defined for children of this age, so monsters and scary creatures that lurk in the preschooler's imagination become real to the child after the light is turned off. A nightlight may help ease the child's fears. A dark room may be scary to a preschooler. High-carbohydrate snacks increase energy and do not promote relaxation. Most 2-year-olds take one nap each day. Many give up the habit by age 3 years. Insufficient rest during the day can lead to irritability and difficulty sleeping at night.
A father tells the nurse that his toddler wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should suggest that the family do which of the following? a. Do not take the child to restaurants until this behavior has stopped. b. Take the child but do not give in to this demand. c. Explain to the child that restaurants have their own dishes. d. Suggest the family take the dishes and use them at the restaurant.
ANS: D The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain the sameness and reliability. It provides a sense of comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. The family can take the dishes and serve the toddler's food and drink with them. Not taking the child out sometimes deprives him or her of a social experience. Not giving in sets the stage for temper tantrums. This child is too young to understand an explanation.
A parent is very frustrated by the amount of time a toddle says "no" and asks the nurse about effective strategies to manage this negativism. The most appropriate recommendation is to a. punish the child for the behavior. b. provide more attention to the child. c. ask the child to not always say "no." d. reduce the opportunities for a "no" answer.
ANS: D The nurse should suggest that the parent phrase questions or directives with restrictive choices rather than yes or no answers. This provides a sense of control for the toddler and reduces the opportunity for negativism. Negativism is not an indication of stubbornness or insolence and should not be punished. The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. The toddler is too young for this approach.
A nurse is assessing an 8-year-old child. Which finding leads the nurse to conduct further assessment? a. Understands that his or her point of view is not the only one b. Enjoys telling riddles and silly jokes c. Demonstrates the principle of object conservation d. Engages in fantasy and magical thinking
ANS: D The preschool-age child engages in fantasy and magical thinking. The school-age child moves away from this type of thinking and becomes more skeptical and logical. Belief in Santa Claus or the Easter Bunny ends in this period of development. If the child demonstrated this type of thinking, the nurse would need to follow up with more developmental screening. School-age children enter the stage of concrete operations. They learn that their point of view is not the only one. The school-age child has a sense of humor. The child's increased language mastery and increased logic allow for appreciation of plays on words, jokes, and incongruities. The school-age child understands that properties of objects do not change when their order, form, or appearance does (object conservation).
The school nurse has been asked to begin teaching sex education in the 5th grade. The nurse should recognize that a. children in 5th grade are too young for sex education. b. children should be discouraged from asking too many questions. c. correct terminology should be reserved for children who are older. d. sex can be presented as a normal part of growth and development.
ANS: D When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development. Fifth graders are usually 10 to 11 years old. This age is not too young to speak about physiologic changes in their bodies. The students should be encouraged to ask questions. Preadolescents need precise and concrete information.
