PEDS Exam 1

The nurse is assessing a child admitted with possible Kawasaki's disease. A characteristic sign or symptom that the nurse should observe and document would be: 1.) cardiac dysrhythmia 2.) decreased urine output 3.) peeling skin on fingers 4.) decreased level of consciousness

3.) peeling skin on fingers

When assessing a child suspected of having epiglottitis, the nursing action is to A) Keep the child calm while administering 100% oxygen and awaiting an expert at intubation. B) Send the child to x-ray immediately for a chest x-ray. C) Lay the child down flat to calm him/her down. D) Give IM antibiotics as standard orders while attempting to start an IV.

A) Keeping the child calm is important because any added trauma to the airway, even from crying, could cause airway obstruction. Children should be positioned upright in "sniffing position" to help maintain airway patency. Oxygen is delivered in the method best tolerated by the child and only the most experienced nurse should attempt intubation--difficult because of swollen tissues. Children suspected of having epiglottitis should never be left alone.

The nurse is doing a neurologic assessment on a 2-month-old infant after a car accident. Moro, tonic neck, and withdrawal reflexes are present. The nurse recognizes that these reflexes suggest: A. neurologic health. The Moro, tonic neck, and withdrawing reflexes are usually present in infants less than 3 to 4 months old. Therefore the presence of these reflexes indicates neurologic health. B. severe brain damage. Moro, tonic neck, and withdrawal reflexes are expected in a 2-month-old. C. decorticate posturing. Decorticate posturing is indicative of severe dysfunction of the cerebral cortex. D. decerebrate posturing. Decerebrate posturing is indicative of dysfunction at the level of the midbrain.

A. neurologic health. The Moro, tonic neck, and withdrawing reflexes are usually present in infants less than 3 to 4 months old. Therefore the presence of these reflexes indicates neurologic health.

39. A child is in the pediatric intensive care unit immediately after cardiac surgery. Which nursing action is most important? A.Assess the airway. B.Administer sedation C.Maintain semi-Fowler's position. D.Monitor oxygen saturation readings.

A.Assess the airway. Child will return from surgery with ET tube and nurse should check for bilateral breath sounds to evaluate tube placement.

3. The leading cause of death in infants younger than 1 year is/are: a. Congenital anomalies. b. Sudden infant death syndrome. c. Respiratory distress syndrome. d. Infections specific to the perinatal period.

ANS: A Congenital anomalies account for 20.6% of deaths in infants younger than 1 year. Sudden infant death syndrome accounts for 7.7% of deaths in this age group, while respiratory distress syndrome accounts for 3.6% of deaths in this age group. Infections specific to the perinatal period account for 2.9% of deaths in this age group.

3. Katie, 4 years old, is admitted to outpatient surgery for removal of a cyst on her foot. Her mother puts the hospital gown on her, but Katie is crying because she wants to leave on her underpants. The most appropriate nursing action is to: a. Allow her to wear her underpants. b. Discuss with her mother why this is important to Katie. c. Ask her mother to explain to her why she cannot wear them. d. Explain in a kind, matter-of-fact manner that this is hospital policy.

ANS: A It is appropriate for the child to leave her underpants on. This allows her some measure of control during the foot surgery. The mother should not be required to make the child more upset. Katie is too young to understand what hospital policy means.

The parents of a 2-year-old tell the nurse they are concerned because the toddler has started to use "baby talk" since the arrival of their new baby. The nurse should recommend which of the following? a.Ignore the baby talk. b.Tell the toddler frequently, "You are a big kid now." c.Explain to the toddler that baby talk is for babies. d.Encourage the toddler to practice more advanced patterns of speech.

ANS: A The baby talk is a sign of regression in the toddler. Often toddlers attempt to cope with a stressful situation by reverting to patterns of behavior that were successful in earlier stages of development. It should be ignored, while praising the child for developmentally appropriate behaviors. Regression is children's way of expressing stress. The parents should not introduce new expectations and allow the child to master the developmental tasks without criticism.

1. The nurse is seeing an adolescent boy and his parents in the clinic for the first time. What should the nurse do first? a. Introduce self. c. Explain the purpose of the interview. b. Make the family comfortable. d. Give an assurance of privacy.

ANS: A The first thing that nurses must do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. During the initial part of the interview the nurse should include general conversation to help make the family feel at ease. Next the purpose of the interview and the nurse's role should be clarified. The interview should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which information will be shared with other members of the health care team and any limits to the confidentiality.

1. What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? a. Separation anxiety b. Loss of control c. Fear of bodily injury d. Fear of pain

ANS: A The major stress for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. This is a major stressor of hospitalization. Loss of control, fear of bodily injury, and fear of pain are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age group.

In terms of cognitive development, the 5-year-old child would be expected to do which of the following? a.Think abstractly. b.Use magical thinking. c.Understand conservation of matter. d.Understand another person's perspective.

ANS: B Magical thinking is believing that thoughts can cause events. An example would be that thinking of the death of a parent might cause it to happen. Abstract thought does not develop until school-age years. The concept of conservation is the cognitive task of school-age children, ages 5 to 7 years. A five-year-old child cannot understand another's perspective.

4. Using knowledge of child development, the best approach when preparing a toddler for a procedure is to: a. Avoid asking the child to make choices. b. Demonstrate the procedure on a doll. c. Plan for the teaching session to last about 20 minutes. d. Show necessary equipment without allowing child to handle it.

ANS: B Prepare toddlers for procedures by using play. Demonstrate on a doll, but avoid the child's favorite doll because the toddler may think the doll is really "feeling" the procedure. In preparing a toddler for a procedure, the child is allowed to participate in care and help whenever possible. Teaching sessions for toddlers should be about 5 to 10 minutes. Use a small replica of the equipment and allow the child to handle it.

5. Amy, age 6 years, needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her, "We are sick of Mom always sitting with you in the hospital and playing with you. It isn't fair that you get everything and we have to stay with the neighbors." The nurse's best assessment of this situation is that: a. The siblings are immature and probably spoiled. b. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling. c. The family has ineffective coping mechanisms to deal with chronic illness. d. The siblings need to better understand their sister's illness and needs.

ANS: B Siblings experience loneliness, fear, worry, anger, resentment, jealousy, and guilt. The siblings experience stress equal to that of the hospitalized child. These are not uncommon responses by normal siblings. There is no evidence that the family has maladaptive coping.

Which assessment finding in a preschooler would suggest the need for further investigation? a. The child is able to dress independently. b. The child rides a tricycle. c. The child has an imaginary friend. d. The child has a 2-lb weight gain in 12 months.

ANS: D A A preschool child should be able to dress independently. B A preschool child should be able to ride a tricycle. C Imaginary friends are common for preschoolers. D 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.

3. Because of their striving for independence and productivity, which age group of children is particularly vulnerable to events that may lessen their feeling of control and power? a. Infants b. Toddlers c. Preschoolers d. School-age children

ANS: D When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurps individual power and identity. This is especially detrimental to school-age children, who are striving for independence and productivity and are now experiencing events that lessen their control and power. Infants, toddlers, and preschoolers, although affected by loss of power, are not as significantly affected as are school-age children.

13. Nurse Dave is conducting an examination of a 6-month-old baby. During the examination, the nurse should be able to elicit which reflex? a. Babinski's b. Startle c. Moro's d. Dance

Answer: A. Babinski's reflex may be present the entire first year of life. The startle reflex disappears around 4 months of age; the Moro reflex, by 3 or 4 months of age; and the dance reflex, after the 3rd or 4th week.

By preschool age the child's body image has developed to include: A. a well-defined body boundary. Preschoolers have poorly defined body images. B. fear of intrusive procedures. Preschoolers fear that their insides will come out with intrusive procedures. C. anxiety and fear of separation. Preschoolers are able to separate. Separation anxiety is characteristic of toddlers. D. knowledge about his or her internal anatomy. Preschoolers have little or no knowledge of their internal anatomy.

B. fear of intrusive procedures. Preschoolers fear that their insides will come out with intrusive procedures.

4. When palpating the brachial, radial, and femoral pulses of a neonate, the nurse notes a difference in pulse amplitude between the femoral and radial pulses bilaterally. This difference suggests: A. Patent ductus arteriosus B.Coarctation of the aorta C.Diminished cardiac output D.Left to right shunting in the heart.

B.Coarctation of the aorta A difference in pulse amplitude between the upper and lower extremities or between the femoral and radial pulses suggests a coarctation of the aorta (narrowing of the aorta below the left subclavian artery). A patent ductus arteriousus is associated with a bounding pulse due to left-to-right shunting of blood in the heart. A weak or thinner pulse indicates diminished cardiac output.

9. The mother of a child with a congenital cardiac defect asks the nurse why her child squats after exertion. The nurse should reply that this position: A.Reduces muscle aches B.Increases cardiac efficiency C.Enhances the pull of gravity D.Decreases blood volume in the extremities

B.Increases cardiac efficiency When the child squats, blood pools in the lower extremities because of flexion of the hips and knees; less blood returns to the hear, enabling the heart to beat more effectively.

25. An infant with tetralogy of Fallot becomes cyanotic and dyspneic after a crying episode. To relieve the cyanosis and dyspnea, the nurse should place the infant in the: A.Orthopneic position B.Knee-chest position C.Lateral Sims' position D.Semi-Fowler's position

B.Knee-chest position Flexing the hips and knees decreases venous return to the heart from the legs; when venous return to the heart is decreased, the cardiac workload is decreased.

36. A complete blood workup is ordered for a 5 month old with tetralogy of Fallot. Because of the infant's heart disease, the nurse would expect the report to show: A.Anemia B.Polycythemia C.Agranulocytosis D.Thrombocytopenia

B.Polycythemia The body responds to the chronic hypoxia caused by the heart defect by increasing the production of red blood cells in an attempt to increase the oxygen-carrying capacity of the blood.

A 5 year old child is brought into the emergency department with drooling, strident cough, and lethargy. Epiglottitis is suspected. The priority intervention for this child is to: A.Take vital signs B.Secure the child's airway C.Visualize the child's throat with a tongue depressor D.Obtain throat cultures

B.Secure the child's airway Explanation The priority in treating epiglottitis is achieving a patent airway as quickly as possible.

29. A nurse is teaching the parents of a child with tetralogy of Fallot about hypercyanotic spells ("tet spells"). When a spell occurs, the parents should: A.Call the physician immediately B.Use a calm, comforting approach C.Lay the child in the supine position D.Take the child to the nearest emergency dept.

B.Use a calm, comforting approach Hypercyanotic spells ("tet spells"), in which a child has an extreme bluish discoloration of the skin and mucous membranes, are commonly seen in children with tetralogy of Fallot (a condition with four cardiac anomalies: VSD, pulmonic stenosis, an overriding aorta, and right ventricular hypertrophy). The parents should maintain a calm, comforting approach and place the child in the knee-chest position. It isn't necessary to call the physician, and the spells aren't considered a medical emergency unless profound hypoxia occurs.

26. An appropriate nursing action to include in the care of an infant with congenital heart disease who has been admitted with heart failure is: A.Positioning flat on the back B.Encouraging nutritional fluids C.Offering small frequent feedings D.Measuring the head circumference

C.Offering small frequent feedings Because these infants become extremely fatigued while sucking, small frequent feedings with adequate rest periods can improve their total intake.

1. Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety? A. Inactivity B. Clings to parent C. Depressed, sad D. Regression to earlier behavior

Correct Answer: B

6. The nurse is ready to begin a physical examination on an 8-month-old infant. The child is sitting contentedly on his mother's lap, chewing on a toy. What should the nurse do first? A. Elicit reflexes B. Auscultate heart and lungs C. Examine eyes, ears, and mouth D. Examine head, systematically moving toward feet

Correct Answer: B Your Response:

28. A one month old infant is admitted for confirmation of the diagnosis of ventricular septal defect. During the initial admission assessment, the nurse would expect to find: A.Bradycardia at rest B.Bounding peripheral pulses C.An activity related cyanosis D.A murmur at the left sternal border.

D.A murmur at the left sternal border. This murmur is the most characteristic finding in children with VSD

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. The nurse's BEST reply is: a. "Mommy will be here after lunch." b. "Mommy always comes back to see you." c. "Your mommy told me yesterday that she would be here today about noon." d. "Mommy had to go home for a while, but she will be here today."

a. "Mommy will be here after lunch." Since toddlers have a limited concept of time, the nurse should translate the mother's statement about being back around noon by linking the arrival time to a familiar activity that takes place at that time. Such statements do not give the child any information about when his mother will visit. Twelve noon is a meaningless concept for a toddler. Such statements do not give the child any information about when his mother will visit.

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.

a. concrete operations. 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.

An early sign of congestive heart failure that the nurse should recognize is: a. tachypnea. b. bradycardia. c. inability to sweat. d. increased urine output.

a. tachypnea. Tachypnea is one of the early signs that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure. The child may be diaphoretic. Urine output usually will be decreased due to decreased kidney perfusion.

The nurse educator instructs a nursing student that according to Erikson, infancy is concerned with acquiring a sense of: a. trust. b. industry. c. initiative. d. separation.

a. trust. The task of infancy is the development of trust. Industry vs. inferiority is the developmental task of school-age children. Initiative vs. guilt is the developmental task of preschoolers. Separation occurs during the sensorimotor stage as described by Piaget.

A school nurse initiates an asthma action plan after checking a student's peak expiratory flow meter after three readings. Which peak expiratory flow rate indicates the child is having a moderate asthma exacerbation? a.45% b. 60% c. 35% d. 85%

b. 60% Rationale: Eighty to one hundred percent of peak expiratory flow is green, or best. Fifty to eighty percent is yellow, or a warning. In order to prevent the symptoms from increasing, action must be taken. Less than fifty percent is red, or a warning. This is an emergency that requires medical care.

The nurse is ready to begin a physical examination on an 8-month-old infant. The child is sitting contentedly on his mother's lap, chewing on a toy. What should the nurse do FIRST? a. Elicit reflexes b. Auscultate heart and lungs c. Examine eyes, ears, and mouth d. Examine head, systematically moving toward feet

b. Auscultate heart and lungs This may disturb or upset the child, making auscultation and the remainder of the physical examination difficult. Auscultation should be performed while the child is quiet. This may disturb or upset the child, making auscultation and the remainder of the physical examination difficult. Although this is the way most physical examinations proceed, the nurse should perform the assessment for a child in an order that moves from least disturbing to most disturbing from the child's perspective.

The nurse should teach volunteers in the after school program that which characteristic is MOST descriptive of the social development of school-age children? a. Identification with peers is minimal. b. Children frequently have "best friends." c. Boys and girls play equally well with children of either gender. d. Peer approval is not yet an influence toward conformity.

b. Children frequently have "best friends." Identification with peer group is an important factor toward gaining independence from families. Same-sex peers form relationships that encourage sharing of secrets and jokes and coming to each other's aid. During the school-age years there are more gender-specific groups. Conforming to the rules is an essential part of group membership.

8. When developing a plan of care for a male adolescent, the nurse considers the child's psychosocial needs. During adolescence, psychosocial development focuses on: a. Becoming industrious b. Establishing an identity c. Achieving intimacy d. Developing initiative

b. Establishing an identity According to Erikson, the primary psychosocial task during adolescence is to establish a personal identity confusion. The adolescent attempts to establish a group identity by seeking acceptance and approval from peers, and strives to attain a personal identity by becoming more independent from the family. Becoming industrious is the developmental task of the school-age child, achieving intimacy is the task of the young adult, and developing initiative is the task of the preschooler.

The nurse is preparing a health teaching session for school age children. The nurse should include which information about injury prevention in the plan? a. Peer pressure is not strong enough to affect risk-taking behavior. b. Most injuries occur in or near school or home. c. Injuries from burns are the highest at this age because of fascination with fire. d. Lack of muscular coordination and control results in an increased incidence of injuries.

b. Most injuries occur in or near school or home. Peer pressure is significant in this age group. This is where most injuries occur. Automobile accidents account for the majority of severe accidents, either as a pedestrian or passenger. School-age children have more refined muscle development, which results in an overall decrease in the number of accidents.

9. When developing a plan care for a hospitalized child, nurse Mica knows that children in which age group are most likely to view illness as a punishment for misdeeds? a. Infancy b. Preschool age c. School age d. Adolescence

b. Preschool age Preschool-age children are most likely to view illness as a punishment for misdeeds. Separation anxiety, although seen in all age group, is most common in older infants. Fear of death is typical of older school-age children and adolescents. Adolescents also fear mutilation.

Which behavior by parents or teachers will 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 the child can master tasks c. Completing homework for children who are having difficulty in completing assignments d. Decreasing expectations to eliminate potential failures

b. Structuring the environment so the child can master tasks

When teaching injury prevention during the school-age years, the nurse should include: a. Teaching the need to fear strangers. b. Teaching basic rules of water safety. c. Avoiding letting children cook in microwave ovens. d. Cautioning children against engaging in competitive sports.

b. Teaching basic rules of water safety.

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. allow the toddler to start making choices about what to wear. A toddler is developing autonomy and is able to start making some choices about what he or she can wear. A toddler is developing autonomy and 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.

Congenital heart defects (CHDs) are anatomic abnormalities in the heart that are present at birth, although they may not be diagnosed immediately. The most common type of CHD is: a. tetralogy of Fallot. b. ventricular septal defect (VSD). c. pulmonary stenosis. d. transposition of the great vessels.

b. ventricular septal defect (VSD). Tetralogy of Fallot has an incidence of 4.7 per 10,000 births and is the most common cardiac defect with decreased blood flow. VSD with increased pulmonary blood flow is the most common type of heart defect with a prevalence of 27 per 10,000 births and accounts for about 30% to 35% of all congenital heart defects. Pulmonary stenosis is less common and is a defect that causes obstruction to blood flow out of the heart. Transposition of the great vessels is a complex cardiac anomaly that involves a flow of mixed saturated and desaturated blood in the heart or great vessels.

At what age would the nurse advise parents to expect their infant to be able to say "mama" and "dada" with meaning? a. 4 months b. 6 months c. 10 months d. 14 months

c. 10 months Consonants are added to infant vocalizations. Babbling resembles one-syllable sounds. At this age infants say sounds with meaning. This is late for the development of sounds with meaning.

Because the absorption of fat-soluble vitamins is decreased in children with cystic fibrosis, supplementation of which vitamins is necessary? a. C, D b. A, E, K c. A, D, E, K d. C, folic acid

c. A, D, E, K C is not one of the fat-soluble vitamins. D also needs to be supplemented. A, D, E, and K are the fat-soluble vitamins that need to be supplemented in higher doses. C and folic acid are not fat soluble.

You are educating a first-time mother about newborn reflexes. The mother notes that when her baby is searching for food he turns his head in the direction of the side of his cheek that is stroked. The mother asks you the name of this reflex. Which of the following is the correct answer? a. Sucking reflex b. Neck reflex c. Rooting reflex d. Moro reflex

c. Rooting reflex

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

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

When caring for a preschool age child, the nurse should incorporate knowledge that body image has developed to include: a. a well-defined body boundary. b. knowledge about his or her internal anatomy. c. fear of intrusive procedures. d. anxiety and fear of separation.

c. fear of intrusive procedures. Preschoolers have poorly defined body images. Preschoolers have little or no knowledge of their internal anatomy. Preschoolers fear that their insides will come out with intrusive procedures. Preschoolers are able to separate.

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

c. initiative. Identity is the stage associated with adolescence. Intimacy is an adult stage. Preschoolers focus on developing initiative. The stage is known as initiative vs. guilt. Industry is an adult stage.

Tetralogy of Fallot (TOF) involves which defects? Select all that apply. 1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy. 3. Left ventricular hypertrophy. 4. Pulmonic stenosis (PS). 5. Pulmonic atresia. 6. Overriding aorta. 7. Patent ductus arteriosus (PDA).

1, 2, 4, 6. 1. TOF is a congenital defect with a ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 2. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 4. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 6

7. The nurse is aware that a common physiologic adaptation of children with tetralogy of Fallot is: A.Clubbing of fingers B.Slow, irregular respirations C.Subcutaneous hemorrhages D.Decreased red blood cell count

A.Clubbing of fingers Hypoxia leads to poor peripheral circulation; clubbing occurs as a result of additional capillary development and tissue hypertrophy of the fingertips.

5. When caring for a 3 year old with tetralogy of Fallot, he nurse expects to see fatigue and poor activity tolerance. This is caused by: A.Poor muscle tone B.Inadequate oxygenation of tissues. C.Restricted blood flow leaving the heart D.Inadequate intake of food.

B.Inadequate oxygenation of tissues. The child's fatigue results from left to right shunting that occurs with tetralogy of Fallot. This shunting causes poorly oxygenated blood to circulate through the body. Poor muscle tone and inadequate food intake can result from this condition, but these are effects, not causes. Restricted blood flow leaving the heart is associated with aortic stenosis.

Which characteristic best describes the fine motor skills of a 5-month-old infant? A. Neat pincer grasp This is characteristic of an 11-month-old infant. B. Strong grasp reflex This is characteristic of a 1-month-old infant. C. Able to grasp object voluntarily This characteristic is appropriate for a 5-month-old infant. D. Able to build a tower of two cubes This is characteristic of a 15-month-old infant.

C. Able to grasp object voluntarily This characteristic is appropriate for a 5-month-old infant.

41. A 3 month old infant is admitted with a diagnosis of tetralogy of Fallot. Assessment reveals that the infant's weight is in the 5th percentile. The nurse is aware that the reason for this inadequate weight gain is: A.Cyanosis leading to cerebral changes B.Decreased arterial Po2 resulting in polycythemia C.Activity intolerance resulting in deficient caloric intake D.Pulmonary hypertension resulting in recurrent respiratory infections.

C.Activity intolerance resulting in deficient caloric intake Because the infant tires so easily, sufficient calories cannot be infested to meet nutritional needs.

The nurse needs to take the blood pressure of a preschool boy for the first time. Which action would be best in gaining his cooperation? A. Taking his blood pressure when a parent is there to comfort him B. Telling him that this procedure will help him get well faster. C. Explaining to him how the blood flows through the arm and why the blood pressure is important D. Permitting him to handle equipment and see the dial move before putting the cuff in place

Correct Answer: D

13. The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. What should be the next action by the nurse? A. Notifying the surgeon B. Performing oral intubation C. Trying to insert a larger-size tube D. Trying to insert smaller-size tube

Correct Answer: D Your Response:

38. A child is suspected of having Kawasaki disease. Which finding is significant? A.Extreme lethargy B.Increased appetite C.Respiratory congestion D.Fever for at least 5 days

D.Fever for at least 5 days Kawasaki disease is a type of vasculitis affecting small to medium sized vessels. It primarily affects the lymph nodes but may progress to the coronary arteries. A child with Kawasaki disease has afever for at least five days along with an erythematous rash, red tongue, and red, cracked dry lips. Irritability, not lethargy is seen in Kawasaki disease, along with decreased appetite and edema of the hands and feet. Respiratory congestion isn't a common symptom.

6. What congenital heart defect causes cyanosis in children? A.Atrial septal defect B.Coarctation of the aorta C.Ventricular septal defect D.Transposition of the great vessels

D.Transposition of the great vessels With transposition of the great vessels, the pulmonary artery is attached to the left ventricle and the aorta is attached to the right ventricle. The child is cyanotic because blood reaches the tissues from the right ventricle before being oxygenated by the lungs. In atrial septal defect and ventricular septal defect, blood is shunted from the left side of the heart to the right side through patent openings. Because the blood travels from left to right, it's oxygenated and doesn't produce cyanosis. Coarctation of the aorta is a narrowing of the aorta that decreases the circulation of oxygenated blood to the body. With this condition, the child won't be cyanotic unless cardiac output drops.

A child who has reddened eyes with no discharge; red, swollen, and peeling palms and soles of the feet; dry, cracked lips; and a "strawberry tongue" most likely has _____________________.

Kawasaki Disease

The nurse is conducting an assessment of a child with a VSD. The nurse's assessment reveals hypoxemia as indicated by cyanosis, SaO2 of 84%, and bradycardia. What action should the nurse anticipate taking first? a. Administering oxygen b. IV placement c. Notifying the physician d. Preparing the family for imminent surgery

a. Administering oxygen Rationale: Surgery is not necessarily imminent in this case. IV placement and notification of the physician are important but not the first action.

Teasing can be common during the school-age years. Which of the following does the nurse recognize as applying most to teasing? a. Can have a lasting effect on children b. Is not a significant threat to self-concept c. Is rarely based on anything that is concrete d. Is usually ignored by the child who is being teased

a. Can have a lasting effect on children

Apnea of infancy has been diagnosed in an infant who will soon be discharged with home monitoring. When teaching the parents about the infant's care, what is the most important information the nurse should include in the discharge teaching plan? a. Cardiopulmonary resuscitation (CPR) b. Administration of intravenous (IV) fluids c. Reassurance that the infant cannot be electrocuted during monitoring d. Advice that the infant not be left with other caretakers such as baby-sitters

a. Cardiopulmonary resuscitation (CPR) CPR is essential for parent and caregivers to know. Most likely the child will not have venous access; thus home IV therapy is not necessary. The monitor is insulated and grounded. The parents should arrange for other caregivers to help out. All need to be taught how to use the monitoring equipment and how to perform CPR.

The nurse would expect that most children would be using sentences of six to eight words by age: a. 18 months. b. 24 months. c. 3 years. d. 5 years.

d. 5 years. This age child has a vocabulary of only 10 words. A child this age uses two- to three-word phrases. A child this age uses three- to four-word sentences. Children can make sentences of six to eight words at this age.

The doctor suggests that surgery be performed for patent ductus arteriosus (PDA) to prevent: a. pulmonary infection. b. right-to-left shunt of blood. c. decreased workload on left side of heart. d. increased pulmonary vascular congestion.

d. increased pulmonary vascular congestion. The increased pulmonary vascular congestion is the primary complication. The shunt of blood is left to right. The increased pulmonary vascular congestion is the primary complication. A PDA allows blood to flow from the aorta (high pressure) to the pulmonary artery (low pressure). If the PDA stays open, increased pulmonary congestion can occur.

The parent of 16-month-old Brian asks, "What is the best way to keep Brian from getting into our medicines at home?" The nurse should advise which of the following? a."All medicines should be locked securely away." b."The medicines should be placed in high cabinets." c."Brian just needs to be taught not to touch medicines." d."Medicines should not be kept in the homes of small children."

ANS: A The major reason for poisoning in the home is improper storage. Toddlers can climb, unlatch cabinets, and obtain access to high-security places. For medications, only a locked cabinet is safe. Toddlers can climb using furniture. High places are not a deterrent to an exploring toddler. Toddlers are not able to generalize that all the different forms of medications in the home may be dangerous. Keeping medicines out of the homes of small children is not feasible. Many parents require medications for chronic or acute illnesses. Parents must be taught safe storage for their home and when they visit other homes.

5. The nurse is preparing a 12-year-old girl for a bone marrow aspiration. She tells the nurse that she wants her mother with her "like before." The most appropriate nursing action is to: a. Grant her request. b. Explain why this is not possible. c. Identify an appropriate substitute for her mother. d. Offer to provide support to her during the procedure.

ANS: A The parents' preferences for assisting, observing, or waiting outside the room should be assessed, as well as the child's preference for parental presence. The child's choice should be respected. If the mother and child are agreeable, the mother is welcome to stay. An appropriate substitute for the mother is necessary only if the mother does not wish to stay. Support is offered to the child regardless of parental presence.

5. When introducing hospital equipment to a preschooler who seems afraid, the nurse's approach should be based on which principle? a. The child may think the equipment is alive. b. The child is too young to understand what the equipment does. c. Explaining the equipment will only increase the child's fear. d. One brief explanation is enough to reduce the child's fear.

ANS: A Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. The child should be given simple concrete explanations about what the equipment does and how it will feel to the child. Simple, concrete explanations help alleviate the child's fear. The preschooler will need repeated explanations as reassurance.

Which play patterns does a 3-year-old child typically display? (Choose all that apply.) a. Imaginary play c. Cooperative play b. Parallel play d. Structured play

ANS: A, B, C Correct A, B, C. 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. Imaginary friends are common around age 3 years. Incorrect D. Structured play is typical of school-age children.

Which statement best identifies the characteristics of language development in a toddler? a. Language development skills slow during the toddler period. b. The toddler understands more than he can express. c. Most of the toddler's speech is not easily understood. d. The toddler's vocabulary contains approximately 600 words.

ANS: B A Although language development varies in relationship to physical activity, language skills are rapidly accelerating by 15 to 24 months of age. B The toddler's ability to understand language (receptive language) exceeds the child's ability to speak it (expressive language). C By 2 years of age, 60% to 70% of the toddler's speech is understandable. D The toddler's vocabulary contains approximately 300 or more words.

A mother asks when toilet training is most appropriately initiated. What would be the nurse's best response? a. "When your child is 12 to 18 months of age." b. "When your child exhibits signs of physical and psychological readiness." c. "When your child has been walking for 9 months." d. "When your child is able to sit on the 'potty' for 10 to 15 minutes."

ANS: B A Toilet training is not arbitrarily started at 12 to 18 months of age. The child needs to demonstrate signs of bowel or bladder control before attempting toilet training. The average toddler is not ready until 18 to 24 months of age. Waiting until 24 to 30 months of age makes the task easier; toddlers are less negative, more willing to control their sphincters, and want to please their parents. B Neurologic development is completed at approximately 18 months of age. Parents need to know that both physical and psychological readiness are necessary for toilet training to be successful. C One of the physical signs of readiness for toilet training is that the child has been walking for 1 year. D The ability to sit on the "potty" for 10 to 15 minutes may demonstrate parental control rather than being a sign of developmental readiness for toilet training.

6. An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler is to: a. Provide for privacy. b. Encourage parents to room in. c. Explain procedures and routines. d. Encourage contact with children the same age.

ANS: B A toddler experiences separation anxiety secondary to being separated from the parents. To avoid this, the parents should be encouraged to room in as much as possible. Maintaining routines and ensuring privacy are helpful interventions, but they would not substitute for the parents. Contact with same-aged children would not substitute for having the parents present.

16. A venipuncture will be performed on a 7-year-old girl. She wants her mother to hold her during the procedure. The nurse should recognize that this: a. Is unsafe. b. May help the child relax. c. Is against hospital policy. d. Is unnecessary because of the child's age.

ANS: B Both the mother's preference for assisting, observing, or waiting outside the room and the child's preference for parental presence should be assessed. The child's choice should be respected. This will most likely help the child through the procedure. If the mother and child are agreeable, the mother is welcome to stay. Her familiarity with the procedure should be assessed, and potential safety risks identified (mother may sit in chair). Hospital policies should be reviewed to ensure that they incorporate family-centered care

2. The nurse is planning how to prepare a 4-year-old child for some diagnostic procedures. Guidelines for preparing this preschooler should include to: a. Plan for a short teaching session of about 30 minutes. b. Tell the child that procedures are never a form of punishment. c. Keep equipment out of the child's view. d. Use correct scientific and medical terminology in explanations.

ANS: B Illness and hospitalization may be viewed as punishment in preschoolers. Always state directly that procedures are never a form of punishment. Teaching sessions for this age group should be 10 to 15 minutes in length. Demonstrate the use of equipment and allow the child to play with miniature or actual equipment. Explain the procedure in simple terms and how it affects the child.

4. What is an important consideration for the nurse who is communicating with a very young child? a. Speak loudly, clearly, and directly. b. Use transition objects such as a doll. c. Disguise own feelings, attitudes, and anxiety. d. Initiate contact with child when parent is not present.

ANS: B Using a transition object allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This facilitates communication with this age child. Speaking loudly, clearly, and directly tends to increase anxiety in very young children. The nurse must be honest with the child. Attempts at deception lead to a lack of trust. Whenever possible, the parent should be present for interactions with young children.

What is the primary purpose of a transitional object? a. It helps the parents deal 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 A A decrease in parental guilt (distress) is an indirect benefit of a transitional object. B A transitional object may be part of a bedtime ritual, but it may not keep the child quiet at bedtime. 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. D A transitional object does not significantly affect negativity and tantrums, but it can comfort a child after tantrums.

18. With the National Center for Health Statistics (NCHS) criteria, which body mass index (BMI)-for-age percentile indicates a risk for being overweight? a. 10th percentile b. 9th percentile c. 85th percentile d. 95th percentile

ANS: C Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile are at risk for being overweight. Children in the 9th and 10th percentiles are within normal limits. Children who are greater than or equal to the 95th percentile are considered overweight.

21. By what age do the head and chest circumferences generally become equal? a. 1 month b. 6 to 9 months c. 1 to 2 years d. 2.5 to 3 years

ANS: C Head circumference begins larger than chest circumference. Between ages 1 and 2 years, they become approximately equal. Head circumference is larger than chest circumference at ages 1 month and 6 to 9 months. Chest circumference is larger than head circumference at age 2.5 to 3 years.

13. The nurse is caring for an adolescent who had an external fixator placed after suffering a fracture of the wrist during a bicycle accident. Which statement by the adolescent would be expected about separation anxiety? a. "I wish my parents could spend the night with me while I am in the hospital." b. "I think I would like for my siblings to visit me but not my friends." c. "I hope my friends don't forget about visiting me." d. "I will be embarrassed if my friends come to the hospital to visit."

ANS: C Loss of peer-group contact may pose a severe emotional threat to an adolescent because of loss of group status; friends visiting are an important aspect of hospitalization for an adolescent and would be very reassuring. Adolescents may welcome the opportunity to be away from their parents. The separation from siblings may produce reactions from difficulty coping to a welcome relief.

17. An appropriate approach to performing a physical assessment on a toddler is to: a. Always proceed in a head-to-toe direction. b. Perform traumatic procedures first. c. Use minimal physical contact initially. d. Demonstrate use of equipment.

ANS: C Parents can remove clothing, and the child can remain on the parent's lap. The nurse should use minimal physical contact initially to gain the child's cooperation. The head-to-toe assessment can be done in older children but usually must be adapted in younger children. Traumatic procedures should always be performed last. These will most likely upset the child and inhibit cooperation. The nurse should introduce the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex for this age group.

10. Kimberly, age 3 years, is being admitted for about 1 week of hospitalization. Her parents tell the nurse that they are going to buy her "a lot of new toys because she will be in the hospital." The nurse's reply should be based on an understanding that: a. New toys make hospitalization easier. b. New toys are usually better than older ones for children of this age. c. At this age children often need the comfort and reassurance of familiar toys from home. d. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt.

ANS: C Parents should bring favorite items from home to be with the child. Young children associate inanimate objects with significant people; they gain comfort and reassurance from these items. New toys will not serve the purpose of familiar toys and objects from home. The parents may experience some guilt as a response to the hospitalization, but there is no evidence that it is maladaptive.

6. Which age group is most concerned with body integrity? a. Toddler b. Preschooler c. School-age child d. Adolescent

ANS: C School-age children have a heightened concern about body integrity. They place importance and value on their bodies and are overly sensitive to anything that constitutes a threat or suggestion of injury. Body integrity is not as important a concern to children in the toddler, preschooler, and adolescent age groups.

7. An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to: a. Ask her why she wants to know. b. Determine why she is so anxious. c. Explain in simple terms how it works. d. Tell her she will see how it works as it is used.

ANS: C School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child. A nurse should respond positively for requests for information about procedures and health information. By not responding the nurse may be limiting communication with the child. The child is not exhibiting anxiety, just requesting clarification of what will be occurring. The nurse must explain how the blood pressure cuff works so the child can then observe during the procedure.

29. The nurse must suction a child with a tracheostomy. Interventions should include: a. Encouraging the child to cough to raise the secretions before suctioning. b. Selecting a catheter with a diameter three fourths as large as the diameter of the tracheostomy tube. c. Ensuring that each pass of the suction catheter take no longer than 5 seconds. d. Allowing the child to rest after every five times the suction catheter is passed.

ANS: C Suctioning should require not longer than 5 seconds per pass. Otherwise the airway may be occluded for too long. If the child is able to cough up secretions, suctioning may not be indicated. The catheter should have a diameter one-half the size of the tracheostomy tube. If it is too large, it might block the child's airway. The child is allowed to rest for 30 to 60 seconds after each aspiration to allow oxygen tension to return to normal. Then the process is repeated until the trachea is clear.

3. What is the single most important factor to consider when communicating with children? a. The child's physical condition b. The presence or absence of the child's parent c. The child's developmental level d. The child's nonverbal behaviors

ANS: C The nurse must be aware of the child's developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Although the child's physical condition is a consideration, developmental level is much more important. The parents' presence is important when communicating with young children, but it may be detrimental when speaking with adolescents. Nonverbal behaviors vary in importance based on the child's developmental level.

What is helpful to tell a mother who is concerned about preventing sleep problems in her 2-year-old child? a. Have the child always sleep in a quiet, darkened room. b. Provide high-carbohydrate snacks before bedtime. c. Communicate with the child's daytime caretaker about eliminating the afternoon nap. d. Use a nightlight in the child's room.

ANS: D A A dark, quiet room may be scary to a preschooler. B High-carbohydrate snacks increase energy and do not promote relaxation. C Most 2-year-olds take one nap each day. Many give up the habit by age 3. Insufficient rest during the day can lead to irritability and difficulty sleeping at night. D The preschooler has a great imagination. Sounds and shadows can have a negative effect on sleeping behavior. Nightlights provide the child with the ability to visualize the environment and decrease the fear felt in a dark room.

Which is the priority concern in developing a teaching plan for the parents of a 15-month-old child? 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 A 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. B Parents of a 15-month-old child should have been advised to beginning weaning from the breast or bottle at 6 to 12 months of age. C 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. 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.

Which is the most appropriate action for the nurse to take when telling a preschool child about an upcoming procedure? a. Explain all the information in detail to the child. b. Speak loudly and clearly to the child. c. Inform the parents of the procedure and ask them to tell the child. d. Allow the child to play with medical supplies that may be used during the procedure.

ANS: D A It is inappropriate to give a preschooler all the information in detail. The child needs to understand what is going to happen to him or her without explicit details of the procedure. B Speaking in clear sentences with simple words is important, but the conversation should be conducted at a nonthreatening, normal sound level. C The nurse has the most knowledge and best ability for explaining the procedure to the child; however, the parents can be an important resource when explaining the procedure. D Symbolic play is important for emotional development because it allows the child to work through distressing feelings and can be therapeutic.

26. The nurse should expect the anterior fontanel to close at age: a. 2 months b. 2 to 4 months c. 6 to 8 months d. 12 to 18 months

ANS: D Ages 2 through 8 months are too early. The expected closure of the anterior fontanel occurs between ages 12 and 18 months; if it closes at these earlier ages, the child should be referred for further evaluation.

The developmental task with which the child of 15 to 30 months is likely to be struggling is a sense of what? a.Trust b.Initiative c.Intimacy d.Autonomy

ANS: D Autonomy versus shame and doubt is the developmental task of toddlers. Trust versus mistrust is the developmental stage of infancy. Initiative versus guilt is the developmental stage of early childhood. Intimacy and solidarity versus isolation is the developmental stage of early adulthood.

9. The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique might be most helpful? a. Suggest that the child keep a diary. b. Suggest that the parent read fairy tales to the child. c. Ask the parent if the child is always uncommunicative. d. Ask the child to draw a picture.

ANS: D Drawing is one of the most valuable forms of communication. Children's drawings tell a great deal about them because they are projections of the child's inner self. It would be difficult for a 6-year-old child to keep a diary, since the child is most likely learning to read. Reading fairy tales to the child is a passive activity involving the parent and child. It would not facilitate communication with the nurse. The child is in a stressful situation and is probably uncomfortable with strangers, not necessarily uncommunicative.

The psychosocial developmental tasks of toddlerhood include which of the following? a.Development of a conscience b.Recognition of sex differences c.Ability to get along with age-mates d.Ability to delay gratification

ANS: D If the need for basic trust has been satisfied, then toddlers can give up dependence for control, independence, and autonomy. One of the tasks that the toddler is concerned with is the ability to delay gratification. Development of a conscience and recognition of sex differences occur during the preschool years. The ability to get along with age-mates develops during the preschool and school-age years.

44. A 1-year-old with postductal coarctation of the aorta is admitted to the acute care unit for treatment. When performing an assessment, the nurse finds that the lower extremities are cool. Which finding should the nurse anticipate as the assessment continues? A.Lethargy B.Low blood pressure in the arms C.Low blood pressure in the legs D.Bilateral pedal edema

C.Low blood pressure in the legs Postductal coarctation of the aorta causes several changes in the lower extremities: diminished peripheral pulses, hypotension, and resulting cool temp. A child under age 3 can't describe his symptoms, but may exhibit exceptional irritability (rather than lethargy). High blood pressure in the upper portions of the body produces headache and vertigo. Pedal edema isn't related to diminished perfusion of the lower extremities.

Which is characteristic of the psychosocial development of school-age children? A. Peer approval is not yet a motivating power. Peer group formation is one of the major characteristics of this age group. B. A developing sense of initiative is very important. A developing sense of initiative is characteristic of preschoolers. C. Motivation comes from extrinsic rather than intrinsic sources. School-age children gain satisfaction from successful independent behaviors. D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment. The school-age child is eager to develop skills and participate in activities. Not all children are able to do all tasks well, and the child must be prepared to accept some feelings of inferiority.

D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment. The school-age child is eager to develop skills and participate in activities. Not all children are able to do all tasks well, and the child must be prepared to accept some feelings of inferiority.

The ability to mentally understand that 1 + 3 = 4 and 4 - 3 = 1 occurs in which stage of cognitive development? a. Concrete operations stage c. Intuitive thought stage b. Formal operations stage d. Preoperations stage

a. Concrete operations stage

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.) a. Falls b. Drowning c. Poisoning d. Sports injuries e. Tricycle and bicycle accidents

a. Falls b. Drowning c. Poisoning e. Tricycle and bicycle accidents Falls occur frequently in preschoolers. Closely monitor playground activities such as climbing a jungle-gym. Closely supervise around any water and ensure swimming pools are securely fenced to prevent near-drowning. Place all medications and poisons out of reach and in locked cabinets. Administer medications as a drug, not "candy." Keep poison control phone number by telephone. When riding tricycles and bicycles, children often forget not to ride in the streets. Sports injuries occur in older children.

What should the nurse recommend to help a toddler cope with the birth of a new sibling? a. Give the toddler a doll on which he or she can imitate parenting. b. Discourage the toddler from helping with care of new sibling. c. Prepare the toddler for upcoming changes about 1 to 2 weeks before birth of the sibling. d. Explain to the toddler that a new playmate will soon come home.

a. Give the toddler a doll on which he or she can imitate parenting. The toddler can participate in the activity of caring for a new family member. The child should be encouraged to participate in accordance with his or her abilities. Preparation should begin as soon as changes in the mother's physical appearance and the home setting occur. This will establish unrealistic expectations.

19. Nurse Walter should expect a 3-year-old child to be able to perform which action? a. Ride a tricycle b. Tie the shoelaces c. Roller-skates d. Jump rope

a. Ride a tricycle At age 3, gross motor development and refinement in eye-hand coordination enable a child to ride a tricycle. The fine motor skills required to tie shoelaces and the gross motor skills requires for roller-skating and jumping rope develop around age 5.

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.

a. The amount of medicine is less. 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.

Which statement characterizes moral development in older school-age children? a. They are able to judge an act by the intentions that prompted it rather than just by the consequences. b. Rules and judgments become more absolute and authoritarian. c. They view rule violations in an isolated context. d. They know the rules but cannot understand the reasons behind them.

a. They are able to judge an act by the intentions that prompted it rather than just by the consequences.

When completing the health assessment for a 2-year-old child, the nurse should expect the child to: a. engage in parallel play. b. fully dress self with supervision. c. have a vocabulary of at least 500 words. d. be one third of the adult height.

a. engage in parallel play. Two-year-olds typically play alongside each other (p. 1023). The child still needs help with clothing at 2 years of age. A vocabulary of 300 words is expected at this age. The child typically has grown to one half of adult height.

Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety? a. Inactivity b. Clings to parent c. Depressed, sad d. Regression to earlier behavior

b. Clings to parent These are characteristics of despair. In the protest phase, the child aggressively responds to separation from parents. These are characteristics of despair. These are characteristics of despair.

42. At the community center, the nurse leads an adolescent health information group, which often expands into other areas of discussion. She knows that these youths are trying to find out "who they are," and discussion often focuses on which directions they want to take in school and life, as well as peer relationships. According to Erikson, this stage is known as: a. identity vs. role confusion. b. adolescent rebellion. c. career experimentation. d. relationship testing

a. identity vs. role confusion. During this period, which lasts up to the age of 18-21 years, the individual develops a sense of "self." Peers have a major big influence over behavior, and the major decision is to determine a vocational goal.

The nurse is preparing the playroom on a newly opened pediatric unit. The nurse should include which items to foster the development of the preschool child? (Select all that apply.) a. large blocks b. alphabet flash cards c. 100-piece puzzles d. dolls e. hand puppets

a. large blocks b. alphabet flash cards d. dolls Manipulative, constructive, creative, and educational toys provide for quiet activities, fine motor development, and self-expression. Easy construction sets, large blocks of various sizes and shapes, a counting frame, alphabet or number flash cards, paints, crayons, simple carpentry tools, musical toys, illustrated books, simple sewing or handicraft sets, large puzzles, and clay are suitable. Probably the most characteristic and pervasive preschool activity is imitative, imaginative, and dramatic play. Dress-up clothes, dolls, housekeeping toys, dollhouses, play store toys, telephones, farm animals and equipment, village sets, trains, trucks, cars, planes, hand puppets, and medical kits provide hours of self-expression toys. Large puzzles are appropriate for preschoolers, but 100-piece puzzles are likely too small and may cause frustration for the preschooler.

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.

a. push-pull toys. c. pop-up toys, such as a Jack-in-the-box. e. toys that pop apart and go back together. 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.

47. Kim is using bronchodilators for asthma. The side effects of these drugs that you need to monitor this patient for include: a. tachycardia, nausea, vomiting, heart palpitations, inability to sleep, restlessness, and seizures. b. tachycardia, headache, dyspnea, temp . 101 F, and wheezing. c. blurred vision, tachycardia, hypertension, headache, insomnia, and oliguria. d. restlessness, insomnia, blurred vision, hypertension, chest pain, and muscle weakness.

a. tachycardia, nausea, vomiting, heart palpitations, inability to sleep, restlessness, and seizures. Bronchodilators can produce the side effects listed in answer choice (A) for a short time after the patient begins using them.

A hospitalized toddler clings to a worn, tattered blanket. She screams when anyone tries to take it away. What is the nurse's BEST explanation to the parents for the child's attachment to the blanket? a. The blanket encourages immature behavior. b. The blanket is an important transitional object. c. She has not mastered the developmental task of individuation-separation. d. She has not bonded adequately with her mother.

b. The blanket is an important transitional object. Transitional objects are important to help toddlers separate. The blanket is an important transitional object that provides security when the child is separated from parents. Transitional objects are helpful when the child is experiencing an increased stress situation such as hospitalization. This does not reflect bonding behavior.

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.

b. The child can throw a large ball but not a small ball. 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 assessing an older school-age child recently admitted to the hospital. Which assessment indicates that the child is in an appropriate stage of cognitive development? a. The child's addition and subtraction ability b. The child's ability to classify c. The child's vocabulary d. The child's play activity

b. The child's ability to classify

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 sequence of developmental milestones is predictable. 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.

The nurse is teaching the parents of a 24-month-old about motor skill development. The nurse should include which statement in the teaching? a. The toddler walks alone but falls easily. b. The toddler's activities begin to produce purposeful results. c. The toddler is able to grasp small objects but cannot release them at will. d. The toddler's motor skills are fully developed but occur in isolation from the environment.

b. The toddler's activities begin to produce purposeful results. The child is able to walk up and down stairs at this age. Gross and fine motor mastery occur with other activities. This is a task of infancy. Interaction with the environment is essential at this age.

One of the major tasks of toddlerhood is toilet training. In teaching the parents about a child's readiness for toilet training, it is important for the nurse to emphasize that: a. nighttime bladder control develops first, so parents should focus on that in the initial teaching with their toddler. b. bowel control is accomplished before bladder control, so the parent should focus on bowel training first. c. the toddler must have the gross motor skill to climb up to the adult toilet before training is begun. d. the universal age for toilet training to begin is 2 years, and the universal age for completion is 4 years.

b. bowel control is accomplished before bladder control, so the parent should focus on bowel training first. Bowel training is usually accomplished before bladder training because of its greater regularity and predictability. The sensation to defecate is stronger than that of urination. The completion of bowel training will give the toddler a sense of accomplishment that can be carried onto bladder training. Nighttime bladder control normally takes several months to years after daytime training; therefore, this should not be the initial focus of toilet training with a toddler. There is no universal right age to begin toilet training or an absolute deadline to complete training. One of the nurse's most important responsibilities is to help parents identify the readiness signs in their child.

The nurse's BEST approach for effective communication with a preschool age child is through: a. speech. b. play. c. drawing. d. actions.

b. play. Language is not specific for children. Play is the child's way to learn to understand and adjust to situations. Drawing is not developed at this age. Actions are not effective for communication.

The nurse needs to start an intravenous (IV) line on an 8-year-old child to begin administering intravenous antibiotics. The child starts to cry and tells the nurse, "Do it later, O.K.?" The nurse should: a. start the IV line because allowing the child to manipulate the nurse is bad. b. start the IV line because unlimited procrastination results in heightened anxiety. c. postpone starting the IV line until the child is ready so that the child experiences a sense of control. d. postpone starting the IV line until the child is ready so the child's anxiety is reduced.

b. start the IV line because unlimited procrastination results in heightened anxiety. The nurse should start the IV line, recognizing that the child is attempting to gain control. Intravenous antibiotics are a priority action for the nurse. A short delay may be possible to allow the child some choice, but a prolonged delay only serves to increase the anxiety. If the timing of the IV line start was not essential for the start of IV antibiotics, this might be acceptable. The child may never be ready. The anxiety is likely to increase with prolonged delay.

Poisoning in toddlers can best be prevented by: a. consistently using safety caps. b. storing poisonous substances in a locked cabinet. c. keeping ipecac syrup in the home. d. storing poisonous substances out of reach.

b. storing poisonous substances in a locked cabinet. Not all poisonous substances have safety caps. This is an appropriate action. Ipecac does not prevent poisoning and is not recommended. Toddlers can climb; therefore little is out of reach.

A parent of an 8-month-old infant tells the nurse that the baby cries and screams whenever he or she is left with the grandparents. The nurse's reply should be based on knowledge that: a. the infant is most likely spoiled. b. this is a normal reaction for this age. c. this is an abnormal reaction for this age. d. grandparents are not responsive to that infant.

b. this is a normal reaction for this age. These are developmentally appropriate. The infant is experiencing stranger anxiety, which is expected for this age child. These are developmentally appropriate. No data have been shown to support this.

Who among these clients with congenital heart diseases should be cared for first by the nurse? a) the child with coarctation of aorta with elevated blood pressure in the upper extremity b) the child with tetralogy of Fallot with clubbing of fingers and elevated red blood cells c) the child with ductus arteriosus who experiences fatigue after feeding d) the child with ventricular septal defect who murmurs on auscultation of the chest

c) the child with ductus arteriosus who experiences fatigue after feeding - the client is experiencing hypoxia. Need for oxygenation take priority. Choices A, B and D are expected findings.

Identify the statement that 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.

c. The school-age child conforms to rules to please others.

The nurse is assessing a 6-month-old infant who smiles, coos, and has a strong head lag. The nurse should recognize that: a. this assessment is normal. b. the child is probably cognitively impaired. c. developmental/neurologic evaluation is needed. d. the parent needs to work with the infant to stop head lag.

c. developmental/neurologic evaluation is needed. A 6-month-old infant should have social interaction beyond smiling and cooing. The child requires evaluation. The head lag should be almost gone by 4 months of age. This child requires evaluation. The child requires evaluation before interventions can be determined.

The parents of a 4-year-old girl are worried because she has an imaginary playmate. The nurse's BEST response is to tell the parents: a. a psychosocial evaluation is indicated. b. an evaluation of possible parent-child conflict is indicated. c. having imaginary playmates is normal and useful at this age. d. having imaginary playmates is abnormal after about age 2 years.

c. having imaginary playmates is normal and useful at this age. Since an imaginary playmate is part of normal development, an evaluation is not necessary. Since an imaginary playmate is part of normal development, an evaluation is not necessary. Imaginary playmates are a part of normal development at this age. The peak incidence of imaginary playmates occurs at 2.5 to 3 years of age. These "playmates" usually are not present once school starts.

Nursing care of the infant or child with congestive heart failure would include: a. forcing fluids appropriate to age. b. monitoring respirations during active periods. c. organizing activities to allow for uninterrupted sleep. d. giving larger feedings less often to conserve energy.

c. organizing activities to allow for uninterrupted sleep. The child who has congestive heart failure has an excess of fluid. Monitoring vital signs is appropriate, but minimizing energy expenditure is a priority. The child needs to be well rested before feeding. The child's needs should be met as quickly as possible to minimize crying. The nurse must organize care to facilitate a decrease in his or her energy expenditure. The child often cannot tolerate larger feedings.

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. "Cooperative play is organized, and children play in a group with other children." 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. Cooperative play is play that is organized; children play in a group with other children and plan activities for purposes of accomplishing an end.

A parent has a 2-year-old in the clinic for a well-child checkup. Which statement by the parent would indicate to the nurse that the parent needs more instruction regarding accident prevention? a. "We locked all the medicines in the bathroom cabinet." b. "We turned the thermostat down on our hot water heater." c. "We placed gates at the top and bottom of the basement steps." d. "We stopped using the car seat now that my child is older."

d. "We stopped using the car seat now that my child is older." These are appropriate actions. These are appropriate actions. These are appropriate actions. A car seat should be used until child weighs 40 pounds, at approximately 4 years of age.

A school nurse initiates an asthma action plan after checking a student's peak expiratory flow meter after three readings. Which peak expiratory flow rate indicates the child is having a moderate asthma exacerbation? a. 45% b. 35% c. 85% d. 60%

d. 60% Rationale: Eighty to one hundred percent of peak expiratory flow is green, or best. Fifty to eighty percent is yellow, or a warning. In order to prevent the symptoms from increasing, action must be taken. Less than fifty percent is red, or a warning. This is an emergency that requires medical care.

The nurse expects which characteristic of fine motor skills in a 5-month-old infant? a. Strong grasp reflex b. Neat pincer grasp c. Able to build a tower of two cubes d. Able to grasp object voluntarily

d. Able to grasp object voluntarily a. This is characteristic of a 1-month-old infant. b. This is characteristic of an 11-month-old infant. c. This is characteristic of a 15-month-old infant. d. This is appropriate for a 5-month-old infant.

When assessing an 18-month-old child, which technique should the nurse plan to use? a. Have the child lie in a supine position on an examining table. b. Allow the child to sit on the examining table. c. Restrain the child on the examining table. d. Examine the child on the parent's lap.

d. Examine the child on the parent's lap. Rationale: The toddler generally has a high level of anxiety during physical assessment. Allowing the child to sit in the parent's lap offers comfort to the child. The child can be positioned in a variety of ways in the parent's lap to facilitate the examination. The examining table is appropriate for other age groups. Restraining this age child on the examining table for assessment will only increase the child's anxiety.

The father of 12-year-old Ryan tells the nurse that he is concerned about his son getting "fat." Ryan's body mass index for age is at the 60th percentile. The most appropriate nursing action is to: a. Reassure the father that Ryan is not "fat." b. Reassure the father that Ryan is just a growing child. c. Suggest a low-calorie, low-fat diet. d. Explain that this is typical of the growth pattern of boys at this age.

d. Explain that this is typical of the growth pattern of boys at this age

The school nurse knows that which attribute is characteristic of the psychosocial development of school-age children? a. A developing sense of initiative is very important. b. Peer approval is not yet a motivating power. c. Motivation comes from extrinsic rather than intrinsic sources. d. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.

d. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment. Developing initiative is characteristic of preschoolers. Peer group formation is one of the major characteristics of this age group. School-age children gain satisfaction from independent behaviors. This age child is eager to develop skills and participate in activities. All children are not able to do all tasks well, and the child must be prepared to accept some feeling of inferiority.

32. Which of the following is the best method for performing a physical examination on a toddler a. From head to toe b. Distally to proximally c. From abdomen to toes, the to head d. From least to most intrusive

d. From least to most intrusive When examining a toddler or any small child, the best way to perform the exam is from least to most intrusive. Starting at the head or abdomen is intrusive and should be avoided. Proceeding from distal to proximal is inappropriate at any age.

12. A mother asks the nurse how to handle her 5-year-old child, who recently started wetting the pants after being completely toilet trained. The child just started attending nursery school 2 days a week. Which principle should guide the nurse's response? a. The child forgets previously learned skills b. The child experiences growth while regressing, regrouping, and then progressing c. The parents may refer less mature behaviors d. The child returns to a level of behavior that increases the sense of security.

d. The child returns to a level of behavior that increases the sense of security. The stress of starting nursery school may trigger a return to a level of successful behavior from earlier stages of development. A child's skills remain intact, although increased stress may prevent the child from using these skills. Growth occurs when the child does not regress. Parents rarely desire less mature behaviors.

Which is considered a mixed cardiac defect? a. Pulmonic stenosis b. Atrial septal defect c. Patent ductus arteriosus d. Transposition of the great arteries

d. Transposition of the great arteries Pulmonic stenosis is classified as an obstructive defect. Atrial septal defect is classified as a defect with increased pulmonary blood flow. Patent ductus arteriosus is classified as a defect with increased pulmonary blood flow. Transposition of the great arteries allows the mixing of blood in the heart.

A child with asthma is having pulmonary function tests. The purpose of the peak expiratory flow rate (PEFR) is to: a. confirm the diagnosis of asthma. b. determine the cause of asthma. c. identify "triggers" of asthma. d. assess the severity of asthma.

d. assess the severity of asthma. Diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination. The causes of asthma are inflammation, bronchospasm, and obstruction. Some of the triggers of asthma are identified with allergy testing. The PEFR measures the maximum amount of air that can be forcefully exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared to the child's baseline.

One of the goals for children with asthma is to prevent respiratory infection. This is because respiratory infection: a. lessens effectiveness of medications. b. encourages exercise-induced asthma. c. increases sensitivity to allergens. d. can trigger an episode or aggravate an asthmatic state.

d. can trigger an episode or aggravate an asthmatic state. The infection affects the asthma, not the medications. Exercise-induced asthma is caused by vigorous activity. Sensitivity to allergens is independent of respiratory infection. Respiratory infections can trigger an asthmatic attack. Annual influenza vaccine is recommended. All respiratory equipment should be kept clean.

Myelination of the spinal cord is almost complete by 2 years of age. As a result of this, the toddler can gradually achieve: a. throwing a ball without falling. b. slowing of gastrointestinal transit time. c. visual acuity of 20/20. d. control of anal and urethral sphincters.

d. control of anal and urethral sphincters. Casting and throwing a ball occurs at approximately 15 months. Increased capacity is responsible for the decreased number of bowel movements each day. Visual acuity is 20/40. The voluntary control of elimination occurs between 18 and 24 months.

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

d. desirability of promoting normalcy within the limits of the child's condition. Child needs increased caloric intake. Child needs discipline and appropriate limits. Because cyanotic spells occur in children with some defects, the parents need to be taught how to manage these. 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 nurse is discussing toddler development with a parent. Which intervention will foster the achievement of autonomy? a. help the toddler complete tasks. b. provide opportunities for the toddler to play with other children. c. help the toddler learn the difference between right and wrong. d. encourage the toddler to do things for himself or herself when he or she is capable of doing them.

d. encourage the toddler to do things for himself or herself when he or she is capable of doing them. Toddlers have an increased ability to control their bodies, themselves, and the environment. Autonomy develops when children complete tasks of which they are capable. To successfully achieve autonomy, the toddler needs to have a sense of accomplishment. This does not occur if parents complete tasks. Children at this age engage in parallel play. This will not foster autonomy. This concept is too advanced for toddlers and will not contribute to autonomy.

Girls experience an increase in weight and fat deposition during puberty. Nursing considerations related to these changes include: a. giving reassurance that these changes are normal. b. suggesting dietary measures to control weight gain. c. recommending increased exercise to control weight gain. d. encouraging low-fat diet to prevent fat deposition.

d. encouraging low-fat diet to prevent fat deposition. A certain amount of fat is increased along with lean body mass to fill the characteristic contours of the child's gender. A healthy balance must be achieved between expected healthy weight gain and obesity. Such advice would not be given unless weight gain were excessive; eating disorders can develop in this group. Such advice would not be given unless weight gain were excessive; eating disorders can develop in this group. Some fat deposition is essential for normal hormone regulation. Menarche is delayed in girls with body fat contents that are too low.

The nurse needs to give an injection in the deltoid to a 4-year-old child. The BEST approach to use is to: a. smile while giving the injection to help child relax. b. tell the child that you will be so quick that the injection will not even hurt. c. explain that the child will experience a little stick in the arm. d. explain with concrete terms, such as putting medicine under the skin.

d. explain with concrete terms, such as putting medicine under the skin. This is too abstract. The young child will not correlate a smile with relaxation. Distraction techniques are more appropriate. The nurse does not know that the injection will not hurt the child. Lying or distorting the truth is never appropriate. This response will block trust, especially if the injection does hurt the child. The child may visualize an actual stick being placed in the arm. Children at this age are very literal. By using concrete terms the nurse helps the child understand what the nurse is going to do.

Cystic fibrosis may affect singular or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is: a. atrophic changes in the mucosal wall of intestines. b. hypoactivity of the autonomic nervous system. c. hyperactivity of the sweat glands. d. mechanical obstruction caused by increased viscosity of mucous gland secretions.

d. mechanical obstruction caused by increased viscosity of mucous gland secretions. Thick mucous secretions are the probable cause of the multiple body system involvement. There is an identified autonomic nervous system anomaly, but it is not hypoactivity. The sweat glands are not hyperactive. The child loses a greater amount of salt because of abnormal chloride movement. Children with cystic fibrosis have thick mucous gland secretions. The viscous secretions obstruct small passages in organs such as the pancreas.

Congenital heart defects have traditionally been divided into acyanotic or cyanotic defects. The nurse should recognize that in clinical practice this system is: a. helpful because it explains the hemodynamics involved. b. helpful because children with cyanotic defects are easily identified. c. problematic because cyanosis is rarely present in children. d. problematic because children with acyanotic heart defects may develop cyanosis.

d. problematic because children with acyanotic heart defects may develop cyanosis. The classification does not reflect the path of blood flow within the heart. Children with cyanosis may be easily identified, but that does not help with the diagnosis. Cyanosis is present when children have defects in which oxygenated blood and unoxygenated blood are mixed. This classification is problematic. Children with traditionally named acyanotic defects may be cyanotic, and children with traditionally classified cyanotic defects may appear pink.

A young child with tetralogy of Fallot may assume a posturing position as a compensatory mechanism. The position automatically assumed by the child is: a. low Fowler's. b. prone. c. supine. d. squatting.

d. squatting. Low Fowler's would assist with respiratory issues but would not assist with the need for cardiac compensation. Prone does not offer any advantage to the child. Supine does not offer any advantage to the child. The squatting or knee-chest position decreases the amount of blood returning to the heart and allows the child time to compensate.