PEDs MIDTERM EXAM

Which should the nurse recommend to the parents of a 9-year-old hospitalized following a bicycle injury? To prevent future injury, their child should: 1. Wear safety equipment while riding bicycles. 2. Read educational material on bicycle safety. 3. Watch a video on bicycle safety. 4. Ride his bike in the presence of adults.

1

Which statement by the mother of an 18-month-old would lead the nurse to believe that the child should be referred for further evaluation for developmental delay? 1. "My child is able to stand but is not yet taking steps independently." 2. "My child has a vocabulary of approximately 15 words." 3. "My child is still sucking his thumb." 4. "My child seems to be quite wary of strangers."

1

A child with laryngotracheobronchitis (croup) is placed in a cool mist tent. The mother becomes concerned because the child is frightened, consistently crying and trying to climb out of the tent. Which is the most appropriate nursing action? 1. tell the mother that the child must stay in the tent 2. place a toy in the tent to make the child feel more comfortable 3. call the pediatrician and obtain a prescription for a mild sedative 4. let the mother hold the child and direct the cool mist over the childs face

4. cool mist therapy is prescribed to liquefy secretions and to assist in breathing, if the hood is causing distress, treatment may be more beneficial if the parent is holding thei child and a cool mist is directed towards the childs face (options 1 and 2 dont alleviate the childs fear)

When does ARDS occur?

72 hours after drowning, sepsis, pneumonia or smoke inhalation

Sleep patterns for infant: 6 months

8-12 hours per night

The nurse observes a 10-month-old infant using her index finger and thumb to pick up pieces of cereal. This behavior is evidence that the infant has developed: a. the pincer grasp. b. a grasp reflex. c. prehension ability. d. the parachute reflex.

A By 1 year, the pincer-grasp coordination of index finger and thumb is well established.

A 6-month-old male is at his well-child checkup. The nurse weighs him, and his mother asks if his weight is normal for his age. The nurse's best response is: A. At 6 months his weight should be approximately three times his birth weight. B. "Each child gains weight at his or her own pace." C. "At 6 months his weight should be approximately twice his birth weight." D. "At 6 months a child should weigh about 10 lb more than his or her birth weight."

C

The nurse explains that by the age of 6 months an iron-rich formula should be offered because the infant has: a. limited ability to produce red blood cells. b. ineffective digestive enzymes. c. exhausted maternal iron stores. d. need of the iron to support dentition.

C

Immunizations at birth

Hep B

Immunizations at 2 months

Hep B, RV, DTaP, Hib, PCV, IPV

Newborn Reflex: Babinski

Hyper extension and fanning of toes

What does VSD cause?

R ventricular hypertrophy stiffening of lungs ineffective ventilation

When should antiviral medications for the flu be started?

Within 24-48 hours of the onset of symptoms

Manifestations of Rheumatic Fever

abdominal pain nosebleeds chest pain heart palpitations chorea erythema marginatum

Signs and symptoms of Influenza

abrupt fever flushing of face chills headache malaise nasal discharge

Triggers for asthma

air pollutants, allergens, pet dander, tobacco, indoor mold

The mother of a toddler asks a nurse when it is safe to place the car safety seat in a face-forward position. The best nursing response is which of the following? A) When the toddler weighs 20 lbs B) The seat should not be placed in a face-forward position unless there are safety locks in the car C) The seat should never be place in a face-forward position because the risk of the child unbuckling the harness D) When the weight of the toddler is greater than 40 lbs

A. The transition point for switching to the forward facing position is defined by the manufacturer of the convertible car safety seat but is generally at a body weight of 9 kg or 20 lb and 1 year of age. Convertible car safety seats are used until the child weighs at least 40 lb. Options b, c, and d are incorrect

Albert Bandura: Social Learning Theory

power of observation, observing and modeling behaviors, attitudes and emotional reactions of others

Leiniger's Culture Care Theory

provide culturally congruent nursing care through cognitively based assistive, supportive, facilitative acts that tailor to fit individual group

What defects combine to cause tetralogy of fallot?

pulmonary stenosis ventricular septal defect overriding of aorta right ventricular hypertrophy

Manifestations of Hypoplastic Left Heart Syndrome

rapid difficulty breathing difficulty feeding dusky/ashen (as PDA closes) single S1 gallop

Signs and Symptoms of epiglottitis

refusal to speak soft voice when speaking cannot catch breath when lying down sitting forward with neck extended drooling anxiety frightened look

What is the Pathophysiology of Tetralogy of fallot?

right to left shunting of blood in heart which recirculates venous blood to the body without going to the lungs to be oxygenated

Interventions for Sinusitis

saline drops cool mist humidifier increase oral fluids antibiotics

Interventions for children with hypertension

salt restrictions K and Ca supplements weight reduction program portion control increase physical activity antihypertensive therapy

Signs and Symptoms of Cystic Fibrosis

salty taste to skin meconium ileus bulky greasy stools due to poor weight gain despite adequate appetite pollops cough sputum barrel chest clubbing of nails crackles wheezing rectal prolapse

intrinsic reinforcement

satisfaction and accomplishment

Feedings for an infant: 8 months

start with cereal, vegetables, meats, then fruits introduce new foods for 2-3 days at a time to watch for allergies

What is SIDS?

sudden infant death syndrome

Systems effected in Cystic Fibrosis: Skin

sweat glands produce more chloride, causing salty skin

Manifestations of Coarctation of the Aorta

systolic ejection murmur decreased femoral pulses hypertension SOB CHF

Centration (Piaget)

the act of focusing on one aspect of something rather than considering things whole. It is a key factor in the preoperational stage.

Systems effected in Cystic Fibrosis: Reproductive

thick cervical secretions, difficult penetration of sperm, causing infertility

What is tricuspid atresia?

tricuspid valve does not exist or is missing, so blood cannot flow from the body into the heart in the normal way. The blood is not being properly refilled with oxygen so it does not complete the normal cycle of body-heart-lungs-heart-body (causing diminished blood flow to the lungs)

Immunizations 6-12 months

seasonal flu yearly

Piaget's Theory of Cognitive Development

sensorimotor, preoperational, concrete operational, formal operational

What position should the child be placed in after a tonsillectomy?

side lying or prone

Differentiation

simple to complex

What is the intensity of a Heart Murmor: Grade I

soft and hard to hear

What is the intensity of a Heart Murmor: Grade II

soft and more easily heard

Which toy is the best choice for a 12-month-old? 1. Baby doll. 2. Musical rattle. 3. Board book. 4. Colorful beads.

2. musical rattle

School Age

6-12 years

What is otitis media?

Chronic infectious/inflammatory disease of the middle ear

Systems effected in Cystic Fibrosis: Respiratory

Thick mucous blocks airways

Newborn Reflexes: Palmar Grasp

grasp finger tightly

Giger and Davidhizar Transcultural Assessment Model

the six phenomena are communication, space, social organization, time, environmental control, and biologic variations.

Signs and Symptoms of ARDS

tachypnea dyspnea retractions hypoxia tachycardia PO2 low pulmonary edema (decreased surfactant leading to atelectasis, resp failure and death)

Newborn Reflexes: Plantar Grasp

toes reflex tightly down in grasping motion

Animism (Piaget)

inanimate objects are alive, talk to toys as if they're alive

Which stressor is common in hospitalized toddlers? Select all that apply. 1. Social isolation. 2. Interrupted routine. 3. Sleep disturbances. 4. Self-concept disturbances. 5. Fear of being hurt.

2 3 5

Preschooler

3-6 years

Which stage of development is most unstable and challenging regarding development of personal identity? A) Adolescence B) Toddler hood C) Childhood D) Infancy

A. adolescence

ABC's stands for what when teaching parents about SIDS prevention

A: alone B: on Back C: in Crib (no co-sleeping)

Neonate

birth to 4 weeks

Signs and Symptoms of Infectious Mononucleois

fever malaise sore throat lymphadenopathy photophobia redness and white patches on tonsils enlargement of spleen abdominal pain

Signs and Symptoms of Tuberculosis

fever malaise weight loss anorexia cough

Signs and Symptoms of Bronchiolitis

flu like symptoms poor feeding air hungry cyanotic respiratory distresss wheezing

Colic

great amount of intestinal gas resulting in crying

Signs and symptoms of a child with sinusitis

halitosis facial pain eyelid edema nasal drainage pain with mild pressure thick yellow nasal drainage

Education for Sinusitis

oral decongestants or nasal spray warm compresses to sinuses proper blowing of nose (one side at a time)

Diagnosis requirements for Rheumatic Fever

patient must have 2 major and 1 minor criteria or 1 major and 2 minor criteria along with recent strep throat

Prevention of SIDS

place babies on their backs to sleep firm mattress fitted sheets avoid toys in cribs

Signs and Symptoms of Croup

Slow onset (barking cough turns into crowing cough) inspiratory stridor retractions crowing cough

Which finding would the nurse consider abnormal when performing a physical assessment on a 6-month-old? 1. Posterior fontanel is open. 2. Anterior fontanel is open. 3. Beginning signs of tooth eruption. 4. Able to track and follow objects.

1

Which method is the most effective way to present an educational program on abstinence to adolescents? 1. Use peer-led programs that emphasize the consequences of unprotected sexual contact. 2. Teach students methods to resist peer pressure. 3. Offer students the opportunity to care for a simulator infant for 1 week. 4. Offer statistics, pamphlets, and films discussing the consequences of unprotected sexual contact.

1

Proximodistal

"inside-to-outside rule" motor skills emerge in a sequence of center moving outward (Ex: can lift themselves up on belly)

What is Acute Respiratory Distress Syndrome (ARDS)?

(ARDS) is a series of reactions leading to inflammation, resulting in a decrease in lung compliance, shunting, hypoxemia

Developmental Differences in respiratory systems of a child

-Larynx is more flexible causing more spasms -upper airway is shorter and more narrow -intercostal muscles are not fully developed -cartilage around trachea is very flexible, can compress airway -respiratory rate is faster -eustacian tubes are shorter and more horizontal -lung volume is proportional to chest size

Expected Urine output for children: 8-12 years old

0.5-1 ml/kg/hr

A 13-year-old boy is hospitalized for a femur fracture. He was hit by a car while he and his friends were racing bikes near a major intersection. The child's parents are concerned about his judgment. The nurse should tell the parents that the behavior is: 1. Typical of young teens. 2. Related to hormonal surges during adolescence. 3. An isolated incident and will not likely happen again. 4. Related to teen rebellion.

1

A 3-year-old is hospitalized for an ASD repair. The parents have decided to go home for a few hours to spend time with her siblings. The child asks when her mommy and daddy will be back. The nurse's best response is: 1. "Your mommy and daddy will be back after your nap." 2. "Your mommy and daddy will be back at 6:00 p.m." 3. "Your mommy and daddy will be back later this evening." 4. "Your mommy and daddy will be back in 3 hours."

1

The nurse is monitoring a client who is experiencing an acute asthma attack. What observations would indicate an improvement in the childs condition? 1. respiratory rate of 18 breaths/min 2. pulse ox 88% 3. pulse rate of 110 bpm 4. productive cough with rapid breathing

1

What can a nurse do to reinforce a 5-year-old's intellectual initiative when he asks about his upcoming surgery? 1. Answer the child's questions about his upcoming surgery in simple terms. 2. Provide the child with a book that has vivid illustrations about his surgery. 3. Tell the child he should wait and ask the doctor his questions. 4. Tell the child that she will answer his questions at a later time.

1

What symptoms would the nurse expect with a 19 month old client diagnosed with laryngotracheobronchitis? 1. strider on inspiration 2. expiratory wheezing 3. paroxysmal coughing 4. hemoptysis

1

A 16 year old pateint arrived at the cystic fibrosis clinic for a routine 3 month visit. The most recent respiratory culture results are negative. Which action is best for the nurse to take? 1. place the patient in an exam room immediately upon arrival to the clinic 2. allow the patient to wait in the reception area until the provider is available to see the patient 3. allow the patient to wait in the reception area with a mask on until the provider is able to see the patient 4. place the patient in a waiting area with other patients who also have negative respiratory cultures

1 RATIONALE: All individuals with CF must be separated from others with CF regardless of the negative cultures, it helps reduce the risk of droplet transmission of CF pathogens

Betty is a 9 year old diagnosed with cystic fibrosis. Which of the following must the nurse keep in mind when developing a care plan for the child? 1. pulmonary secretions are abnormally thick 2. elevated levels of K are found in sweat 3. CF is an autosomal dominant hereditary disorder 4. Obstruction of the endocrine glands occurs

1 RATIONALE: CF is identified by abnormally thick pulmonary secretions

Which assessment finding for Billy is the most urgent and requires immediate intervention and notification of the pediatrician? 1. suddenly increase in respiratory rate and decreased breath sounds 2. rattling cough productive of frothy, clear, gelatinous sputum 3. crackles auscultated on inspiration in the lower lung fields 4. restlessness and wheezing auscultated at the end of expiration

1 RATIONALE: increased resp rate and decreased breath sounds indicate airway obstruction and respiratory arrest is imminent

After a tonsillectomy, the child begins to vomit bright red blood. The initial nursing action would be to: 1. turn the child to the side 2. administer the prescribed antiemetic 3. maintain NPO status 4. notify the primary health care provider

1 RATIONALE: prevent aspiration by turning the child on their side

The nurse has obtained this assessment information about a 3 year old patient who has just returned to the pediatric unit after having a tonsillectomy. Which finding requires the most immediate follow up? 1. frequent swallowing 2. hypotonic bowel sounds 3. reports of sore throat 4. heart rate 112 bpm

1 (may indicate bleeding)

What education should be given to a patient or parent after a cardiac catherization? Select all that apply 1. report any heart fluttering, fever or difficulty breathing 2. regular activity is allowed after surgery 3. temperature of 100.4 or higher should be reported 4. return to school in 3 days 5. heart palpitations are normal

1 3 and 4

The nurse is caring for a child with a foreign body in the ear canal who has not been evaluated by the PCP. Which actions should the nurse implement? Select all that apply 1. inspect the pinna for trauma 2. irritagate the auditory canal with warm water 3. obtain a history for the type of object 4. attempt to remove the object with forceps 5. use an otoscope to check for perforation

1 and 3

Expected Urine output for children: 6-7 years old

1-2 ml/kg/hr

Toddler

1-3 years

Four stages of sleep

1. drowsiness 2. light sleep 3. deep sleep 4. very deep sleep

When does colic usually resolve?

12-16 weeks

Adolescent

12-18 years

Sleep Patterns for infant: 1 year

15 hours of sleep per day (3 hours during day, 11 hours at night)

A 16-year-old male is hospitalized for cystic fibrosis. He will be an inpatient for 2 weeks while he receives IV antibiotics. Which action taken by the nurse will most enhance his psychosocial development? 1. Fax the teen's teacher, and have her send in his homework. 2. Encourage the teen's friends to visit him in the hospital. 3. Encourage the teen's grandparents to visit frequently. 4. Tell the teen he is free to use his phone to call or text friends.

2

A 3-year-old boy has been hospitalized because he fell down the stairs. His mother is crying and states, "This is all my fault." Which is the nurse's best response? 1. "Accidents happen. You shouldn't blame yourself." 2. "Falls are one of the most common injuries in this age group." 3. "It may be a good idea to put a baby gate on the stairs." 4. "Your son should be proficient at walking down the stairs by now."

2

A 3-year-old is attending her grandfather's funeral. Her parents told her that her grandfather is in heaven with God. Which statement describes a 3-year-old child's understanding of spirituality? 1. "The body is here with us on Earth, and the spirit is in heaven." 2. "He is in heaven. Is this heaven?" 3. "The spirit is no longer in his body." 4. "He won't need his body in heaven."

2

A 5-year-old boy has always been one of the shortest children in class. His mother tells the school nurse that her husband is 6 tall and she is 57. What should the nurse tell the child's mother? 1. He is expected to grow about 3 inches every year from ages 6 to 9 years. 2. He is expected to grow about 2 inches every year from ages 6 to 9 years. 3. He should be seen by an endocrinologist for growth-hormone injections. 4. His growth should be re-evaluated when he is 7 years old.

2

A 9-year-old girl builds a clubhouse in her backyard. She hangs a sign outside her clubhouse that says "No boys allowed" printed on it. The child's parents are concerned that she is excluding their neighbor's son, and they are upset. What should the school nurse tell the child's parents? 1. Her behavior is cause for concern and should be addressed. 2. Her behavior is common among school-age children. 3. Her feelings about boys will subside within the next year. 4. They should have their daughter speak with the school counselor.

2

A first-time mother brings in her 5-day-old baby for a well-child visit. The nurse weighs the infant and reports a weight of 7 lb 5 oz to the mother. The mother looks concerned and tells the nurse that her baby weighed 7 lb 10 oz when she was discharged 4 days ago. The nurse's best response to the mother is: 1. "I will let the doctor know, and he will talk with you about possible causes of your infant's weight loss." 2. "All weight loss of a few ounces is common among newborns, especially for breastfeeding mothers." 3. "I can tell you are a first-time mother. Don't worry; we will find out why she is losing weight." 4. "Maybe she isn't getting enough milk. How often are you breastfeeding her?"

2

A mother requests that her child receive the varicella vaccine at the 9-month well-child checkup. The nurse tells the mother that: 1. Children who are vaccinated will likely develop a mild case of the disease. 2. The vaccine cannot be given at that visit. 3. The vaccine will be administered after the physician examines the child. 4. A booster vaccination will be needed at 18 months of age.

2

An 18-year-old with a rash and itching in the groin area is concerned that he has contracted a sexually transmitted disease and does not want his parents to find out. The nurse's best response is: 1. "We will need to contact your parents to let them know." 2. "We will not contact your parents regarding this visit." 3. "Who would you like us to contact about your visit here today?" 4. "We cannot promise that the hospital will not contact your parents."

2

Six year old Billy woke last night with dyspnea, restlessness, wheezing and cough. Mother and child spent the night in a reclining chair. His mother declares "he is having an asthma attack. We are both exhausted. I'm tired of waiting forever to see the doctor" What is the priority nursing concern? 1. Billy's poor sleep quality and restlessness 2. Billy's ongoing shortness of breath 3. mothers report of feeling exhausted 4. mothers frustration with health care system

2

The mother of a newborn asks the nurse when the infant will receive the first hepatitis B immunization. Which is the nurse's best response? 1. "Babies receive the hepatitis B vaccine only if their mother is hepatitis B-positive." 2. "The first dose of the hepatitis B vaccine will be given prior to discharge today." 3. "The first dose of hepatitis B vaccine is given at 1 year of age." 4. "Babies receive their first hepatitis B vaccine at 6 months of age."

2

The nurse is going to give a 6-month-old a dose of Rocephin IM. What must the nurse do when the 1.5-mL dose arrives from the pharmacy? 1. Administer the injection into the deltoid muscle. 2. Divide the dose into two injections. 3. Administer the injection into the dorsogluteal muscle. 4. Give dose as a single injection into the vastus lateralis muscle.

2

Which activity can the nurse provide for a 9-year-old to encourage a sense of industry? 1. Allow the child to choose what time to take his medication. 2. Provide the child with the homework his teacher has sent. 3. Allow the child to assist with his bath. 4. Allow the child to help with his dressing change.

2

Which reaction would a nurse expect when giving a preschooler immunizations? 1. The child remains silent and still. 2. The child cries and tells the nurse that it hurts. 3. The child tries to stall the nurse. 4. The child remains still while telling the nurse that she is hurting him.

2

Which statement by an infant's mother leads the nurse to believe that she needs further education about the nutritional needs of a 6-month-old? 1. "I will continue to breastfeed my son and will give him rice cereal three times a day." 2. "I will start my son on fruits and gradually introduce vegetables." 3. "I will start my son on carrots and will introduce one new vegetable every few days." 4. "I will not give my son any more than 8 ounces of baby juice per day."

2

The Andrews family has been taking good care of their younges child, who was diagnosed with asthma. Which of the following statements indicates a need for further home care teaching? 1. "He should increase his fluid intake regularly to thin secretions" 2. "We'll make sure that he avoids exercise to prevent attacks" 3. "He is to use his bronchodilator inhaler before the steroid inhaler" 4. "We need to identify what things trigger his attacks."

2 (exercise should be encouraged as tolerated)

The nurse is preparing to care or a child after a tonsillectomy. What position should the child be placed in? 1. supine 2. side lying 3. high Fowler's 4. trendelenburgs

2 (prone or side lying to promote drainage and decrease aspiration

What allergy needs to be addressed before a cardiac catherization? Select all that apply 1. sulfa allergy 2. shellfish allergy 3. peanut allergy 4. iodine allergy 5. pollen allergy

2 and 4

What position will the child go into when suffering a tet spell? Select all that apply 1. older child will lay down flat 2. child will bend at the knees 3. older child will squat 4. child will lay on stomach 5. older child will lift arms up in the air 6. child will go into a fetal position

2, 3, 6

The nurse is caring for an infant with bronchiolitis and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which is the MOST appropriate nursing action. 1. initiate strict enteric precautions 2. move the infant to a private room 3. leave the infant in the present room, becasue RSV is not contagious 4. Inform the staff that using standard precautions is all that is necessary when caring for the child

2. (contact, droplet and stand precautions are necessary, high communicable disorder)

The emergency department nurse is caring for a child diagnosed with epiglottitis. In assessing the child, the nurse should monitor for whihc indication that the child may be experiencing airway obstruction. 1. the child exhibits nasal flaring and bradycardia 2. the child is leaning forward with arms supporting them, with the chin thrust out and mouth open 3. the child has a low grade fever adn complains of a sore throat 4. the child is leaning backward, supporting herself or himself with the hands and arms

2. (tripod positioning)

To obtain an adolescent's health information, the nurse should: 1. Interview the adolescent using direct questions. 2. Gather information during a casual conversation. 3. Interview the adolescent only in the presence of the parents. 4. Gather information only from the parents.

2. Gather information during a casual conversation.

A 10 year old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for teh child should monitor for which sign, knowing that indicated an worsening of the condition? 1. warm dry skin 2. decreased wheezing 3. pulse rate of 90 bpm 4. respiration's of 18 breaths per minute

2. decreased wheezing (in a child with asthma, this may show a postive sign of the inability to move air, "silent chest", increased wheezing should actually show signs of improvement because the child is normally diaphoresis during exacerbation

After a tonsillectomy, the nurse reviews the surgeons post op prescriptions. Which prescription should the nurse QUESTION? 1. monitor for bleeding 2. suction every 2 hours 3. give no milk or milk products 4. give clear, cool liquids when awake and alert

2. suction is only performed if there is an airway obstruction, dont want to risk any trauma to the surgical site

A 12-month-old boy weighed 8 lb 2 oz at birth. Understanding developmental milestones, what should the nurse caring for the child expect the current weight to be? 1. 16 lb 4 oz 2. 20 lb 5 oz 3. 24 lb 6 oz 4. 32 lb 8 oz

3

A 3-year-old admitted to the hospital with croup has the following vital signs: heart rate 90, respiratory rate 44, blood pressure 100/52, and temperature 98.8°F (37.1°C). The parents ask the nurse if these vital signs are normal. The nurse's best response is: 1. "Your son's blood pressure is elevated, but the other vital signs are within the normal range.." 2. "Your son's temperature is elevated, but the other vital signs are within the normal range.." 3. "Your son's respiratory rate is elevated, but the other vital signs are within the normal range." 4. "Your son's heart rate is elevated, but the other vital signs are within the normal range."

3

As the nurse approaches billy which presentation would be most concerning and require immediate attention? (Acute asthma attack child) 1. alert and irritable, lying recumbent on the exam table 2. awake and nervous, sitting upright and crying, skin pale and dry 3. agitated, sweating, and sitting upright with shoulders hunched forward 4. asleep in a side lying postion breathing through open mouth

3

During an adolescent's initial physical assessment, the nurse notes signs and symptoms of nutritional deficit. Which assessment led the nurse to this initial conclusion? 1. Protein level within normal limits. 2. Blood pressure is 110/66. 3. Hair and nails are brittle and dry. 4. Teeth appear to be eroded.

3

How can the nurse best facilitate the trust relationship between infant and parents while the infant is hospitalized? The nurse should: 1. Encourage the parents to remain at their child's bedside as much as possible. 2. Keep parents informed about all aspects of their child's condition. 3. Encourage the parents to hold their child as much as possible. 4. Advise the parents to participate actively in their child's care.

3

The best method to explain a procedure to a hospitalized preschool-age child is to: 1. Show the child a pamphlet with pictures showing the procedure. 2. Have the 5-year-old next door tell the 4-year-old about the experience. 3. Demonstrate the procedure on a doll. 4. Show the child a video of the procedure

3

The mother of 11-year-old fraternal twins tells the nurse at their well-child checkup that she is concerned because her daughter has gained more weight and height than her twin brother. The mother is concerned that there is something wrong with her son. The nurse's best response is: 1. "I understand your concern. I will talk with the physician, and we can draw some lab work." 2. "Let me ask you whether your son has been ill lately." 3. "It is normal for girls to grow a little taller and gain more weight than boys at this age." 4. "It is normal for you to be concerned, but I am sure your son will catch up with your daughter eventually."

3

The mother of a 13-year-old girl tells the nurse that she is concerned because her daughter has gained 10 lb since she began puberty. The child's mother asks the nurse for advice about what to do about her daughter's weight gain. Which should the nurse do? 1. Provide the child's mother with some pamphlets on nutrition and healthy eating. 2. Provide the child's mother with information about a new exercise program for teens. 3. Inform the child's mother that it is common for teen girls to gain weight during puberty. 4. Inform the child's mother that her daughter will likely gain another 5 to 10 lb in the next year.

3

The mother of a 15-year-old is frustrated because he spends much of his weekend time sleeping. Which is the nurse's best response to the mother's frustration? 1. "Your son may be trying to catch up on the sleep missed during the week." 2. "Developmental theorists believe that teens require more sleep as they begin to integrate new roles into their lives." 3. "Teens require more sleep due to the rapid physical growth that is occurring."

3

The mother of a child 2 years 6 months has arranged a play date with the neighbor and her child 2 years 9 months. During the play date the two mothers should expect that the children will do which of the following? 1. Share and trade their toys while playing. 2. Play with one another with little or no conflict. 3. Play alongside one another but not actively with one another. 4. Only play with one or two items, ignoring most of the other toys.

3

The nurse is assessing the pain level in an infant who just had surgery. The infant's parent asks which vital sign changes are expected in a child experiencing pain. The nurse's best response is: 1. "We expect to see a child's heart rate decrease and respiratory rate increase." 2. "We expect to see a child's heart rate and blood pressure decrease." 3. "We expect to see a child's heart rate and blood pressure increase." 4. "We expect to see a child's heart rate increase and blood pressure decrease."

3

The nurse is caring for a 5 year old whose mother asks why he still wets the bed. What is the best response by the nurse? 1. "He is old enough that he should no longer be wetting the bed" 2. "Most children outgrow bed wetting by the time they start school" 3. "His bed wetting may be due to an immature bladder or deep sleep pattern" 4. "He will probably stop once he realizes how embarrassing it is to wet the bed"

3

The nurse is instructing a new breastfeeding mother in the need to provide her premature infant with an adequate source of iron in her diet. Which statement reflects a need for further education of the new mother? 1. "I will use only breast milk or an iron-fortified formula as a source of milk for my baby until she is at least 12 months old." 2. "My baby will need to have iron supplements introduced when she is 4 months old." 3. "I will need to add iron supplements to my baby's diet when she is 2 months old." 4. "When my baby begins to eat solid foods, I should introduce iron-fortified cereals to her diet."

3

The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure. The nurse should assess the infant for which early sign of HF. 1. pallor 2. cough 3. tachycardia 4. slow and shallow breathing

3

The nurse is using the FLACC scale to rate the pain level in a 9-month-old. Which is the nurse's best response to the father's question of what the FLACC scale is? 1. "It estimates a child's level of pain utilizing vital sign information." 2. "It estimates a child's level of pain based on parents' perception." 3. "It estimates a child's level of pain utilizing behavioral and physical responses." 4. "It estimates a child's level of pain utilizing a numeric scale from 0 to 5."

3

The nurse prepares a teaching plan for the mother of a child diagnosed with bacterial conjunctivitis. Which if stated by the mother, indicates the need for further teaching. 1. "I need to wash my hands frequently" 2 I need to clean the eye as prescribed" 3. "It is okay to share towels and washcloths" 4. "I need to give the eye drops as prescribed"

3

The nurse realizes that a 5-year-old's mother needs further education about the Denver Developmental Screening Test when she states: 1. "It screens for gross motor skills." 2. "It screens for fine motor skills." 3. "It screens for intelligence level." 4. "It screens for language development."

3

The parents of a newborn are asking the nurse how to use the infant car seat and where it should be placed in their vehicle. Which is the next most appropriate actionby the nurse? 1. Give the parents a pamphlet explaining how to install the car seat. 2. Accompany the parents to the car, and show them how to install the car seat. 3. Contact the hospital's car-seat safety officer, and ask the officer to accompany the parents to the car for car-seat installation. 4. Show the parents a video on car-seat installation and safety, and ask if they are comfortable with the information.

3

What food should the mother introduce to her child when they are eating solid foods? 1. fruits before veggies 2. no fruits only veggies 3. veggies before fruits 4. only feed the child milk products

3

What should parents understand is one of the most common causes of injury and death for a 7-month-old infant? 1. Poisoning. 2. Child abuse. 3. Aspiration. 4. Dog bites.

3

Which action is a developmentally appropriate method for eliciting a 4-year-old's cooperation in obtaining the blood pressure? 1. Have the child's parents help put on the blood pressure cuff. 2. Tell the child that if he sits still, the blood pressure machine will go quickly. 3. Ask the child if he feels a squeezing of his arm. 4. Tell the child that measuring the blood pressure will not hurt.

3

Which is the best method of distraction for an 8-year-old who is having surgery later today and is NPO? 1. Use the telephone to call friends. 2. Watch television. 3. Play a board game. 4. Read the central line pamphlet he was given.

3

Which nursing action is most appropriate to gain information about how a child is feeling? 1. Actively attempt to make friends with the child before asking about her feelings. 2. Ask the child's parents what feelings she has expressed in regard to her diagnosis. 3. Provide the child with some paper to draw a picture of how she is feeling. 4. Ask the child direct questions about how she is feeling.

3

Which nursing action would help foster a hospitalized 3-year-old's sense of autonomy? 1. Let the child choose what time to take the oral antibiotics. 2. Allow the child to have a doll for medical play. 3. Allow the child to administer her own dose of Keflex (cephalexin) via oral syringe. 4. Let the child watch age-appropriate videos.

3

Which should the nurse do to prevent separation anxiety in a hospitalized toddler? 1. Assume the parental role when parents are not able to be at the bedside. 2. Encourage the parents to always remain at the bedside. 3. Establish a routine similar to that of the child's home. 4. Rotate nursing staff so the child becomes comfortable with a variety of nurses.

3

The nurse is observing a preschool classroom of children between ages 3 to 4 years old. When planning actions to ensure that each child meets normal developmental goals, which child will require the most immediate intervention? 1. 3 year old boy who needs help dressing 2. 4 year old girl who has an imaginary friend 3. 4 year old girl who engages only in parallel play 4. 3 year old boy who draws stick figures

3 RATIONALE: 4 years old the child should engage in pretend play, parallel play is seen in childre between ages 2 and 3 when they play side by side with limited interaction

The nurse obtains this information when assessing a 3 year old with uncorrected tetralogy of fallot who is crying. Which finding requires immediate action? 1. apical pulse is 118 bpm 2. a loud systolic murmur is heard in the pulmonic area 3. there is marked clubbing of the childs nail beds 4. the lips and oral mucosa are dusky in color

4 RATIONALE: circumpolar cyanosis indicates a drop in the partial pressure of oxygen, nurse should rapidly place the child in a knee to chest position, administer oxygen and take steps to calm the child.

A 9 month old arrives at teh health center with his mother for immunizations. The child is fussy with rhinorrhea and has an axillary temperature of 100.4 F. The pediatrician has determined the child has nasopharyngitis. What is the priority nursing action? 1. administer half of the immunizations and reschedule a subsequent appointment for the other half 2. advise the mother that fever is a contraindication for immunization and to reschedule the appointment 3. administer acetaminophen to reduce fever and apply an anesthetic cream to injection site 4. advise the mother that the child will likely need an antibiotic and reschedule the appointment

3 RATIONALE: acetaminophen will reduce the child's fever, and the anesthetic cream will reduce the pain at the injection site (preparing the child for the immunizations). fever and minor illnesses are not contraindicated in vaccinations, nasopharyngitis is the common cold caused by a virus and is not treated with antibiotics, splitting immunizations is not good for the child and the set scheduling of immunizations protects the child at all times when they are most vulnerable to the diseases they are vaccinated for

After receiving change-of-shift report, which patient should the nurse assess first? 1. 18 month old patient with coarctation of the aorta who has decreased pedal pulses 2. 3 year old with rheumatic fever who reports severe knee pain 3. 5 year old pateint with endocarditis who has crackles audible throughout both lungs 4. 8 year old patient with Kawasaki disease who has a temperature of 102.2F

3 RATIONALE: crackles throughout both lungs indicates severe left ventricular failure as a complication of endocarditis

Language development for 3 years old

3-4 word sentences

Sleep patterns for Infant: 3 months

3-8 hours of sleep during the day, 8 hours at night

Infant

4 weeks to 1 year

Language development for 4 years old

4-5 word sentences

How long should the patients leg be straight for post catheterization? 1. 2-4 hours 2. 8-12 hours 3. 4-6 hours 4. it doesnt have to be straight after catheterization

3. 4-6 hours

Which technique should the nurse suggest to the mother of an 8-year-old who does not want to complete her chores? 1. Grounding. 2. Time-out. 3. Reward system. 4. Spanking.

3. Reward System

Which statement would indicate to the nurse that a school-age child is not developmentally on track for age? 1. The child is able to follow a four- to five-step command. 2. The child started wetting the bed on admission to the hospital. 3. The child has an imaginary friend named Kelly. 4. The child enjoys playing board games with her sister.

3. The child has an imaginary friend named Kelly.

A 13 year old tells the nurse that he is worried because his breasts are growing. They hurt, and he is embarrassed to take his shirt off during gym class. What should the nurse tell him? 1. The pediatrician will draw some blood to find out why your breasts are growing. 2. It is just a slight hormonal imbalance that can be easily corrected with medication. 3. This is a normal condition of puberty that will resolve within a year or two. 4. This is a rare finding that occurs in about 5% of boys during puberty.

3. This is a normal condition of puberty that will resolve within a year or two.

On assessment of a child admitted with a diagnosis of acute Kawasaki disease, the nurse expects to note which clinifical manifestation of the acute stage of the disease? 1. cracked lips 2. normal appearance 3. conjunctival hyperemia 4. desquamation of the skin

3. conjunctival hyperemia RATIONAL: the acute stage shows fever, conjunctival hyperemia, red throat, swollen hands, rash and enlargement of the cervical lymph nodes, subacute stage shows cracking lips, desqumation of skin of fingers and toes, joint pain, cardiac manifestations and thrombocytosis, convalescent stage shows normal appearance

A child with laryngotracheobronchitis (croup) asks the nurse why the pediatrician did not prescribe antibiotics. Which response should the nurse make? 1. "The child may be allergic to antibiotics" 2. "The child is too young to receive antibiotics" 3. "Antibiotics are not indicated unless a bacterial infection is present" 4. "The child still has the maternal antibodiesw from birth and does not need antibiotics"

3. it can be viral or bacterial, antibiotics are only indicated if it is bacterial

A 2-year-old admitted to the hospital 2 days ago has been crying and is inconsolable much of the time. The nurse's best response to the child's parents who are concerned about this behavior is that the child is in the: 1. Detachment phase of separation anxiety, which is normal for children during hospitalization. 2. Despair stage of separation anxiety, which is normal for children during hospitalization. 3. Bargaining stage of separation anxiety, which is normal for children during hospitalization. 4. Protest stage of separation anxiety, which is normal for children during hospitalization.

4

A parent calls the ER saying "I think my toddler might have swallowed a little toy, he is breathing okay but I dont know what to do?" What is the most essential question to ask the caller? 1. Has he vomited? 2. Have you been checking his stools? 3. What do you think he swallowed? 4. Has he been coughing?

4

According to developmental theories, which important event is essential to the development of the toddler? 1. The child learns to feed self. 2. The child develops friendships. 3. The child learns to walk. 4. The child participates in being potty-trained.

4

An 8-day-old was admitted to the hospital with vomiting and dehydration. The newborn's heart rate is 170, respiratory rate is 44, blood pressure is 85/52, and temperature is 99°F (37.2°C). What is the nurse's best response to the parents who ask if the vital signs are normal? 1. "The blood pressure is elevated, but the other vital signs are within normal limits." 2. "The temperature is elevated, but the other vital signs are within normal limits." 3. "The respiratory rate is elevated, but the other vital signs are within normal limits." 4. "The heart rate is elevated, but the other vital signs are within normal limits."

4

The clinic nurse is providing instructions to a parent of a child with cystic fibrosis regarding the immunization schedule for the child. WHhich statement should the nurse make to the parent? 1. "The immunization schedule will need to be altered" 2. "The child should not recieve any hepatitis vaccines" 3. "The child will recieve all of the immunizations except for the polio series" 4. "The child will recieve the recommended basic series of immunizations along with the yearly flu vaccine"

4

The nurse is obtaining the history and physical information for a child who is recovering from Kawasaki disease and receives aspirin therapy. Which information concerns the nurse the most? 1. the child attends a day care center 5 days a week 2. the childs fingers have areas of peeling skin 3. the child is very irritable adn cries frequently 4. the child has not recieved any immunizations

4

When assessing a childs cultural background, the nurse in charge should keep in mind that: 1. heritage dictates a groups shared values 2. physical characteristics make the child as part of a particular culture 3. cultural background usually has little bearing on a family's health practices 4. behavorial patters are passed from one generation to the next

4

Which approach should the nurse use to gather information from a child brought to the ED for suspected child abuse? 1. Promise the child that her parents will not know what she tells the nurse. 2. Promise the child that she will not have to see the suspected abuser again. 3. Use correct anatomical terms to discuss body parts. 4. Tell the child that the abuse is not her fault and that she is a good person.

4

Which comment should the parent of a 2-year-old expect from the toddler about a new baby brother? 1. "When the baby takes a nap, will you play with me?" 2. "Can I play with the baby?" 3. "The baby is so cute. I love him." 4. "It is time to put him away so we can play."

4

Which of the following infants is least probably to develop SIDS? 1. premature 2. sibling of a child who died of SIDS 3. prenatal drug exposure 4. sleeps on their back

4

Which statement accurately describes the best method for assessing a 12-month-old? 1. The nurse should assess the child on the examining table. 2. The nurse should assess the child in a head-to-toe sequence. 3. The nurse should have the child's mother assist in holding her down. 4. The nurse should assess the child while she is in her mother's lap.

4

The mother of an adolescent complains that he has had some recent behavioral changes. He comes home from school every day, closes his door, and refrains from interaction with his family. The nurse's best response to the mother is: 1. "You should speak with your son and ask him directly what is wrong with him." 2. "You should set limits with your son and tell him that this is unacceptable behavior." 3. "Your son's behavior is abnormal, and he is going to need a psychiatric referral." 4. "Your son's behavior is normal. You should listen to him without being judgmental."

4. "Your son's behavior is normal. You should listen to him without being judgmental."

What information should a school nurse include in a discussion on nutrition with a fourth-grade class? 1. The number of calories that a fourth-grade child should consume in a day. 2. A list of high-calorie foods that all fourth-graders should avoid. 3. How to read food labels so children know which foods are good for them. 4. A list of nutritious foods with basic scientific information about how they affect the body organs and systems.

4. A list of nutritious foods with basic scientific information about how they affect the body organs and systems.

A new parent expresses concern to the nurse regarding sudden infant death syndrome (SIDS). She asks the nurse how to position her new infant for sleep. In which position should the nurse tell the parent to place the infant? 1. Side or prone 2. Back or prone 3. Stomach with the face turned 4. Back rather than on the stomach

4. Back rather than on the stomach

Which statement accurately describes how the nurse should approach an 11-year-old to do a physical assessment? 1. Ask the child's parents to remain in the room during the physical exam. 2. Auscultate the heart, lungs, and abdomen first. 3. Explain that the physical exam will not hurt. 4. Explain what the nurse will be doing in basic understandable terms.

4. Explain what the nurse will be doing in basic understandable terms.

In terms of fine motor development, the infant of 7 months should be able to: a. Transfer objects from one hand to the other. b. Use thumb and index finger in crude pincer grasp. c. Hold crayon and make a mark on paper. d. Release cubes into a cup.

A By age 7 months infants can transfer objects from one hand to the other, crossing the midline. The crude pincer grasp is apparent at about age 9 months. The child can scribble spontaneously at age 15 months. At age 12 months the child can release cubes into a cup.

In terms of cognitive development the 5-year-old child would be expected to: a. Use magical thinking. b. Think abstractly. c. Understand conservation of matter. d. Be unable to comprehend another person's perspective.

A Magical thinking is believing that thoughts can cause events. 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. Five-year-olds cannot understand another's perspective.

In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? a. Roll from abdomen to back. b. Roll from back to abdomen. c. Sit erect without support. d. Move from prone to sitting position.

A Rolling from abdomen to back is developmentally appropriate for a 5-month-old infant. The ability to roll from back to abdomen usually occurs at 6 months old. Sitting erect without support is a developmental milestone usually achieved by 8 months. The 10-month-old infant can usually move from a prone to a sitting position.

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

A The baby talk is a sign of regression in the toddler. It should be ignored, while praising the child for developmentally appropriate behaviors. Regression is children's way of saying that they are expressing stress. The parents should not introduce new expectations and should allow the child to master the developmental tasks without criticism.

The parent of a 3-month-old infant asks the nurse, "At what age do infants usually begin drinking from a cup?" The nurse would reply: a. 5 months. b. 9 months. c. 1 year. d. 2 years.

A The infant can usually drink from a cup when it is offered at about 5 months.

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

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.

The nurse is aware that the age at which the posterior fontanelle closes is _____ months. a. 2 to 3 b. 3 to 6 c. 6 to 9 d. 9 to 12

A The posterior fontanelle closes between 2 and 3 months of age.

A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. The nurse should interpret this as: a. Normal development. b. Significant developmental lag. c. Slightly delayed development caused by prematurity. d. Suggestive of a neurologic disorder such as cerebral palsy.

A This indicates normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. No evidence of neurologic dysfunction is present.

A parent of an 18-month-old boy tells the nurse that he says "no" to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. The nurse's best interpretation of this behavior is that: a. This is normal behavior for his age. b. This is unusual behavior for his age. c. He is not effectively coping with stress. d. He is showing he needs more attention.

A Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and use of the word "no." Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old.

A maternity nurse is providing instruction to a new mother regarding the psychosocial development of the newborn infant. Using Erikson's psychosocial development theory, the nurse would instruct the mother to A) Allow the newborn infant to signal a need B) Anticipate all of the needs of the newborn infant C) Avoid the newborn infant during the first 10 minutes of crying D) Attend to the newborn infant immediately when crying

A) Allow the newborn infant to signal a need. Trust vs Mistrust stage-This will allow the infant opportunity to gain trust.

In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? Choose all that apply. a. Roll from abdomen to back b. Put feet in mouth when supine c. Roll from back to abdomen d. Sit erect without support e. Move from prone to sitting position f. Adjust posture to reach an object

A, B Rolling from abdomen to back and placing the feet in the mouth when supine are developmentally appropriate for a 5-month-old infant.

The nurse cautions that children who have unmet hunger needs will likely display which characteristic(s)? Select all that apply. a. Irritability b. Ineffective feeding patterns c. No predictable sleep-wake cycle d. Distrust e. Effective parent bonding

A, B, C, D Children who experience frequent hunger do not have effective parental bonding. All other options are probable outcomes for a child who has unmet hunger needs.

What should the teaching plan include about infant fall precautions? Select all that apply. a. Remove all unsteady furniture. b. Keep crib rails up and in locked position. c. Steady infant with hand when on changing table. d. Use tray attachment on high chair as restraint. e. Keep infant seat on the floor.

A, B, C, E The tray attachment to a high chair is an inadequate restraint. All other options are good precautions to prevent an infant from a fall.

What is Kawasaki disease?

An autoimmune disease involving the inflammation of blood vessels, lymph nodes, skin, and mucosa - initial symptom is a high fever, later symptoms include conjunctivitis, rash, peeling, and edema

Newborn Reflexes: Tonic Neck

Arms/legs extend in direction in which head is turned

The parent of a 4-year-old son tells the nurse that the child believes "monsters and boogeyman" are in his bedroom at night. The nurse's best suggestion for coping with this problem is to: a. Insist that the child sleep with his parents until the fearful phase passes. b. Suggest involving the child to find a practical solution such as a night light. c. Help the child understand that these fears are illogical. d. Tell the child frequently that monsters and boogeyman do not exist.

B A night light shows a child that imaginary creatures do not lurk in the darkness. Letting the child sleep with parents will not get rid of the fears. A 4-year-old is in the preconceptual age and cannot understand logical thought.

The nurse discusses child-proofing the home for safety with the mother of a 9-month-old. The statement made by the mother that indicates an unsafe behavior is: a. "I put covers on all of the electrical outlets." b. "In the car, she rides in a front-facing car seat." c. "There are locks on all of the cabinets in the house." d. "I have a gate at the top and bottom of the stairs."

B A rear-facing infant car seat should be used for infants younger than 1 year of age.

What describes a toddler's cognitive development at age 20 months? a. Searches for an object only if he or she sees it being hidden b. Realizes that "out of sight" is not out of reach c. Puts objects into a container but cannot take them out d. Understands the passage of time such as "just a minute" and "in an hour"

B At this age the child is in the final sensorimotor stage. Children will now search for an object in several potential places, even though they saw only the original hiding place. Children have a more developed sense of objective permanence. They will search for objects even if they have not seen them hidden. Putting an object in a container but being able to take it out indicates tertiary circular reactions. An embryonic sense of time exists, although the children may behave appropriately to time-oriented phrases; their sense of timing is exaggerated.

A parent brings a 6-month-old infant to the pediatric clinic for her well-baby examination. Her birth weight was 8 pounds, 2 ounces. The nurse weighing the infant today would expect her weight to be at least _____ pounds. a. 12 b. 16 c. 20 d. 24

B Birth weight is usually doubled by 6 months of age.

Which statement best describes fear in school-age children? a. They are increasingly fearful for body safety. b. Most of the new fears that trouble them are related to school and family. c. They should be encouraged to hide their fears to prevent ridicule by peers. d. Those who have numerous fears need continuous protective behavior by parents to eliminate these fears.

B During the school-age years children experience a wide variety of fears, but new fears related predominantly to school and family bother children during this time. During the middle-school years children become less fearful of body safety than they were as preschoolers. Parents and other persons involved with children should discuss their fear with them individually or as a group activity. Sometimes school-age children hide their fears to avoid being teased. Hiding the fears does not end them and may lead to phobias.

The nurse is aware that the earliest age at which the infant should be able to walk independently is _____ months. a. 8 to 10 b. 12 to 15 c. 15 to 18 d. 18 to 21

B For the majority of children, the milestone of walking alone is achieved between 12 and 15 months.

Which statement accurately describes physical development during the school-age years? a. The child's weight almost triples. b. A child grows an average of 2 inches per year. c. Few physical differences are apparent among children at the end of middle childhood. d. Fat gradually increases, which contributes to the child's heavier appearance.

B In middle childhood growth in height and weight occur at a slower pace. Between the ages of 6 to 12 years, children grow 2 inches per year. In middle childhood children's weight will almost double; they gain 3 kg/year. At the end of middle childhood girls grow taller and gain more weight than boys. Children take on a slimmer look with longer legs in middle childhood.

What is descriptive of the play of school-age children? a. Individuality in play is better tolerated than at earlier ages. b. Knowing the rules of a game gives an important sense of belonging. c. They like to invent games, making up the rules as they go. d. Team play helps children learn the universal importance of competition and winning.

B Play involves increased physical skill, intellectual ability, and fantasy. Children form groups and cliques and develop a sense of belonging to a team or club. At this age children begin to see the need for rules. Conformity and ritual permeate their play. Their games have fixed and unvarying rules, which may be bizarre and extraordinarily rigid. With team play children learn about competition and the importance of winning, an attribute highly valued in the United States.

A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was "bad." The nurse's best interpretation of this comment is that it is: a. A sign of stress. b. Common at this age. c. Suggestive of maladaptation. d. Suggestive of excessive discipline at home.

B Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think that they are directly responsible for events, making them feel guilt for things outside of their control. Children of this age show stress by regressing developmentally or acting out. Maladaptation is unlikely. This comment does not imply excessive discipline at home.

The nurse knows that an infant's birth weight should be tripled by: a. 9 months. b. 1 year. c. 18 months. d. 2 years.

B The infant usually triples his or her birth weight by about 12 months of age.

According to Erikson, the psychosocial task of adolescence is developing: a. Intimacy. c. Initiative. b. Identity. d. Independence.

B Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity. Intimacy is the developmental stage for early adulthood. Initiative is the developmental stage for early childhood. Independence is not one of Erikson's developmental stages.

Which statement is correct about toilet training? a. Bladder training is usually accomplished before bowel training. b. Wanting to please the parent helps motivate the child to use the toilet. c. Watching older siblings use the toilet confuses the child. d. Children must be forced to sit on the toilet when first learning.

B Voluntary control of the anal and urethral sphincters is achieved sometime after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please the parent by holding on rather than pleasing self by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner.

The nurse teaches parents how to help their children learn impulse control and cooperative behaviors. This would occur during which of the stages of development defined by Erikson? A.Trust versus mistrust B.Initiative versus guilt C.Industry versus inferiority D.Autonomy vs. Shame and doubt

B) Initiative vs Guilt. The stage of initiative versus guilt occurs from ages 3 to 6 years, during which children develop direction and purpose. Teaching impulse control and cooperative behaviors during this stage help the child to avoid risks of altered growth and development. In the autonomy versus sense of shame and doubt stage, toddlers learn to achieve self-control and willpower. Trust versus mistrust is the first stage, during which children develop faith and optimism. During the industry versus inferiority stage, children develop a sense of competency.

A nurse is evaluating the developmental level of a 2-year-old. Which of the following does the nurse expect to observe in this child? A) Uses a fork to eat B) Uses a cup to drink C) Uses a knife for cutting food D) Pours own milk into a cup

B. By age 2 years, the child can use a cup and can use a spoon correctly but with some spilling. By ages 3 to 4, the child begins to use a fork. By the end of the preschool period, the child should be able to pour milk into a cup and begin to use a knife for cutting.

A clinic nurse assesses the communication patterns of a 5-month-old infant. The nurse determines that the infant is demonstrating the highest level of developmental achievement expected if the infant: A) Uses simple words such as "mama" B) Uses monosyllabic babbling C) Links syllables together D) Coos when comforted

B. Using monosyllabic babbling occurs between 3 and 6 months of age. Using simple words such as "mama" occurs between 9 and 12 months. Linking syllables together when communicating occurs between 6 and 9 months. Cooing begins at birth and continues until 2 months.

What is pertussis (whooping cough)?

Bordetella pertussis. infected persons respiratory tract. spread via droplet, direct contact, and indirect contact with inanimate articles.

Which type of play is most typical of the preschool period? a. Solitary c. Associative b. Parallel d. Team

C Associative play is group play in similar or identical activities but without rigid organization or rules. Solitary play is that of infants. Parallel play is that of toddlers. School-age children play in teams.

The nurse would expect a 4-month-old to be able to: a. hold a cup. b. stand with assistance. c. lift head and shoulders. d. sit with back straight.

C Because development is cephalocaudal, of these choices, lifting the head and shoulders is the one that the infant learns to do first. The infant can usually sit with support at about 5 months of age and can sit alone at about 8 months.

Most infants begin to fear strangers at age: a. 2 months b. 4 months c. 6 months d. 12 months

C Between ages 6 and 8 months fear of strangers and stranger anxiety become prominent and are related to the infant's ability to discriminate between familiar and nonfamiliar people. At age 2 months infants are just beginning to respond differentially to the mother. At age 4 months the infant is beginning the process of separation individuation when the infant begins to recognize self and mother as separate beings. Twelve months is too late and requires referral for evaluation if the child does not fear strangers at this age.

Although a 14-month-old girl received a shock from an electrical outlet recently, her parents find her about to place a paper clip in another outlet. The best interpretation of this behavior is: a. Her cognitive development is delayed. b. This is typical behavior because toddlers are not very developed. c. This is typical behavior because of inability to transfer knowledge to new situations. d. This is not typical behavior because toddlers should know better than to repeat an act that caused pain.

C During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. Her cognitive development is appropriate for her age and represents typical behavior for a toddler. Only some awareness exists of a causal relation between events.

A group of boys ages 9 and 10 years have formed a "boys-only" club that is open to neighborhood and school friends who have skateboards. This should be interpreted: a. Behavior that encourages bullying and sexism. b. Behavior that reinforces poor peer relationships. c. Characteristic of social development of this age. d. Characteristic of children who later are at risk for membership in gangs.

C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. A boys-only club does not have a direct correlation with later gang activity.

Generally the earliest age at which puberty begins is: a. 13 years in girls, 13 years in boys b. 11 years in girls, 11 years in boys c. 10 years in girls; 12 years in boys d. 12 years in girls, 10 years in boys

C Puberty signals the beginning of the development of secondary sex characteristics. This begins in girls earlier than in boys. Usually a 2-year difference occurs in the age at onset. Girls and boys do not usually begin puberty at the same age; girls usually begin earlier than boys do.

The most appropriate activity to recommend to parents to promote sensorimotor stimulation for a 1-year-old would be to: a. ride a tricycle. b. spend time in an infant swing. c. play with push-pull toys. d. read large picture books.

C Push-pull toys are appropriate to promote sensorimotor stimulation for a 1-year-old child.

When assessing development in a 9-month-old infant, the nurse would expect to observe the infant: a. speaking in 2-word sentences. b. grasping objects with palmar grasp. c. creeping along the floor. d. beginning to use a spoon rather sloppily.

C The 9-month-old tries to creep, has developed pincer movement, and can grasp a spoon without keeping food on it.

The nurse is aware that the earliest age at which an infant is able to sit steadily alone is _____ months. a. 4 b. 5 c. 8 d. 15

C The infant can sit alone without support at about 8 months of age.

The abnormal finding in an evaluation of growth and development for a 6-month-old infant would be: a. weight gain of 4 to 7 ounces per week. b. length increase of 1 inch in 2 months. c. head lag present. d. can sit alone for a few seconds.

C The infant should be holding the head up well by 5 months of age. If head lag is present at 6 months, the child should undergo further evaluation.

Peer relationships become more important during adolescence because: a. Adolescents dislike their parents. b. Adolescents no longer need parental control. c. They provide adolescents with a feeling of belonging. d. They promote a sense of individuality in adolescents.

C The peer group serves as a strong support to teenagers, providing them with a sense of belonging and strength and power. During adolescence the parent/child relationship changes from one of protection-dependency to one of mutual affection and quality. Parents continue to play an important role in the personal and health-related decisions. The peer group forms the transitional world between dependence and autonomy.

A mother of a 3-year-old tells a clinic nurse that the child is rebelling constantly and having temper tantrums. The nurse most appropriately tells the mother to: A) Punish the child every time the child says "no", to change the behavior B) Allow the behavior because this is normal at this age period C) Set limits on the child's behavior D) Ignore the child when this behavior occurs

C) Set limits on the child's behavior-According to Erikson, the child focuses on independence between ages 1 and 3 years. Gaining independence often means that the child has to rebel against the parents' wishes. Saying things like "no" or "mine" and having temper tantrums are common during this period of development. Being consistent and setting limits on the child's behavior are the necessary elements.

A nurse is preparing to care for a 5-year-old who has been placed in traction following a fracture of the femur. The nurse plans care, knowing that which of the following is the most appropriate activity for this child? A) Large picture books B) A radio C) Crayons and coloring book D) A sports video

C. In the preschooler, play is simple and imaginative and includes activities such as crayons and coloring books, puppets, felt and magnetic boards, and Play-Doh. Large picture books are most appropriate for the infant. A radio and a sports video are most appropriate for the adolescent.

Signs and Symptoms of Asthma

Coughing (especially at night) expiratory wheezes, shortness of breath, chest tightness, trouble sleeping at night, cyanosis, barrel chest, dyspnea

The nurse explains that the second process of self-mobility an infant learns is seen at the age of 9 months, when the infant begins to ___________.

Creep At 7 months the infant begins to crawl, using arms and dragging trunk and legs. At 9 months the infant begins to creep, holding his or her trunk above the floor. The next self-mobility activity is cruising, where the child walks from one piece of furniture to the next before it begins to walk independently.

What would the nurse expect of a healthy 3-year-old child? a. Jump rope b. Ride a two-wheel bicycle c. Skip on alternate feet d. Balance on one foot for a few seconds

D 3-year-olds are able to accomplish the gross motor skill of balancing on one foot. Jumping rope, riding a two-wheel bike, and skipping on alternative feet are gross motor skills of 5-year-old children

The most common cause of death in the adolescent age-group involves: a. Drownings. b. Firearms. c. Drug overdoses. d. Motor vehicles.

D 36% of all adolescent deaths in the United States are the result of motor vehicle accidents. Drownings, firearms, and drug overdoses are major concerns in adolescence but do not cause the majority of deaths.

The statement made by a parent that indicates correct understanding of infant feeding is: a. "I've been mixing rice cereal and formula in the baby's bottle." b. "I switched the baby to low-fat milk at 9 months." c. "The baby really likes little pieces of chocolate." d. "I give the baby any new foods before he takes his bottle."

D New solid foods should be introduced before formula or breast milk to encourage the infant to try new foods.

A mother calls the pediatrician's office because her infant is "colicky." The helpful measure the nurse would suggest to the parent is to: a. sing songs to the infant in a soft voice. b. place the infant in a well-lit room. c. walk around and massage the infant's back. d. rock the fussy infant slowly and gently.

D One technique the nurse can offer parents of a fussy infant is to rock the infant gently and slowly while being careful to avoid sudden movements.

The nurse would advise a parent when introducing solid foods to: a. begin with one tablespoon of food. b. mix foods together. c. eliminate a refused food from the diet. d. introduce each new food 4 to 7 days apart.

D Only one new food is offered in a 4- to 7-day period to determine tolerance.

The role of the peer group in the life of school-age children is that it: a. Gives them an opportunity to learn dominance and hostility. b. Allows them to remain dependent on their parents for a longer time. c. Decreases their need to learn appropriate sex roles. d. Provides them with security as they gain independence from their parents.

D Peer-group identification is an important factor in gaining independence from parents. Through peer relationships children learn ways to deal with dominance and hostility. They also learn how to relate to people in positions of leadership and authority and explore ideas and the physical environment. Peer-group identification helps in gaining independence rather than remaining dependent. A child's concept of appropriate sex roles is influenced by relationships with peers.

A 17-month-old child would be expected to be in what stage according to Piaget? a. Trust b. Preoperations c. Secondary circular reaction d. Tertiary circular reaction

D The 17-month-old is in the fifth stage of the sensorimotor phase: tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Trust is Erikson's first stage. Preoperations is the stage of cognitive development usually present in older toddlers and preschoolers. Secondary circular reactions last from about ages 4 to 8 months.

Which characteristic best describes the gross motor skills of a 24-month-old child? a. Skips b. Rides tricycle c. Broad jumps d. Walks up and down stairs

D The 24-month-old child can go up and down stairs alone with two feet on each step. Skipping and the ability to broad jump are skills acquired at age 3. Tricycle riding is achieved at age 4.

The school nurse has been asked to begin teaching sex education in the 5th grade. The nurse should recognize that: a. Children in 5th grade are too young for sex education. b. Children should be discouraged from asking too many questions. c. Correct terminology should be reserved for children who are older. d. Sex can be presented as a normal part of growth and development.

D When sex information is presented to school-age children, sex should be treated as a normal part of growth and development. Fifth graders are usually 10 to 11 years old. This age is not too young to speak about physiologic changes in their bodies. They should be encouraged to ask questions. Preadolescents need precise and concrete information.

An adolescent boy tells the nurse that he has recently had homosexual feelings. The nurse's response should be based on knowledge that: a. This indicates that the adolescent is homosexual. b. This indicates that the adolescent will become homosexual as an adult. c. The adolescent should be referred for psychotherapy. d. The adolescent should be encouraged to share his feelings and experiences.

D These adolescents are at increased risk for health-damaging behaviors, not because of the sexual behavior itself, but because of society's reaction to the behavior. The nurse's first priority is to give the young man permission to discuss his feelings about this topic, knowing that the nurse will maintain confidentially, appreciate his feelings, and remain sensitive to his need to talk it. In recent studies among self-identified gay, lesbian, and bisexual adolescents, many of the adolescents report changing their self-labels one or more times during their adolescence.

A child diagnosed with tetralogy of fallot becomes upset, crying and thrashing around when a blood specimen is obtained. The child's color becomes blue and respiratory rate increases to 44 bpm. Which of the following actions would the nurse do first? a) obtain an order for sedation for the child b) assess for an irregular heart rate and rhythm c) explain to the child that it will only hurt for a short time d) place the child in knee-to-chest position

D. the child is experiencing a "tet spell" or hypoxic episode. Therefore the nurse should place the child in a knee-to-chest position. Flexing the legs reduces venous flow of blood from lower extremities and reduces the volume of blood being shunted through the interventricular septal defect and the overriding aorta in the child with tetralogy of fallot. As a result, the blood then entering the systemic circulation has higher oxygen content, and dyspnea is reduced. Flexing the legs also increases vascular resistance and pressure in the left ventricle. An infant often assumes a knee-to-chest position to relieve dyspnea. If this position is ineffective, then the child may need sedative. Once the child is in this position, the nurse may assess for an irregular heart rate and rhythm. Explaining tho the child that it will only hurt for a short time does nothing to alleviate hypoxia.

A 16-year-old is admitted to the hospital for acute appendicitis, and an appendectomy is performed. Which of the following nursing interventions is most appropriate to facilitate normal growth and development? A) Allow the family to bring in the child's favorite computer games B) Encourage the parents to room-in with the child C) Encourage the child to rest and read D) Allow the child to participate in activities with other individuals in the same age group when the condition permits

D. Adolescents often are not sure whether they want their parents with them when they are hospitalized. Because of the importance of the peer group, separation from friends is a source of anxiety. Ideally, the members of the peer group will support their ill friend. Options a, b, and c isolate the child from the peer group.

Interventions for Epiglottitis

DO NOT place in supine position trach at bedside IV hydration Provide oxygen

Immunizations at 6 months

DTaP, IPV, PCV, Hep B, RV, Hib

Immunizations at 4 months

DTaP, RV, IPV, Hib, PCV

Risk factors for Influenza

Diabetes chronic renal disease immune deficiency chronic heart or lung conditions

4 D's or epiglottitis symptoms

Drooling Dysphasia Dysphonia Distress on inspiration (stridor)

FICA Tool Stands for

F: faith I: importance C: community A: address in care

What is cystic fibrosis?

It is a genetic disorder (autosomal recessive) of the cell membranes. Causes thick, sticky mucus to build up in air passages and pancreas.

Newborn Reflexes: Moro/Startle

Jar crib, baby's arms and legs extend and flex through trunk

Medications for Congenital heart disease

Lanoxin: given 1 hr prior to meals, 2 hours after meals (take apical pulse before med) Lasix: monitor K, Mg and Ca

Which side of the heart has an increase of workload with PDA?

Left side

What is patent ductus arteriosus?

PDA is failure of the fetal ductus arterioles (artery connecting the aorta and the pulmonary artery) to close within the first weeks of life. (aorta and pulmonary artery remain connected after birth)

Acute Rheumatic Fever

Systemic complication of pharyngitis due to group A beta-hemolytic streptococci; affects children 2-3 weeks after an episode of streptococcal pharyngitis

True or False: tetralogy of fallot is more common in boys than girls

True

Erickson's stages of psychosocial development

Trust/Mistrust, Autonomy/Shame, Initiative/Guilt, Industry/Inferiority, Identity/Role Confusion

What vessels are involved in the transposition of great vessels?

aorta and pulmonary artery's are reversed

Feedings for an infant: 6 months

baby can be started on rice, 2-3 teaspoons, continue with breast milk/formula

Subacute Bacterial Endocarditis (SBE)

bacteria enters and damages area of endocardium

What is sinusitis?

bacterial infection of paranasal sinuses (maxillary and ethmoid sinuses most common site for children)

Piaget's stages of cognitive development: Sensorimotor

birth to 2 years stage 1: birth to 2 months (reflexes), sucking stage 2: 1-4 months, (primary circular reaction), reflexes with sensations stage 3: 4-8 months (secondary circular reaction), environment and repeat reaction that triggers response stage 4: 8-12 months (coordination of secondary schemata) repeats action to achieve efforts

Interventions for ASD

cardiac catherization trans septal closing monitor feedings assess for s/s of CHF (increased breathing, grunting, retractions, flaring, monitor growth pattern)

Signs and symptoms of a child with otitis media

child pulling on ears, sleep disturbances, high grade fever, yellow purulent drainage, lymph enlargement, eardrum buldging and red

Pink Tet

child remains pink but has low degree of mixing of blood

object permanence

child understands that an object exists despite being unable to see or hear it, achieved by 9 months old (ex: hide toy under blanket, child believes toy is gone forever before object permanence is established, once established the child understands they coudl go under blanket and retrieve object

Stages of Pertussis (Whooping Cough): Stage 3

chronic cough lasting up to 10 weeks or longer

Asthma

chronic inflammatory airway disorder

Interventions for PDA

coli embolization/ligation procedure decrease workload of child provide frequent rest periods (cluster care) strict I&O daily weights assess toleration to feedings

What is tuberculosis?

contagious disease caused by inhalation of mycobacterium tuberculosis

Presentation of Colic

crying frowning red face knees to chest clenching fist excessive gas

What is cystic fibrosis caused by?

deletion on long arm of chromosome 7 at cystic fibrosis transmembrane regulator (CTFR)

Cephalocaudal

development from head to toes (Ex: child can control their head and neck before arms and legs, can hold head up before walking/crawling)

hypercyanotic spells (tet spells)

episodes of sudden increased cyanosis, hypoxia, dyspnea and agitation

What are the physical manifestations of congenital heart disease?

failure to thrive small gestational age poor weight gain dysmorphic feature chest wall deformities scolosis clubbing polycythemia

Manifestations of SBE

fever fatigue heart murmur dyspnea joint pain weight loss

Manifestations of PDA

heart murmur (washing machine sound) wet sound with breath sounds tachypnea apnea poor feeding fatigue excessive weight gain poor O2 sat bounding pulses heart enlargement

Manifestations of ASD(atrial septal defect)

heart murmur ] atrial dysrhythmias (major cause of death) higher incidence of emboli recurrent respiratory infections dyspnea tires easily poor feeding poor growth

Manifestations of Toxic Shock Syndrome

high fever rash hypotension multisystem organ failure any skin wound

What is an atrial septal defect?

hole in septum that divides the right and left atria

What part of the brain stops working during SIDS?

hypothalamus stops signaling baby to breathe

Why does the older child fo into a squatting position?

improve blood flow to the brain and vital organs by increasing systemic vascular resistance

Interventions for Cystic Fibrosis

increase calories and proteins in diet aerosol treatments chest physiotherapy high frequency chest compression vest pulmozyme (decreases sputum and clears secretions) antibiotics pancreatic enzymes and supplemental fat soluble vitamins

Newborn Reflexes: Rooting

infant turns head to direction of stimuli

What is bronchiolitis (Respiratory syncytial virus RSV)

inflammation of the bronchioles (HIGHLY contagious)

What is the epiglottitis?

inflammation of the epiglottis, emergency situation

Stages of Pertussis (Whooping Cough): Stage 2

intense coughing fits for 1 week

What systems does rheumatic fever involve?

joints heart CNS skin subcutaneous tissue

Best method for performing a physical exam on a toddler

least to most intrusive

What is a ventricular septal defect?

left to right shunting (acyanosis) produces increase in pulmonary blood flow that decreases pulmonary compliance

What is the intensity of a Heart Murmor: Grade IV

loud with precordial thrill

What is the intensity of a Heart Murmor: Grade III

loud with thrill

What is the intensity of a Heart Murmor: Grade V

loud, audible with stethoscope

Manifestions of VSD

may be asymptomatic heart murmur dyspnea feeding difficulties failure to thrive recurrent resp infections

Risk factors of SIDS

mothers under the age of 20, maternal smoking, family history

Signs and Symptoms of Tonsillitis

muffled/hoarse voice back of throat is red tonsil enlargement difficulty breathing/swallowing mouth breather

What is coarctation of the aorta?

narrowing of the aorta, blood pressure increased in heart and upper portions of the body and blood pressure decreases in lower portions of the body

5 factors that influence growth and development

nutrition, parent behavior, parenting, social/cultural practice, environment

Hypoplastic Left Heart Syndrome

underdevelopment of the left side of the heart (aorta, aortic valve, left ventricle, and mitral valve)

Stages of Pertussis (Whooping Cough): Stage 1

upper respiratory infection lasting 1-2 weeks

Newborn Reflex: Stepping

when baby is put down on its feet, they will step up and down in place