Prep U QC: Growth and Development
A male nurse is meeting with a group of 12-year-old boys to discuss expected bodily changes. After one of the boy's says, "My older brother told me my bed might be wet and that means I had a wet dream. Is that true?" What is the best response from the nurse? ("When you are thinking about people you find sexually attractive or dating those people you might have a wet dream." "It is not common to wet the bed or urinate when you have a wet dream." "Having wet dreams indicates that your body is going through a process of maturing." "It will be several years before you will start having wet dreams.")
"Having wet dreams indicates that your body is going through a process of maturing." (Explanation: In boys, the appearance of nocturnal emissions ("wet dreams") is often used as the indication that the preadolescent period has ended and that the adolescent is maturing into an adult. Nocturnal emissions usually occur at about the age of 11 in boys. Wet dreams are not associated with urination. Boys at this age start thinking of relationships with people they find sexually attractive, but this is not the best response.)
The nurse is providing anticipatory guidance to a parent to help promote healthy sleep for the 3-week-old newborn. Which recommended guideline will the nurse include in the teaching plan? (A stuffed animal may be placed in the crib for comfort once the newborn is 1 month old. Wrap the newborn in a blanket before placing in the crib for the night. Place the newborn on the back when sleeping during the day or night. Once sleeping through the night, continue to wake the infant up for night feedings.)
Place the newborn on the back when sleeping during the day or night. (Explanation: Sudden infant death syndrome {SIDS} has been associated with prone positioning of newborns and infants, so the newborn and infant should always be placed on the back to sleep. Nothing should be placed in the crib or bassinet except for the infant—no blankets, stuffed animals, pillows, etc. By 4 months of age night waking may occur, but the infant should be capable of sleeping through the night and does not require a night feeding.)
A mother calls the hospital nursing hotline and asks, "My 8-week-old daughter cries 8 hours a day, and she is hard to console. Is that normal?" What should the nurse's response be to this mother? ("Let me ask you some more questions to see if there are symptoms of colic." "Yes, infants cry all the time at that age." "No, call your doctor." "Yes, maybe she is just tired.")
"Let me ask you some more questions to see if there are symptoms of colic." (Explanation: The nurse should seek more information to assess the infant's symptoms. The symptoms suggest colic, which is characteristic of an infant who cries more than 3 hours a day and is fussy and hard to console. The other responses are nontherapeutic and do not seek further information to gather a history.)
The pediatric nurse is meeting with a group of preschoolers' family members to discuss various health topics. The nurse determines the sexual development session is successful after overhearing which comment by one of the participants? ("When I find my son masturbating, I will tell him that is unacceptable." "I will tell my daughter that she will have time to explore her body as she gets older." "I will encourage my son to ask his father any questions that are sexual in nature." "I feel better knowing that her curiosity is normal.")
"I feel better knowing that her curiosity is normal." (Explanation: The child's sexual curiosity is a normal, natural part of total curiosity about oneself and the world. Exploration of the genitalia is natural for the preschooler. It is one way the child learns to perceive the body as a possible source of pleasure and is the beginning of the acceptance of sex as natural and pleasurable. Caregivers can be reassured that this is not uncommon behavior.)
The parent of a toddler notices the child plays nicely next to another toddler but does not play with that child. The parent expresses concern about this behavior to the nurse during an examination. Which response by the nurse is appropriate? ("This is called parallel play and is normal for this age group." "This behavior needs to be further assessed to ensure appropriate development." "I believe your toddler is exhibiting signs of an autism spectrum disorder." "Be sure to inform the primary health care provider of your concern.")
"This is called parallel play and is normal for this age group." (Explanation: Typical play of the toddler period is beside, not with, another toddler (parallel play). No further assessment is needed, nor does this indicate an autism spectrum disorder. The nurse should respond to the parent and not simply tell the parent to talk to the primary health care provider as this does not address the parent's concern.)
A nurse observes a child engaged in parallel play in a nursery. Which behavior would the nurse likely observe? (A boy sitting beside a girl in the floor, each playing independently with a separate set of blocks A girl sitting by herself and alternating between playing with a doll for a time and then with a toy truck for a time Two boys playing cooperatively with stuffed animals, pretending that the toys are fighting each other A group of children playing hide and seek on the playground)
A boy sitting beside a girl in the floor, each playing independently with a separate set of blocks (Explanation: All during the toddler period, children play beside children next to them, not with them. This side-by-side play (called parallel play) is not unfriendly but is a normal developmental sequence that occurs during the toddler period. The other answers are not examples of parallel play.)
The nurse sees a 15-month-old at a health maintenance visit. Of the following assessments, which one is generally included in a 15-month checkup? (Blood pressure Height and weight measurements Clean-catch urine IQ testing)
Height and weight measurements (Explanation: Because height and weight are such strong determinants of health, they are measured at every health assessment.)
The nurse is providing anticipatory guidance for violence prevention to a group of parents with adolescents. Which parental action should the nurse include as the most effective in preventing suicide? (Watching for aggressive behavior or racist remarks. Checking for signs of depression or lack of friends. Becoming acquainted with the teen's friends. Monitoring video games, TV shows, and music.)
Checking for signs of depression or lack of friends. (Explanation: Checking for signs of depression or lack of friends would be most effective for preventing suicide. All other choices are more effective for preventing violence to others.)
The nurse is caring for a hospitalized 10-year-old client. Which nursing action is most appropriate? (Consistently reinforce the child's self-worth. Discourage the child from assisting with dressing change. Correct each of the child's mistakes to ensure learning. Structure a competitive environment between clients.)
Consistently reinforce the child's self-worth. (Explanation: Helping school-aged clients experience satisfaction in projects, social activities, family life, and school helps them gain a sense of industry. Reinforcing self-worth provides this satisfaction. The child should not be discouraged from participating in his or her care. The child's mistakes may need corrected to learn; however, the child has to be allowed to make mistakes in a safe environment to promote learning. Pointing out these mistakes needs to be done with care. Competition between clients will not facilitate growth and development or psychosocial development.)
The nurse is teaching parents of an 11-year-old child how to deal with the issue of peer pressure regarding the use of tobacco and alcohol. Which suggestion by the nurse provides the best course of action for the parents? (Avoid smoking in the house or in front of the child. Keep any alcohol products in the home in a locked cabinet. Encourage the child to avoid having friends who smoke or drink. Discuss tobacco and alcohol use and effects with the child.)
Discuss tobacco and alcohol use and effects with the child. (Explanation: Parents are major influences on school-age children and should discuss the dangers of tobacco and alcohol use with the child. Not smoking in the house and hiding alcohol send mixed messages to the child. Open and honest discussion is the best approach rather than discouraging the child from making friends with kids that use tobacco or alcohol.)
The nurse is assessing the 18-month-old infant. The nurse notes the anterior fontanel (fontanelle) has closed. What initial action by the nurse is indicated? (Document the findings as normal. Review the birth records of the infant to see if there were any other anomalies. Notify the infant's health care provider. Measure the infant's head circumference.)
Document the findings as normal. (Explanation: The anterior fontanel {fontanelle} most often closes between 12 and 24 months of age. The closure of the fontanel {fontanelle} at 18 months of age does not signal any health issues for the infant.)
The nurse is educating a new parent regarding nutritional needs for the newborn. Which statement is accurate and should be taught regarding the nutritional needs of a newborn? (Growth during newborn stage is slow, so fewer calories are needed then when the infant is older. Cow's milk is similar to breast milk in terms of calories and nutrients and is appropriate for the newborn. Newborns require additional water to supplement their diet if they are only formula feeding. Formula is designed to provide similar amounts of calories as breast milk would provide.)
Formula is designed to provide similar amounts of calories as breast milk would provide. (Explanation: Infant formula is designed to mimic the same nutritional value as breast milk. Cow's milk is not appropriate for newborns as a source of nutrition. Water is not needed for formula-fed or breastfed infants. Infants are growing the most during the early months and need more calories, not less.)
The nurse has completed an examination of a 32-month-old girl with normal gross and fine motor skills. Which observation would suggest the child is experiencing a problem with language development? (Her vocabulary is between 10 and 15 words. She asks many questions. She uses complete 3- to 4-word sentences. She talks incessantly.)
Her vocabulary is between 10 and 15 words. (Explanation: A 3-year-old child typically has a vocabulary of approximately 900 words, asks many questions, uses complete sentences consisting of 3 to 4 words, and talks incessantly. Thus a vocabulary of 10 to 15 words suggests a language problem.)
The nurse is teaching a new mother about the development of sensory skills in her newborn. What would alert the mother to a sensory deficit in her child? (The newborn's eyes wander and occasionally are crossed. The newborn does not respond to a loud noise. The newborn's eyes focus on near objects. The newborn becomes more alert with stroking when drowsy.)
The newborn does not respond to a loud noise. (Explanation: Though hearing should be fully developed at birth, the other senses continue to develop as the infant matures. The newborn should respond to noises. Sight, smell, taste, and touch all continue to develop after birth. The newborn's eyes wander and occasionally cross, and the newborn is nearsighted, preferring to view objects at a distance of 8 to 15 inches. Holding, stroking, rocking, and cuddling calm infants when they are upset and make them more alert when they are drows)
A mother reports to the nurse that her 4-year-old does everything that she does. She says she is becoming somewhat frustrated with these actions. What would be the best response by the nurse to this mother? ("I can imagine that it would be very irritating." "I am sure there are ways to get your daughter to stop imitating you." "This is not normal behavior. I am going to get the doctor's advice." "Preschoolers' imitating is a healthy behavior. It is part of their imagination and normal growth and development.")
"Preschoolers' imitating is a healthy behavior. It is part of their imagination and normal growth and development." (Explanation: The nurse needs to inform the mother that preschoolers have an imagination that is keener than it will be at any other stage. They enjoy games using imitation and they mimic exactly what they see parents do. It is a normal part of their development.)
The nurse is performing an assessment of the reproductive system of a 17-year-old girl. What would alert the nurse to a developmental delay in this girl? (Areola and papilla separate from the contour of the breast Mature distribution and coarseness of pubic hair Developed breast tissue Lack of occurrence of first menstrual period)
Lack of occurrence of first menstrual period (Explanation: The first menstrual period usually begins between the ages of 9 and 15 years {average 12.8 years}. Breast budding {thelarche} occurs at approximately ages 9 to 11 years and is followed by the growth of pubic hair.)
The nurse is teaching the parents of a 6-month-old infant about proper dental care. Which action will the nurse indicate as most likely to cause dental caries in this infant? (not cleaning the infant's gums after eating meals or snacks putting the infant to bed with a bottle of milk or juice using a cloth instead of a brush for cleaning the infant's teeth brushing the infant's teeth with fluoride-free toothpaste)
putting the infant to bed with a bottle of milk or juice (Explanation: The nurse will warn against putting the infant to bed with a bottle of milk or juice because this allows the sugar content of these fluids to pool around the infant's teeth at night. Not cleaning the infant's gums when the infant is done eating will have minimal impact on the development of dental caries, as will using a cloth instead of a brush for cleaning teeth when they erupt. Failure to clean the teeth with fluoridated toothpaste is not a problem if the water supply is fluoridated. Fluoridated toothpaste is recommended for use once the infant is able to not swallow during brushing.)
The nurse is observing the behavior of a preschool-aged child and becomes concerned. Which observation suggests that the child's thinking is inconsistent with normal preschooler growth and development? (refusing to play with "real" children refusing to go to bed without the imaginary friend insisting that an imaginary friend have dinner with the family insisting that an imaginary friend watch television with the child)
refusing to play with "real" children (Explanation: Many preschoolers have an imaginary friend who plays with them. Imaginary friends are a normal, creative part of the preschool years and can be invented by children who are surrounded by real playmates as well as by those who have few friends. As long as the child has exposure to real playmates, imaginary friends do not take center stage in the child's life or prevent them from socializing with other children. In these cases, the imaginary friend should not pose a problem. Refusing to go to bed without the friend, having the friend eat dinner with the family, and watching television with the friend are all acceptable behaviors by the preschool-age child.)
The parents of a 10-year-old girl voice concern to the nurse because their daughter seems to "have a higher amount of body fat" than they expect based on the healthy eating habits and high activity level of the family. What is the best response by the nurse? ("Do you think maybe your daughter eats in the evening or when you are monitoring her intake at home? You may want to ask her." "Girls are always heavier than boys it seems. I'm sure she just falls into that category." "Her metabolism may be slower than the rest of your family. Try increasing her activity to see if her body fat decreases." "Before adolescence the body fat composition of school-age children increases earlier and in greater amounts in girls than in boys.")
"Before adolescence the body fat composition of school-age children increases earlier and in greater amounts in girls than in boys." (Explanation: Boys have more lean body mass per inch of height than girls during the late school-age years, in preparation for adolescence.)
The mother of two children ages 6 and 12 reports that her 6-year-old child seems to have "cold after cold" while her older child never seems to be ill. She questions if there is something wrong with her younger child. What is the best response by the nurse? ("All children have differing levels of immunity." "The immune system of your younger child is less mature and may result in having more infections." "Your younger child likely has a greater tendency toward illness." "It is most likely coincidental and there is little to worry about.")
"The immune system of your younger child is less mature and may result in having more infections." (Explanation: The immune system of the school-aged child is not fully mature. Lymphatic tissues continue to grow until the child is 9 years old; immunoglobulins A and G {IgA and IgG} reach adult levels at around 10 years of age.)
During an examination, an adolescent client tells the nurse about being anxious and frustrated because of the facial acne. Which nursing response is appropriate? ("This is one of the most common physical changes during adolescence." "I will tell your primary health care provider about your acne." "Most people get acne during adolescence. It will go away as you get older." "Consuming fried foods and chocolate can cause acne to develop.")
"This is one of the most common physical changes during adolescence." (Explanation: It is important for the nurse to inform the client that acne is a normal physical changes that characterizes adolescence as a result of increased glandular activity. The nurse should address the client's concern and not refer the client to the primary health care provider. The client's worries should not be trivialized or ignored as this is a situation that is worrisome for the adolescent. The type of foods consumed do not cause acne.)
While evaluating the development of a 10-month-old boy, a nurse hides the boy's stuffed animal behind her back. The boy crawls around the examination table to look behind the nurse's back for the stuffed animal. Which developmental phenomena has this infant demonstrated? (Object permanence Hand regard Binocular vision Depth perception)
Object permanence (Explanation: By 10 months, an infant looks under a towel or around a corner for a concealed object (beginning of object permanence, or become aware an object out of sight still exists). Hand regard, which is typically demonstrated by 3-month-olds, is a phenomenon that involves the infant holding his hands in front of his face and studying them. Binocular vision, which is the ability to fuse two images into one, is demonstrated by 2-month-olds when they follow moving objects with their eyes. Depth perception allows 7-month-olds to transfer toys from hand to hand.)
The nurse is watching toddlers at play. Which normal behavior would the nurse observe? (Toddlers engage in parallel play. Toddlers engage in solitary play. Toddlers engage in cooperative play. Toddlers do not engage in play outside the home.)
Toddlers engage in parallel play. (Explanation: Toddlers typically play alongside another child (parallel play) rather than cooperatively. Infants engage in solitary play.)
The developmental task of the school-aged period, according to Erikson, is gaining a sense of: (autonomy versus shame. independence versus dependence. industry versus inferiority. identity versus failure.)
industry versus inferiority. (Explanation: The school-age years, according to Erickson, are the stage of industry versus inferiority. The developmental stage helps increase the child's sense of self worth. Industry is associated with the child's increased interest in knowledge and the development of social skills. Autonomy versus shame is the developmental tasks of 1 to 3 year old children. Erickson's stages do not include the developmental tasks of independence versus dependence nor identity versus failure.)
A school-aged child develops school phobia. When counseling her mother, the nurse would advise her that the accepted action is to: (keep her child home until this fear passes. make her child attend school every day. allow her child to decide daily if she wants to go to school or not. ask the teacher to decide if the child should come to school or not each day.)
make her child attend school every day. (Explanation: School refusal or phobia may result from both a parent not wanting a child to attend school and a child not wanting to leave a parent. Th nurse's role is to help them work together while keeping the child in school to resolve the issue.)
The nurse is assessing a 3-year-old child. The nurse notes the child is able to understand that objects hidden from sight still exist. The nurse correctly documents that the child is displaying: (object permanence. mental combinations. preoperational thinking. concrete thinking.)
object permanence. (Explanation: Object permanence means that the child knows that objects that are out of sight still exist.)
A nurse is reviewing the health records of several 4-month-old infants who were seen in the pediatric office today. Which infant behavior will require referral for further evaluation of growth and development? (reaches for nearby objects unable to support head cannot sit without assistance rolls from prone to supine position)
unable to support head (Explanation: An infant at 4 months of age who cannot support his or her head should be referred for evaluation. A 4-month-old infant should be able to reach for objects of interest and should be able to roll from a prone to a supine position. A 4-month-old infant is not able to sit alone without support.)
The nurse is teaching safety to a group of adolescents. Which common cause of death among adolescents will the nurse include in the teaching? (falls poisoning diseases unintentional injuries)
unintentional injuries (Explanation: Unintentional injuries are among the leading causes of death in adolescents. Injuries kill more adolescents than all diseases combined, with a large percentage being due to motor vehicle accidents. Falls are more common among geriatric populations. Poisoning is more common among young children. Diseases are more common among older adults and geriatrics.)
The nurse is discussing an adolescent's development with the client's parents. Which statement by the parents indicate an understanding of the nurse's teaching? ("We will work toward ensuring our adolescent is developing trusting relationships." "It is most important for our adolescent to achieve independence from our dominance." "Our adolescent is working toward achieving a sense of personal identity." "It is vital our adolescent learns to help others achieve their goals.")
"Our adolescent is working toward achieving a sense of personal identity." (Explanation: According to Erikson's theory of psychosocial development, the major challenge of adolescence is the achievement of identity. Achieving independence from parental domination is another task of adolescence, but not the ultimate one. Helping other adolescents achieve higher goals is not a part of Erikson's theory of psychosocial development. Developing trust occurs in infancy.)
The mother of a 5-year-old kindergarten student tells the school nurse she is concerned that her son doesn't seem to be able to pronounce words correctly that begin with the letters "th" and "r." What is the best response by the nurse? ("It is very common for children 6 years and younger to have difficulty with these sounds, but I will let our speech therapist know so it can be monitored." "Are you sure about this because I haven't noticed this. Maybe he just does this to get a response from you when he is at home." "I will ask your child's teacher if he is speaking this way during class. It may be an attention seeking effort on his part." "Language development is critical at this age. I will notify our language specialist so this can be dealt with as soon as possible.")
"It is very common for children 6 years and younger to have difficulty with these sounds, but I will let our speech therapist know so it can be monitored." (Explanation: It is not unusual for children over the age of 6 to have difficulty with several different letters. The nurse is correct in notifying the speech therapist so that the child's speech can be monitored. There is no indication of the child being attention seeking or of this being a critical issue so these statement by the nurse are not appropriate.)
A mother tells the nurse that her 5-year-old son always pretends his toy rake is a fishing pole no matter how many times she shows him how a rake is used. How should the nurse respond? ("Preschoolers have a vivid imagination so it is very common for them to invent ways to use their toys." "This is a sign of high intelligence since your child has thought of alternative uses for a toy." "Developmentally your child should be using toys for what they were intended. I will let the pediatrician know." "Do you model how to use a rake for your child? This may help your child use the toy rake the correct way.")
"Preschoolers have a vivid imagination so it is very common for them to invent ways to use their toys." (Explanation: Growth and development are promoted through play and preschoolers like using toys for their intended purpose as well as for whatever invented purpose they can imagine, such as using the rake as a fishing pole. Using imagination with the rake does not correlate to high intelligence. Modeling "proper" use of the rake can be done, but the preschooler is encouraged to use his or her imagination; there is no right or wrong way to play with toys at this age.)
An 11-year-old boy is significantly above the 100% percentile for height. The boy tells the school nurse that his parents expect so much out of him when he is playing basketball for the school team that he is thinking of quitting. What action should the nurse take? (Tell the parents that they should stop putting so much pressure on their son just because he is tall. Remind the boy that being so much taller than the other boys is why others have higher expectations for him. Arrange a conference with the parents, son, and nurse to discuss the child's concerns. Encourage the boy to talk to his coach to determine if his parents' expectations are realistic.)
Arrange a conference with the parents, son, and nurse to discuss the child's concerns. (Explanation: The best action is for the nurse to speak with the parents and the child together to discuss concerns in order to establish open dialogue and possible resolution. During the conference, the nurse can point out that physical maturity is not necessarily associated with emotional and social maturity and that the expectations placed on these children are unrealistic and can impact the self-esteem and competence of the child.)
The parents of a preschool-aged child want to begin preparing the child to attend school. What would the nurse suggest the parents discuss with the child to help with this preparation? (Point out how to go to school. Talk about school as an enjoyable experience. Warn about how many rules there will be in school. Encourage working on projects lying on the floor so school tables will be appreciated.)
Talk about school as an enjoyable experience. (Explanation: If school is discussed as something to look forward to, as an adventure that will be satisfying and rewarding, a child comes to look forward to it as a positive experience. Pointing out how to get home from school might be more important than how to get to school. Warning about rules and expecting to work on the floor may cause the child to view school as punishment.)
The nurse is caring for a 17-month-old child admitted to the acute care facility. The child is fretful and becomes calmer when given a tattered blanket from home. What inference can be made about the child's behavior in response to receiving the blanket? (The child is likely neglected and best obtains comfort from objects rather than human contact. The ability of the child to soothe herself is a positive sign of development. No inferences can be made from the child's behavior. The child is likely tired and has managed to "cry it out".)
The ability of the child to soothe herself is a positive sign of development. (Explanation: The ability to achieve emotional comfort by self-soothing behaviors demonstrates a positive adaptation in the stages of growth and development. These actions by the child are not consistent with any type of neglect or problem.)
The 18-month-old toddler has most likely attained which gross motor skill? (The ability to walk independently. The ability to walk up stairs alone. The ability to balance on one foot. The ability to pedal a tricycle.)
The ability to walk independently. (Explanation: The 18-month-old toddler can walk alone, but the gait may still be a little unsteady. By 3 years of age, the child can walk heel-to-toe fashion like an adult. The 18-month-old toddler can walk up the stairs with assistance but cannot walk stairs with alternate feet until 36 months. A 3-year-old child can pedal a tricycle and balance on one foot.)
The nurse is caring for a 4-year-old child who is hospitalized and in traction. The child talks about an invisible friend to the nurse. Which action by the nurse is indicated? (The nurse should document the reports of hallucinations by the child. The nurse should explain to the child that there are no friends present. The nurse should discourage the child from talking about the imaginary friend. The nurse should recognize this behavior as normal for the child's developmental age and do nothing.)
The nurse should recognize this behavior as normal for the child's developmental age and do nothing. (Explanation: Preschool-aged children often interact with imaginary friends. The nurse should recognize this as normal for the age group. No special actions are needed.)
The nurse is assessing an 6-month-old infant at a well-baby visit and is answering questions from the new mother. Which response should the nurse prioritize when addressing the mother's question concerning what the infant should be learning at this point in life? (Trust Feel anger Love Fear)
Trust (Explanation: Erikson identifies various developmental stages which all children accomplish as they grow and develop into adults. The primary psychosocial developmental task for the infant is learning to trust. This task creates the foundation for the developmental tasks of the next stages of the child's life. If the infant does not receive food, love, attention, and comfort, the infant learns to mistrust the environment and those who are responsible for caring for the child. Learning to feel anger, love, and fear come at later times in development.)
An adolescent female with anemia has been prescribed a diet high in iron. Selection of which meal indicates to the nurse that the client understands the prescribed diet? (baked chicken, steamed cauliflower, garden salad. fried chicken, carrots, and mashed potatoes. cookies, candy, and crackers. shrimp, corn on the cob with butter, and cookie.)
baked chicken, steamed cauliflower, garden salad (Explanation: Iron is necessary to meet expanding blood volume requirements. Females require a high iron intake not only because of this increasing blood volume but also because iron begins to be lost with menstruation. Foods high in iron include meats and green leafy vegetables. Cauliflower is the same specifies of plant as green leafy vegetables and as such is included in this category. Carrots, squash, and corn contain very limited amounts of iron.)
The school nurse is providing nutritional guidance to a 9th-grade health class. Which foods should the nurse recommend as good sources for calcium? (strawberries, watermelon, and raisins. beans, poultry, and fish. peanut butter, tomato juice, and whole grain bread. cheese, yogurt, and white beans.)
cheese, yogurt, and white beans (Explanation: Cheese, yogurt, white beans, milk, and broccoli are good sources of calcium. Strawberries, watermelon, raisins, peanut butter, tomato juice, and whole grain bread are all foods high in iron.)
A type of play seen in preschool children encourages children to act out troubling situations, such as one that might occur in the hospitalized child who must undergo an upsetting procedure. This type of play is referred to as: (dramatic play. parallel play. independent play. solitary independent play.)
dramatic play. (Explanation: Dramatic play allows a child to act out troubling situations and to control the solution to the problem. Through dramatic play the child can express anxiety, try out new feelings and conquer fears. This is important to remember when teaching children who are going to be hospitalized. Using dolls and puppets to explain procedures makes the experience less threatening. Parallel play is the play of toddlers where two toddlers play side by side but not with each other. Independent play occurs when a group of children are all playing but each is playing something different {i.e., all may be playing with trucks but each one has a different truck and they do not do the same thing with the trucks}. Solitary play is a child playing alone, even in a group. The child does not participate with other children.)
The nurse is assessing a 3-year-old child. Which assessment finding would the nurse identify as abnormal? (builds a tower of 10 cubes pedals tricycle without assistance unscrews a bolt on a toy falls when bending over to touch toes)
falls when bending over to touch toes (Explanation: Bending over easily without falling is a normal expected gross motor skill in a 3-year-old. Building a tower of nine or ten cubes, pedaling a tricycle without assistance, and unscrewing lids, bolts, or nuts are also expected gross and fine motor skills for this age.)
The nurse is teaching good sleep habits for toddlers to the parent of a 3-year-old client. Which response indicates the parent understands sleep requirements for the client? ("I'll put my child to bed at 7 p.m., except Friday and Saturday." "My child needs 12 hours of sleep per day including a nap." "I should give my child a glass of milk before bed." "The routine at bedtime can fluctuate from day to day.")
"My child needs 12 hours of sleep per day including a nap." (Explanation: The father understands the child needs 12 hours of sleep and one nap per day. Routines, such as the same bedtime every night, promote good sleep. Changing the routine from day to day leads to the child not knowing when it is time to go to bed. Giving the child a glass of milk before bed can cause diaper leakage or, if the child is potty-trained, having to get up during the night to void.)
The nurse is caring for an 8-year-old girl. She is reviewing her nutritional requirements and describing interventions that promote healthy eating habits. Which response by the girl's mother indicates a need for further discussion? ("My daughter eats one item at a time." "My daughter likes to have a glass of milk with her meal." "My daughter must stay at the table until she has cleaned her plate." "My daughter likes many different kinds of fruits and vegetables.")
"My daughter must stay at the table until she has cleaned her plate." (Explanation: School-aged children understand the concept of satiety, of feeling full, and should not ignore this feeling by cleaning their plate. The nurse must encourage the mother not to force a child to eat as this may also lead to obesity. The other responses are appropriate and indicate an understanding of good nutrition and eating habits.)
Parents of a preschool child are discussing a recent story in the local news about a child being abducted. The parents are concerned about the safety of their child and wonder what to tell the child to keep the child safe but without frightening the child. Which would be the best recommendation for the nurse to give these parents? (Explain in a calm and everyday manner how the child should stay away from strangers in cars. Wait until the child is school-aged before telling the child what to do, so the child will be better able to handle it. Don't worry about it; the odds of your child being abducted are very low. It is your responsibility to keep your child safe, not your child's; keep the child in your sight at all times.)
Explain in a calm and everyday manner how the child should stay away from strangers in cars. (Explanation: The preschool years are not too early a time to educate children about the potential threat of harm from strangers. It is often difficult for parents to impart this type of information to preschoolers because they don't want to terrify their child about the world. They also can't imagine their child will ever be in a situation in which the information will be needed. If the information is presented in a calm and everyday manner, however, children can use it to begin to build safe habits that will help them later when they are old enough to walk home from school alone or play with their friends, unsupervised.)
The nurse is counseling the mother of a newborn who is concerned about her baby's constant crying. What teaching would be appropriate for this mother? (Carrying the baby may increase the length of crying. Reducing stimulation may decrease the length of crying. Using vibration, white noise, or swaddling may increase crying. Using a swing or car ride may increase the incidence of crying episodes.)
Reducing stimulation may decrease the length of crying. (Explanation: Prolonged crying leads to increased stress among caregivers. Reducing stimulation may decrease the length of crying, and carrying the infant more may be helpful. Some infants respond to the motion of an infant swing or a car ride. Vibration, white noise, or swaddling may also help to decrease fussing in some infants. Parents should try one intervention at a time, taking care not to stimulate the infant excessively in the process of searching for solutions.)
During a well-child check-up, the parents of a 9-year-old boy tell the nurse that their son's friends told him that soccer is a stupid game, and now he wants to play baseball. Which comment by the nurse best explains the effects of peer groups? ("The child's best friends will continue playing soccer." "The children will cheer for each other regardless of the sport being played." "Your child will rarely talk to you about his friends." "Acceptance by friends, especially of the same sex, is very important at this age.")
"Acceptance by friends, especially of the same sex, is very important at this age." (Explanation: Peer relationships, especially of the same sex, are very important and can influence the child's relationship with his parents. They can provide enough support that he can risk parental conflict and stand his ground about playing soccer. At this age, peer groups are made up of the child's best friends, and they happen to be playing baseball. Peer groups have rules and take up sides against the soccer player. Peers are an authority, so the child will let his parents know their opinions.)
The school nurse has completed an educational program for parents at a local elementary school. Which statement by a parent would indicate the need for further education? ("It's okay for my 10-year-old to sit in the front seat of the car since he doesn't need a booster seat anymore." "My son should wear his helmet whenever he rides his bicycle. " "I will teach my 8-year-old to watch for cars backing up in parking lots." "I need to get childproof locks fixed on the back doors of my car.")
"It's okay for my 10-year-old to sit in the front seat of the car since he doesn't need a booster seat anymore." (Explanation: Children under 12 should ride in the back seat of the car, even if they do not need a booster seat. Wearing helmets when riding, watching for cars backing up in parking lots, and using childproof locks on back doors in cars are all correct statements.)
The mother of a 13-year-old boy confides to the pediatric nurse practitioner that her son has recently had a nocturnal seminal emission. The mother is concerned, and the nurse explains "wet dreams" and the other male traits of puberty to the mother. Which response indicates a need for further discussion? ("My son must be sexually active or having overly sexual thoughts to have a nocturnal emission." "My son's spontaneous erections and nocturnal emissions are very normal." "My son is not doing anything to cause the nocturnal emissions; they occur spontaneously." "My son is developing normally and the traits of puberty vary from child to child.")
"My son must be sexually active or having overly sexual thoughts to have a nocturnal emission." (Explanation: Spontaneous erections and nocturnal seminal emissions do not mean that the child is sexually active or having overactive sexual thoughts. Parents need to be instructed that these occurrences are spontaneous and that the child is not doing anything to cause them.)
The nurse is performing an admission assessment of an adolescent with the teen and the parents. During the assessment the nurse suspects that the teen may be pregnant. What is the best way for the nurse to address this situation? (Ask the teen, with the parents present, if she might be pregnant. Ask the parents to step out of the room and tell them the nurse's suspicion. Ask the parents to wait in the family lounge while finishing the assessment, then ask the teen during the assessment. Ask the teen's physician to talk to the parents and the teen about the possibility of pregnancy.)
Ask the parents to wait in the family lounge while finishing the assessment, then ask the teen during the assessment. (Explanation: During health care visits the adolescent or parent may have concerns that they are hesitant or uncomfortable talking about in front of each other. Asking the parents to wait in the lounge while completing the assessment allows the nurse to talk with the teen. This allows time for the teen to confide in a nonjudgmental adult. Asking the child in front of the parents or asking the parents without speaking to the teen first may cause unnecessary conflict. While it is important to speak with the client's physician, the best opportunity to discuss the concerns is at the present time.)
A nurse, who is also a mother of a 2-year-old child, attends a party at a friend's house and notes some safety concerns that she would like to share with the other mother privately. Which observations during the party would be considered a safety concern that should be addressed privately when appropriate? Select all that apply. (The nurse/mother notes that the toddler's car seat is located in the passenger front seat. The parent is busy entertaining guests and did not notice the toddler running out in the neighborhood street to get a toy. The toddler was wearing a helmet while riding a tricycle. The parents allow the toddler to climb up on the counter and watch as food is stirred on the stove. The safety gate/fence surrounding the pool area is secure and a little hard, even for parents, to unlatch.)
The nurse/mother notes that the toddler's car seat is located in the passenger front seat. The parent is busy entertaining guests and did not notice the toddler running out in the neighborhood street to get a toy. The parents allow the toddler to climb up on the counter and watch as food is stirred on the stove. (Explanation: Toddlers' motor ability jumps ahead of their judgment. To prevent serious injury, the nurse should teach parents to be alert as to what their toddler is doing at all times (like climbing on a countertop next to a stove). Toddlers have no judgment concerning moving cars so they walk across streets with no regard for oncoming cars. Toddlers need to ride in a car seat with a five-point restraint placed in the back seat (not the front seat) so the child is not struck by the passenger seat airbag. Toddlers need to wear a helmet as soon as they begin riding a tricycle. Because they cannot swim well, parents need to check whether backyard pools—another area prone to unintended injury—are securely fenced.)
