Unit 1

Ch 10 The nurse in a pediatric clinic is gathering physical assessment information during a yearly visit on a 6-year-old child. Which finding does the nurse expect during the assessment? 1. A weight gain of 6-1/2 pounds 2. A height increase of 5 inches 3. A blood pressure of 88/50 mm Hg 4. A pulse rate of 102 beats/min

1. A weight gain of 6-1/2 pounds Children in this age group should gain 3 kg/year in weight, which is comparable to 6.6 pounds.

Ch 8 Multiple Choice The nurse is providing information to parents of infants regarding home safety. Which information will the nurse present that is specific to this age group? Select any that apply. 1. Crib safety standards 2. Avoiding taking the infant out in public 3. Hazards of immunizations 4. Diaper rash prevention 5. Signs and symptoms of illness to report

1. Crib safety standards Infants spend most of their time in cribs, which must be safe—no bumper pads, slats no more than 2-3/8 inches apart. 4. Diaper rash prevention Prevention is the best treatment for diaper rash, which can cause pain and possible infections because of a loss of skin integrity. 5. Signs and symptoms of illness to report Parents need to understand the importance of calling a health-care provider if the infant has a fever, refuses to eat, has vomiting and/or diarrhea, is more fussy or quieter than usual or looks jaundiced, and if they are worried or have questions about the infant's growth or development.

Ch 10 Select All The nurse is performing a routine physical assessment on a 7-year-old child. Which specific approaches does the nurse use for this child? Select all that apply. 1. Listen to information shared by the child. 2. Start the exam with obtaining vital signs. 3. Expect the child to be undressed and in a gown. 4. Visually inspect the child's general appearance. 5. Share which immunizations will be given today.

1. Listen to information shared by the child. 4. Visually inspect the child's general appearance. The nurse needs to listen to any information the child provides, especially if it pertains to any recent history or problems. The nurse can gather initial assessment data by visually examining the child for general appearance, muscle tone, and skin condition.

Ch 11 Select All The health department informs the school nurse that a high school student has been identified with active tuberculosis (TB), and students are to be given a TB skin test. Which consideration does the nurse make in regards to student testing? Select all that apply. 1. Permission for testing is obtained from parents or guardians. 2. Students and parents/guardians are assured of confidentiality. 3. Only students who were in physical contact with the infected student are tested. 4. Students are informed the test administration will cause minor pain. 5. The rationale for the testing is explained to students and parents/guardians.

1. Permission for testing is obtained from parents or guardians. 2. Students and parents/guardians are assured of confidentiality. 4. Students are informed the test administration will cause minor pain. 5. The rationale for the testing is explained to students and parents/guardians. 1. This is correct. In a high school setting, a majority of students may be minors, and it is necessary for the nurse to obtain parent/guardian permission to administer a TB test. 2. This is correct. As in all situations of medical care, confidentiality is assured. 4. This is correct. The nurse must be honest about any pain during a medical procedure; the nurse will inform the students of expected minor pain. 5. This is correct. Before seeking parent/guardian permission, the nurse must explain the reasons the testing is being performed. Adolescents also need to know the rationales so they will be compliant and assent to the process.

Ch 10 Select All The school nurse attends a workshop focusing on the identification and prevention of bullying among school-age children. The nurse will be better able to identify both bullies and victims due to knowledge of which factors? Select all that apply. 1. Poor academic achievement 2. Jealousy over sexual attention 3. Lower education level of caregivers 4. Leader or follower personality types 5. Poor health status or increased health needs

1. Poor academic achievement 3. Lower education level of caregivers 5. Poor health status or increased health needs The nurse will be able to associate poor academic achievement as a cause for either the bully or the victim. The nurse will recognize that bullies and victims frequently have parents and caregivers with a high school or lower educational level. The nurse will recognize that poor health status, increased health needs, and mental health issues can be a factor in a child becoming either a bully or a victim.

Ch 7 The nurse in a pediatric clinic is performing well-baby checks. The nurse is checking an infant who is 7 months old for developmental milestones. Which finding is of greatest concern to the nurse? 1. The infant is unable to raise the head when in a prone position 2. The infant exhibits a Babinski reflex 3. The infant opens and closes her hands to grasp objects 4. The infant exhibits a lack of startle reflex to sound

1. The infant is unable to raise the head when in a prone position An infant should be able at the age of 2 to 3 months to raise the head and chest and support the upper body with arms while in a prone position. The finding that the infant at 7 months lies flat when placed prone is a matter of concern to the nurse.

Ch 11 The nurse is preparing to perform a routine physical examination on a female who is 15 years of age. The patient states, "I am anxious about having my private parts examined." Which statement does the nurse make? 1. "Slow breaths and relaxation will manage the pain." 2. "I will only briefly examine your external genitalia." 3. "Pelvic exams are recommended after your periods begin." 4. "The instruments are small and the examination is brief."

2. "I will only briefly examine your external genitalia." The first gynecological examination should occur between ages 13 and 15 years for external examination only; pelvic examinations are performed on an adolescent when problems arise such as pain or abnormal bleeding.

Ch 9 The nurse in a pediatric clinic is performing a routine assessment on a preschool child. The nurse plans to evaluate some of the child's growth and development by interacting directly with the child. Which level of language does the nurse expect if the child is 4 years of age? 1. States full name and address without prompting 2. Appropriately converses using two to three sentences 3. Answers questions consistently with a "yes" or "no" 4. Speaks clearly enough to be understood

2. Appropriately converses using two to three sentences A preschooler 4 years of age is expected to speak in sentences consisting of 4 to 5 words. A toddler is expected to converse using two to three sentences; the expectation is the same for a preschooler 4 years of age.

Ch 11 The parents of an adolescent are distressed about the psychological changes in their child. Which example does the nurse validate as being a source of concern? 1. Constantly compares their body with others 2. Comfortable with doing what the crowd does 3. Regularly tests family limits and rules 4. Presents self in a constantly changing personae

2. Comfortable with doing what the crowd does Because impulsiveness and a sense of invincibility are common characteristics of the adolescent, the nurse will validate the parents' concern when the adolescent is comfortable doing what the crowd does.

Ch 7 The nurse works in an elementary school with students ranging from 6 to 11 years of age. The nurse uses knowledge related to Freud's psychosocial theory to identify which behavior in this pediatric population? 1. Oedipal or Electra conflicts 2. Energy focused on socialization 3. Curiosity about anatomical differences 4. Mild struggles with sexuality

2. Energy focused on socialization The energy focus is on socialization and increasing problem-solving abilities.

Ch 10 The nurse is invited to present a program on child safety to parents of school-age children in the fourth and fifth grades. Considering the age, which information does the nurse include in the teaching plan? 1. Immunization schedule 2. Head injury prevention 3. Age-appropriate toys 4. Symptoms of illnesses

2. Head injury prevention Unintentional injury, including head injury, is the leading cause of death in this age group. Studies show that parents' knowledge of head injuries is limited. This information and the ages of the children makes this an important topic for the nurse to cover.

Ch 7 The nurse in a pediatric clinic is performing an assessment on an infant in the presence of both parents. The parents are short and moderately overweight. one parent states, "We are going to do everything we can to raise a strong, tall, athletic child.: How does the nurse respond? 1. Provides materials about healthy diets and lifestyles for families. 2. Shares the impact of genetics on environmental conditions 3. Suggests to the parents how to alter their lifestyles 4. Recognizes the parents for having positive attitudes and goals

2. Shares the impact of genetics on environmental conditions The nurse is aware that nature involves the traits, capacities, and limitations that a person inherits from parents at conception. Genetically, the infant may not become tall due to any nurturing behaviors; however, the infant can be strong and athletic because of nurturing.

Ch 7 The nurse in a pediatric clinic is checking the developmental milestones for a 3-year-old patient. Which finding causes the nurse to perform additional assessments? 1. The patient's tee shirt is on backward 2. The patient loses balance when kicking a ball 3. The patient draws a circle that is closed but oblong 4. The patient jumps with both feet about 2 inches high

2. The patient loses balance when kicking a ball Between the ages of 2 to 3 years, a toddler should be able to kick a ball. The fact that the patient loses balance when attempting this skill may require additional assessment.

Ch 7 Multiple Choice Erickson's psychosocial development theory proposes that the school-aged child between ages 6 and 12 years is in the stage of industry vs. inferiority. Based on this theory, how will the pediatric nurse design activities as part of a diversional program for children who are in a long-term medical facility? Select all that apply 1. Identify adequate activities suited for solitary play 2. Provide activities that involve more than one person 3. Allow participation in simple tasks on the unit of care 4. Designate methods of recognition for completed tasks 5. Set guidelines and policies that are clear and enforceable

2. The school-aged child enjoys working in groups and forming social relationships. 3. Developing a sense of industry provides the child with purpose and confidence in being successful; participation in small tasks will fulfill this need. 4. If a child is unable to be successful, this can result in a sense of inferiority. Success needs to be recognized and rewarded. 5. The school-aged child in this stage follows the rules and likes order.

Ch 9 The nurse is evaluating the motor development of a preschooler at age 5 years. Which assessment finding is essential for the child to be considered ready for kindergarten? 1. Dresses independently 2. Uses the toilet without assistance 3. Draws stick figures with two or more body parts 4. Throws overhand and catches a bounced ball

2. Uses the toilet without assistance Before entering preschool, the preschooler needs to be able to use the toilet without assistance.

Ch 8 A neonate is delivered 3 weeks before the due date. The nurse performs an assessment of gestational age by using the Ballard maturational scoring tool. Which assessment result indicates a premature infant? 1. A rating of the highest scores for physical maturity and neuromuscular activity 2. A rating of the lowest scores for physical maturity and neuromuscular activity 3. A rating of the lowest scores based on weight, length, and head circumference 4. A rating of the highest scores based on weight, length, and head circumference

3. A rating of the lowest scores based on weight, length, and head circumference The scores for the assessments are plotted on a graph to provide a gestational age based on weight, length, and head circumference to determine whether the neonate is appropriate for gestational age. Term neonates have higher scores than premature neonates. Premature neonates have lower scores; being born at 37 weeks' gestation does indicate prematurity.

Ch 10 The nurse is gathering assessment data on a child who is 8 years of age and newly diagnosed with type 1 diabetes mellitus. The caregiver shares a reluctance to allow the child to return to school because the child's glucose levels need to be checked several times daily. Which information is most important for the nurse to share? 1. The caregiver may consider personally attending school with the child. 2. The child's medical condition is manageable in school and other places. 3. The school nurse can care for the special needs of children in school. 4. The caregiver is interrupting psychosocial development in the child.

3. The school nurse can care for the special needs of children in school. Most children can be cared for at school by a school nurse. Medications for asthma and diabetes are commonly administered by the school nurse. This information will be most beneficial to both the child and the caregiver.

Ch 10 The nurse is visiting the home of a family who is providing care for a school-age child with profound disabilities. The nurse notes that the primary caregiver looks tired and thin. The caregiver admits to feeling overwhelmed and then guilty about negative feelings. Which intervention by the nurse is most helpful? 1. Arrange for a counselor to meet with the family and assess for well-being. 2. Suggest a means of child management so the parents can plan a short getaway. 3. Provide literature about extended-care facilities where the child can be cared for. 4. Recommend the caregiver to a support group where feelings can be shared.

4. Recommend the caregiver to a support group where feelings can be shared. To combat the effects of caregiver fatigue, caregivers must have a good support network and ability to participate in activities that promote stress relief. The nurse's recommendation for a support group is the best intervention to address the caregiver's immediate needs.

Freud's: Genital Stage

Begins at 12 years of age and lasts to adulthood Struggle with sexuality Sexual desires return and are related to physiological changes and fluctuating hormones Changing social relationships Dealing with struggle of dependence and independence issues with parents Learning to form loving, appropriate relationships Must manage sexual urges in socially accepted ways

Piaget: Sensorimotor - Stage 4

Coordination of Secondary Schemata - 8-12 months To achieve the desired effect, the child will repeat the action, such as repeatedly shaking a rattle to make the sound

Kohlberg Three Stages of Moral Development

Preconventional Level Conventional Level Postconventional Autonomous Level

Piaget: Sensorimotor - Stage 2

Primary circular reactions - 1-4 months The child begins to coordinate reflexes and sensations Example: He or she may find the thumb by accident, find pleasure in sucking it, then later repeat sucking it for pleasures

Erikson's: Autonomy vs. Shame and Doubt

1-3 years The child is learning to control bodily functions Independence starts to emerge; for example, toddlers control their worlds by deciding when and where elimination will occur They vocalize by saying no to something and direct their motor activity Children who are consistently criticized for showing independence and autonomy could lead to disregard and an inability to play with others Playing during this stage is known as parallel

Piaget: Preoperational Defined

2-7 years > Application of language > Use of symbols to represent objects > Ability to think about things and events that are not immediately present > Orientated to the present; difficulty conceptualizing time > Thinking influenced by fantasy > Teaching must account for the child's vivid fantasies and undeveloped sense of time

Ch 11 During admission of an adolescent to the hospital for an acute illness, the nurse asks about the use of complementary and alternative medicine (CAM). In which manner does the nurse approach the topic to obtain an accurate answer? 1. Tells the adolescent that unreported CAM is a major cause of complications 2. Asks the adolescent what kind of CAM is used in the home and among friends 3. Informs the adolescent that CAM must be completely avoided when hospitalized 4. States that CAM is actually a primitive type of modern medication therapy

2. Asks the adolescent what kind of CAM is used in the home and among friends Adolescents are often reluctant to discuss their use of CAM. Start out by asking the adolescent about family and peer use of CAM. If the adolescent reports use by a close family member or peer, then the adolescent is most likely also using CAM. The nurse can use therapeutic communication skills to acquire additional information.

Ch 8 The nurse in a pediatric clinic is frequently required to administer medications to infants. Which approach will the nurse take when administering an immunization injection? 1. Use a 1-inch needle with a maximum of 1.5 mL of fluid 2. Keep the infant on the caregiver's lap and use distraction 3. Explain the medication and purpose in simple terms to the infant. 4. Immediately comfort the infant with cuddling and patting

2. Keep the infant on the caregiver's lap and use distraction The nurse should approach the infant slowly and at eye level. Handle the infant gently, keep the infant on the caregiver's lap, and use distraction to decrease anxiety.

Freud's: Oral

Birth - 1 year Children at this stage are preoccupied with activities associated with the mouth Sexual urges are gratified with oral behaviors: sucking, biting, chewing and eating Children who do not have their oral needs met may become thumb suckers or nail biters In adulthood, they may become compulsive eaters or smokers

Piaget: Sensorimotor- Stage 6

Inventions of new means/mental combinations - 18-24 months The child learns that objects and symbols represent events such as the appearance of a bowl and spoon means dinner is coming

Ch 9 Select all The community pediatric nurses are making home visits to families who have children either above or below the normal ranges in weight and/or height. One nurse visits a home with three qualifying children under the age of 5 years who are all below the standards for their ages. Which interventions will the nurse introduce to the caretakers? Select all that apply. 1. Prepare food for a toddler to eat seven times a day. 2. Serve generous portions and insist on a clean plate. 3. Encourage grazing throughout the day. 4. Physically feed the children to assure better intake. 5. Serve a variety of foods to provide varied nutrients.

1. Prepare food for a toddler to eat seven times a day. 3. Encourage grazing throughout the day. The nurse will suggest the caregivers make food available for toddlers to eat approximately seven times a day, consuming more meals than snacks. Children should be allowed to graze throughout the day, as toddlers may not sit for three meals.

Ch 9 During a routine pediatric visit the nurse evaluates the cognitive skills of a toddler. The nurse draws a circle on paper and places the crayon in the toddler's right hand. The toddler shifts the crayon to the left hand and draws a circle. Which advice does the nurse provide to the parent? 1. Respect the toddler's preference of one hand over another. 2. Watch the toddler's tendency to alternately use both hands. 3. Reassure the parent that hand preference is not established until age 5 years. 4. Gently insist drawing instruments be placed in the right hand.

1. Respect the toddler's preference of one hand over another. The nurse advises the parent to respect the toddler's preference of using one hand over the other.

Ch 11 The nurse is aware that the prefrontal cortex of the adolescent brain is still developing. The processes of critical thinking and decision-making are in a stage of development. Which example best identifies these changes? 1. Some awareness of personal limitations 2. Disinterested in politics and social issues 3. Capable of identifying and setting short-term goals 4. Exhibits confidence by not comparing self to peers

1. Some awareness of personal limitations During adolescence, the nurse is aware there is beginning to be some awareness of personal limitations.

Ch 10 Select All A 13-year-old student has cerebral palsy but is able to communicate well with others. The parents support their child being mainstreamed into a school setting even though self-care is limited. The school nurse likely needs to arrange for which type of care for this student? Select all that apply. 1. Tracheostomy suctioning 2. Elimination/personal hygiene assistance 3. Colostomy management 4. Oral or enteral feedings 5. Medication administration

2. Elimination/personal hygiene assistance 4. Oral or enteral feedings Patients with cerebral palsy may have urine and fecal incontinence. This student will need assistance with toileting, personal hygiene, or urinary catheter Due to limited self-care, the student is likely to need assistance with either oral or enteral feedings.

Ch 7 The nurse is performing a development assessment on a 3-month-old infant who was 6 weeks premature. The nurse states the infant's development is normal. The parent expresses that the baby seems behind what other babies the same age are going. Which information does the nurse share to provide reassurance to the parent? 1. The infant will catch up developmentally by age 1 year. 2. Developmental milestones vary from infant to infant. 3. The infant's age is adjusted because of prematurity. 4. Each infant is an individual with a unique development.

3. The infant's age is adjusted because of prematurity. Premature infants can experience delayed growth and development and are thus expected to reach developmental milestones at the same age they would have reached them if born at normal gestational age. Age is adjusted for assessments: subtract the weeks/months that the infant was born prematurely from the current chronological age.

Ch 10 The school nurse is presenting information on the importance of exercise to children in the fifth and sixth grades of school. Which reason does the nurse cite as being the best reason for being physically active? 1. Sports provide an opportunity to bond with peers. 2. Normal childhood activities make exercise fun. 3. Physical activity needs to replace technology hours. 4. Early exercise will carry over as good habits for adults.

4. Early exercise will carry over as good habits for adults. As with nutrition, early education and experience with exercise can help to form good habits that can last a lifetime. This is the best reason for the nurse to promote physical activity, along with proven health benefits.

Ch 8 During a parenting class, a father states, "My wife cannot hold the baby without singing a lullaby, even in public. It's kind of embarrassing for me." Which opinion does the nurse share with the group after researching the topic? 1. Caregivers sometimes sing for their own attention and benefit. 2. The father can walk away from public places if the mother sings. 3. The mother needs to find another way of comforting her baby. 4. Singing of lullabies by caregivers has a calming effect on infants.

4. Singing of lullabies by caregivers has a calming effect on infants. Research indicates music has been shown to stimulate neurological growth and development, to calm, and to improve sleeping patterns in infants. This is an appropriate research finding to present to parents.

Ch 11 The nurse is preparing to perform a physical examination of an adolescent who is 13 years of age. Which action by the nurse will decrease the adolescent's anxiety during the examination? 1. Teaching the anatomical names of body parts 2. Verbalizing findings of physical abnormalities 3. Referring patient concerns to the physician 4. Telling the patient what to expect and why

4. Telling the patient what to expect and why The most effective way to decrease an adolescent's anxiety about a physical examination is to inform the adolescent of the nurse's actions and explain the rationales.

Freud's Five Stages of Psychosexual Development

Oral Anal Phallic Latency Genital

Piaget: Sensorimotor - Stage 3

Secondary circular reactions - 4-8 months The child focuses on his or her environment and begins to repeat actions that will trigger a response Example: The child puts a toy rattle in his or her mouth

Freud's: Anal

1-3 years Preoccupied with the ability to eliminate Sexual urges gratified by learning to voluntarily defecate Sphincter muscles maturing

Ch 7 The pediatric home-care nurse is visiting a toddler born with a genetically related illness. Which comment by the parent is the greatest cause for the nurse to assess for additional information? 1. " I am having more difficulty keeping her confined." 2. " A chronically ill child affects the entire family." 3. " The other children seem so accepting of the illness." 4. " Hospitalization would cause some severe stress."

1. " I am having more difficulty keeping her confined." When the parent states increasing difficulty keeping this toddler confined, the nurse needs to assess for additional information. The nurse needs to reinforce that play is what children do, and playing is important to learn the developmental skills needed to reach the most optimal functioning. Confinement may not be appropriate.

Ch 8 The nurse is teaching a class to parents about emergency care for newborns and infants. Which comment from a parent indicates a need for additional teaching? 1. " I will apply gently tourniquet pressure for serious extremity bleeding." 2. " The most important behavior is to remain calm and get emergency help." 3. " A seriously injured child is moved only if they are in a dangerous situation." 4. " If a seizure occurs, the safest place for the child is on the floor with the head turned."

1. " I will apply gently tourniquet pressure for serious extremity bleeding." The parent who describes applying a tourniquet in any manner for serious extremity bleeding needs additional teaching. When bleeding occurs with an infant, pressure with a clean cloth needs to be applied to the bleeding site.

Ch 8 The nurse is interviewing a parent of a 9-month-old infant during a well-baby visit. Which statement by the parent causes the nurse concern about infant safety? 1. "He loves to get his toys out of a big plastic storage bag on the doorknob." 2. "He thinks the TV remote is a toy, so it is kept on a shelf too high for him to reach." 3. "When we eat cooked vegetables, I cut a few into bite size pieces so he can try them." 4. "It really disturbed me to see my neighbor's infant with a pacifier on a cord around the neck."

1. "He loves to get his toys out of a big plastic storage bag on the doorknob." The nurse is concerned that the infant is getting toys out of a large plastic bag hanging on a doorknob. Plastic bags or wrappings are never kept where the infant can reach them because of the risk for suffocation or choking. If the bag is hung by a cord, there is an additional risk of choking.

Ch 9 Select all A parent tells the nurse a toddler is exhibiting signs of being ready to potty train. Which action by the parent will draw the nurse's approval? Select all that apply. 1. "I am initially teaching my son to urinate sitting down." 2. "He has to sit on the potty 10 minutes each hour." 3. "We are still using diapers to avoid messes." 4. "Accidents result in the loss of a favorite toy for the day." 5. "We are using treats, stickers, and new underwear as incentives."

1. "I am initially teaching my son to urinate sitting down." 5. "We are using treats, stickers, and new underwear as incentives." The nurse will approve of the parent initially teaching a boy to sit to urinate. Once mastered, then move on to standing. The parent or caregiver may use flushable toilet targets for teaching purposes. Incentives are appropriate, and the nurse will approve of providing encouragement in the form of praise and celebration, along with rewards and incentives such as treats, stickers, and new underwear.

Ch 11 The nurse is collecting health data from a 16-year-old male patient. The patient states, "I need to tell you, I had sex with another boy, and I am very confused." Which comment by the nurse is most therapeutic? 1. "You can share your thoughts and feelings with me." 2. "Maybe you should speak with your parents." 3. "Why were you attracted to this boy?" 4. "Let's explore your feelings toward females."

1. "You can share your thoughts and feelings with me." The goal is to create an environment that makes the adolescent feel comfortable to discuss their concerns with the nurse. Therapeutic communication avoids opinions and judgments and attempts to explore the patient's thoughts and feelings.

Ch 7 During a well-baby checkup, the father of an infant states, "Even if he is occupied with a toy, he cries as soon as he notices I have left the room." Which explanation by the nurse is best? 1. "Your baby does not know you exist if he cannot see you." 2. "Babies learn very quickly how to get an adult's attention." 3. "You should move the baby with you if you leave the room." 4. "Just ignore him; he will soon learn that you are still present."

1. "Your baby does not know you exist if he cannot see you." Object permanence is one of the most important developments in the sensorimotor stage. The child will learn that an object exists even when it cannot be seen or heard. Prior to this, the child does not understand that someone or something did not disappear. Playing peek-a-boo is a good way to help the development of object permanence.

Ch 8 The neonatal nurse is assessing a term neonate in the delivery room. Which respiratory assessment finding at 15 minutes after birth causes concern to the nurse? 1. A single episode of apnea occurs for 18 seconds in a 1-minute period 2. Respirations are irregular, sporadic, shallow, and diaphragmatic 3. Acrocyanosis is pronounced in all four extremities 4. Respiratory rate fluctuates between 30 and 60 breaths per minute

1. A single episode of apnea occurs for 18 seconds in a 1-minute period Apnea, a cessation of breathing longer than 15 to 20 seconds, is indicative of an alteration in respiratory transitioning. This assessment finding is of greatest concern to the nurse.

Ch 9 A 4-year-old patient is on a regular regimen of oral medications for a chronic condition. The parent expresses frustration because of the difficulty in administering the liquid medications. Which advice will the nurse provide to the parent for managing the process? 1. Ask if the child wants a different flavor of medicine. 2. Inquire if the child prefers the medication at a certain time. 3. Make sure the medicine is sweet and refer to it as candy. 4. Put the medication in juice or milk as preferred by the child.

1. Ask if the child wants a different flavor of medicine. Allowing a 4-year-old to have some choices regarding medication flavor is likely to foster some cooperation. Ask the pharmacist for advice regarding adding flavors or changing medication manufacturers.

Ch 7 The nurse is counseling parents about management of their children who are 2,4, and 6 years of age. One of the parents states, "We believe in Kohlberg's theory of social-moral development." The nurse is aware that pre-conventional stage of this theory involves which characteristic? 1. Behavior is adjusted according to good/bad and right/wrong thinking 2. A personal and functional value system is constructed by the child 3. The focus of the child is on following rules and maintaining social order 4. Value systems are independent of authority figures and peers

1. Behavior is adjusted according to good/bad and right/wrong thinking The children in the family are all in the preconventional level of Kohlberg's theory. Stages include obedience and punishment orientation, and individualism and exchange. Characteristics include following rules set by those in authority and behavior adjusted according to good/bad and right/wrong thinking.

Ch 9 Select all The nurse is caring for a 1-year-old patient after surgery for an intracranial shunt replacement. The nurse selects the FLACC Scale (faces, legs, activity, cry, consolability) for assessment because of the toddler's inability to participate in pain evaluation. The nurse will recognize which assessment finding as an indication of some level of pain? Select all that apply. 1. Constantly frowns, clenched jaw, quivering chin 2. Squirms, shifting back and forth, tense 3. Cries steadily and loudly, sometimes screams or sobs 4. Legs are positioned normally and appear relaxed 5. Answers to name, sucks thumb, and holds toy

1. Constantly frowns, clenched jaw, quivering chin 2. Squirms, shifting back and forth, tense 3. Cries steadily and loudly, sometimes screams or sobs 1. This is correct. Constantly frowning, with clenched jaw and quivering chin are in the face category on the FLACC Pain Scale, and the score is 2. 2. This is correct. Squirming, shifting back and forth, and appearing tense are in the activity category on the FLACC Pain Scale, and the score is 1. 3. This is correct. Crying steadily and loudly, sometimes screaming or sobbing, are in the cry category on the FLACC Pain Scale, and the score is 2.

Ch 11 The nurse is preparing to teach a class of adolescents about the increasing numbers of young people being sexually assaulted. Which advice by the nurse will promote adolescent safety from sex crimes? Select all that apply. 1. Go out with groups of friends. 2. Avoid alcohol and substance use. 3. Remain in public places. 4. Bring a friend along on a date. 5. Research a date's background.

1. Go out with groups of friends. 2. Avoid alcohol and substance use. 3. Remain in public places. 1. This is correct. Nurses should reinforce safety strategies for avoiding sexual assault, such as going out with a group of friends. The group needs to stay together and should not let a member go off with someone alone. 2. This is correct. Nurses should reinforce safety strategies for avoiding sexual assault, such as avoiding alcohol and substance use, which decreases the ability to think clearly or defend oneself. 3. This is correct. Nurses should reinforce safety strategies for avoiding sexual assault, such as remaining in public places. In addition, the public places should be well lit, well used, and in a safe area.

Ch 11 Select All The nurse is advocating for a transition to home care from a medical inpatient facility for an adolescent patient with a complex medical condition. Which assessment finding/information supports a transition to home for this patient? Select all that apply.term-125 1. Home care is covered by the adolescent's primary and secondary health-care plan. 2. During home care a goal for mainstreaming the adolescent into school is set. 3. The adolescent's parents are older and will benefit from home-care assistance. 4. Home care allows for collaboration and management of care by a medical team. 5. A family member is concerned about the adolescent's complex medication regimen.

1. Home care is covered by the adolescent's primary and secondary health-care plan. 4. Home care allows for collaboration and management of care by a medical team. Home care decreases financial costs and travel costs. When the adolescent has primary and secondary health-care plans that cover home care, the nurse is assured that the transition will not be a financial burden. Home care allows collaboration with the adolescent's medical team and increases family satisfaction. The adolescent will be followed by a medical team that is set up to meet the adolescent's medical and psychosocial needs.

Ch 7 Multiple Choice The school nurse is asked to assess a student in the third grade who is failing to demonstrate academic success. Which statement(s) made by the child indicate an unmet need according to Maslow's hierarchy? Select all that apply. 1. " I have to go to bed at 10:00 every night." 2. " I worry because my parents fight all the time." 3. " Game and movie nights are always fun at my house." 4. " My grandma says I'm stupid just like my mother." 5. " I taught my little brother to ride a bike in just one day."

1. If the student in question goes to bed every night at 10:00 the nurse recognizes a physiological need that is not being met. Children need more sleep than adults. Sleep deprivation can impact the growth and development of a child and cause delays. 2. If the student in question expresses worry about fighting between parents, the nurse recognizes the child has the need to be protected from harm and may not feel safe. Fear and worry can interfere with developmental achievements. 4. Negative feedback interferes with the development of esteem, which is related to the need to respect one's self and be respected by others.

Ch 10 The school nurse is attending a meeting with the teachers, school counselors, and parents of a student who has recently refused to attend school. The parents share that the student is either pretending to be ill or being untruthful about going to classes. Which initial intervention by the nurse is best? 1. Inquire about the student's feelings regarding school. 2. Ask the parents if they have noticed physical injuries. 3. Explain the impact of missing school to the student. 4. Suggest homeschooling until the problem is resolved.

1. Inquire about the student's feelings regarding school. Initially, the reasons for the student's behavior needs to be identified and addressed, and a good approach is to ask about the student's feelings. The nurse is particularly interested in psychological issues.

Ch 8 Multiple Choice The nurse is providing teaching to parents who are expecting their first child. For which reason does the nurse understand this teaching to be so important? Select all that apply. 1. It provides information that defines health and normalcy. 2. It instructs parents about general, safe infant care. 3. It helps reduce the appearance of regressive behavior. 4. It encourages development of parent-infant interactions. 5. It presents methods to help maintain infant/child health.

1. It provides information that defines health and normalcy. 2. It instructs parents about general, safe infant care. 4. It encourages development of parent-infant interactions. 5. It presents methods to help maintain infant/child health. The nurse includes developmental milestones, home infection control measures, the importance of immunizations, and the use of car seats and other safety equipment. The nurse will discuss general health-care concerns, such as nutrition, oral health, the need for sleep, and appropriate hygiene care. The nurse will share the importance of parent-infant interactions, including playing, cuddling, the importance of talking to the child, and separation anxiety. The nurse will share information about nutrition, oral health, prevention of illness and infections, prevention of injury, and childproofing the home. The nurse emphasizes the importance of learning infant/child cardiopulmonary resuscitation (CPR). The nurse will also cover the care for an infant/child that is ill.

Ch 10 A new nurse on a pediatric unit is learning to use eutectic mixture of lidocaine and prilocaine (EMLA) cream in preparation for painful procedures. A school-age patient is scheduled to receive intramuscular (IM) medication. Which behavior by the nurse indicates an understanding about the use of EMLA? 1. Medication is applied at least 45 minutes before the IM injection. 2. The cream is covered with a thin layer of gauze. 3. A thin layer of medication is applied to the area. 4. Cream remaining on the skin is gently rubbed in.

1. Medication is applied at least 45 minutes before the IM injection. It is most effective to apply EMLA to the site for an IM at least 45 minutes before the procedure. The longer the medication is in place, the deeper it will penetrate.

Ch 8 The registered nurse (RN) in a pediatric office is preparing to administer oral medication to an infant. Before the actual administration of the medication, which initial action does the nurse take? 1. Obtain an accurate weight of the infant 2. Provide the caretaker with written information 3. Assist the caretaker in holding the infant supine 4. Acquire a calibrated syringe for administration

1. Obtain an accurate weight of the infant Pediatric dosing must be precise to ensure adequate therapeutic levels; dosing is based on weight. The weight needs to be obtained first.

Ch 10 Select All The nurses at a community pediatric clinic are preparing a presentation about nutrition for the school-age child. Which information is important for the nurses to include? Select all that apply. 1. Over 35% of school-age children are considered to be obese or overweight. 2. Overweight children have an increased likelihood of being overweight adults. 3. Children with a high body mass index (BMI) have increased levels of lipids, insulin, and blood pressure. 4. Notably higher health risks exist for adults who were obese during childhood. 5. School-age children need comparatively more calories than infants or adolescents.

1. Over 35% of school-age children are considered to be obese or overweight. 2. Overweight children have an increased likelihood of being overweight adults. 3. Children with a high body mass index (BMI) have increased levels of lipids, insulin, and blood pressure. 4. Notably higher health risks exist for adults who were obese during childhood. This is correct. Approximately 20% of school children are obese, with a BMI defined as greater than the 95th percentile by the Centers for Disease Control and Prevention (CDC). This is correct. It is a fact that overweight children have a greater risk of being overweight adults. The health consequences of obesity in children will have a negative effect on their morbidity and mortality as adults. This is correct. A high BMI in children is linked with increased lipid levels, insulin levels, and blood pressure; these can lead to higher risks for atherosclerosis and obesity in adulthood. This is correct. The health consequences of obesity in children will have a negative effect on their morbidity and mortality as adults.

Ch 7 The nurse in a pediatric clinic is counseling a parent who expresses concern about a toddler who plays alone at daycare and does not interact with the other children who are present. Which information does the nurse provide to alleviate the parent's concern? 1. Parallel play is being exhibited and is normal at this age 2. The toddler is likely to grow into a shy, introverted adult 3. It is important for the child to learn to be alone at this age 4. The toddler is exhibiting the normal behavior of solitary play

1. Parallel play is being exhibited and is normal at this age Using knowledge about Erikson's theory of psychosocial growth and development, the nurse needs to reassure the parent that the toddler is expected to exhibit parallel play. Parallel play is part of the autonomy versus shame and doubt stage of Erikson's theory; autonomy and independence is being developed.

Ch 10 Select All The school nurse is discussing a student's reasons for leaving school to be homeschooled. The student has a chronic condition that causes mobility and strength deficits. The student states, "I want to stay in school, but I am always late for class. I can't manage getting around fast enough with all my books." Which suggestion by the nurse will best meet the needs of the student? Select all that apply. 1. Place the designated textbook in each class the student attends. 2. Plan for the student to leave class early to get to the next class. 3. Arrange for a set of textbooks to be left in the student's home. 4. Set up closed-circuit TV so the student "attends" from a set location. 5. Inquire if the parents are able to purchase a motorized wheelchair.

1. Place the designated textbook in each class the student attends. 3. Arrange for a set of textbooks to be left in the student's home. The problem the nurse is attempting to solve is the student's inability to get to class because of difficulty carrying heavy textbooks. The student will benefit if a textbook is left in each assigned class. Arranging for a set of textbooks to remain in the student's home will eliminate the need to carry heavy books back and forth from school to home.

Ch 8 Multiple Choice The nurse is preparing to teach to parents the importance of play in the newborn's and infant's life. Which information will the nurse plan to include in the class? Select all that apply. 1. Play is how infants learn about their environment and themselves. 2. Infants may be startled by their own images in a reflective toy. 3. Older siblings are encouraged to share their toys with the infant. 4. Toys should provide a means of sensory stimulation for the infant. 5. Toys can help with physical and fine motor development.

1. Play is how infants learn about their environment and themselves. 4. Toys should provide a means of sensory stimulation for the infant. 5. Toys can help with physical and fine motor development. The nurse needs to explain that play is an important part of an infant's/child's development process. Play promotes learning about the environment and self. Infants explore the world with their mouths and imitate those around them. It is important to provide toys to initiate and promote learning through these methods. Physical development is promoted through play activities. Early on, infants will begin to develop gross and fine motor development; toys should be selected that will promote this type of learning.

Ch 7 Multiple Choice The nurses on a pediatric unit are concerned about developmental delays in patients who are hospitalized frequently and for extended periods of time. Which interventions do the nurses initiate to alleviate the concerns? Select all that apply. 1. Design a play/recreational area with age-appropriate sections 2. Provide nurses with allotted time to play with confined children 3. Extend the services of the child life specialists to all patients 4. Encourage family to bring favorite toys and books from home 5. Have age-appropriate educational TV channels available

1. Play is what children do and should not be overlooked when a child is in the hospital. Play is important for younger children to build the skills needed for development. All ages of pediatric patients can use play as a stress reducer. 3. Many pediatric facilities have a child life specialist on staff who can assist the child in fostering growth and developmental needs through play. An extension of services to meet the needs of all hospitalized children is appropriate. 5. When hospitalized, patients will view TV as a distraction to the manifestations of illness and effects of treatment. However, with pediatric patients, TV provides an opportunity for skills development as well as entertainment.

Ch 9 Select all A community center is offering classes taught by pediatric nurses on summer safety for toddlers and preschoolers. Which topics will the nurses include in the teaching plan? Select all that apply. 1. Safety near swimming areas 2. Dangers of toys being left in a pool 3. Safety related to flotation devices 4. Bicycle safety for riders or passengers 5. Safety during trampoline play

1. Safety near swimming areas 2. Dangers of toys being left in a pool 3. Safety related to flotation devices 4. Bicycle safety for riders or passengers 5. Safety during trampoline play 1. This is correct. Childproof all swimming areas, including access to pools, ponds, and lakes. Never leave children unattended near swimming areas, even if they can swim. 2. This is correct. Toys left in a pool are a dangerous temptation, because children may be tempted to retrieve them. 3. This is correct. Use flotation devices specifically designed for child safety. Floating toys, rafts, and rings do not provide adequate safety. 4. This is correct. Children should always wear a bicycle helmet whether they are riding a bike, or they are the passenger on a bicycle. Children need to know the safety rules for riding on bicycle paths, sidewalks, or on the street. 5. This is correct. Trampolines are a safety risk for children of all ages, but toddlers and preschoolers should not be permitted to play on trampolines.

Ch 9 Select all The parent of a toddler at age 2 years and a preschooler at age 4 years is sharing a concern about sibling rivalry. The parent states, "It is so upsetting to see them fighting with each other. I am afraid one of them will hurt the other." Which interventions will the parent and nurse design together in a plan for management? Select all that apply. 1. Set rules defining acceptable behavior. 2. Separate them to opposite sides of the room. 3. Teach children to be kind to each other. 4. Recognize the toddler has increased risk for injury. 5. Assist with appropriate expression of feelings.

1. Set rules defining acceptable behavior. 3. Teach children to be kind to each other. 5. Assist with appropriate expression of feelings. Together the nurse and parent develop a plan that will set the rules for acceptable behavior. Rules will cover such behaviors such as no name calling, no pushing, and no slamming things. The nurse and parent will identify ways to teach the children to be kind to each other by encouraging apologizing, sharing, and comforting each other when hurt. This intervention will foster positive feelings and behaviors. . Children may be unable to express the proper feelings of anger and frustration. The nurse and parent will identify therapeutic methods designed for self-expression.

Ch 11 The nurse is performing a physical examination on a male who is 15 years of age. The nurse notices the presence of gynecomastia. The patient states, "I hate my chest," pointing to his breasts. "It's embarrassing. I can't even take my shirt off in front of my friends." Which information does the nurse provide for this patient? 1. The condition is self-limiting. 2. Surgical removal is recommended. 3. It indicates the patient is overweight. 4. The male hormone testosterone is deficient.

1. The condition is self-limiting. Gynecomastia refers to abnormal breast development in boys. This is a self-limiting condition.

Ch 9 The nurse is providing care for a 4-year-old patient whose tonsils were removed this morning. The nurse identifies the patient is in pain but not willing to speak. The nurse uses the Wong-Baker FACES Pain Scale for evaluation. Which indicator does the nurse expect the patient to use to describe the level of pain? 1. The frowning face out of a series of faces 2. A number between 7 and 10 from a scale of 0 to 10 3. An intense red color on a range from pink to deep red 4. The word that identifies the degree of pain (i.e., ouch, hurts bad)

1. The frowning face out of a series of faces The Wong-Baker FACES Pain Scale is a self-reporting rating scale that assigns a number value to a facial expression that is chosen by a child.

Ch 7 Multiple Choice The nurse is gathering information during a routine checkup for a preschool-age child who lives with grandparents. The grandmother expresses distress about "how loud and busy" the child is, and "how expensive it is to feed and clothe" the child. Which referrals does the nurse make to the grandmother? Select all that apply. 1. Community programs for the child aimed at playing and learning. 2. Social services for determination of benefits available for the care of the child 3. Legal services to assist in obtaining financial support from the parents 4. Child protection services to survey the home and psychosocial environment 5. Caretaker programs and support groups for grandparents performing as parents

1. The grandmother's statement indicates stress related to the expected behavior of a preschool child. A referral for community programs for the child aimed at playing and learning is appropriate and beneficial. 2. The nurse needs to make a referral to social services who can determine whether the household is entitled to assistance for raising a grandchild. Services can include food, clothing, childcare, and medical services, to name a few. 5. The nurse needs to be sensitive that the grandmother may be expressing caregiver stress. The nurse needs to make referrals to programs that can benefit the grandparents physically, psychosocially, and spiritually.

Ch 8 Multiple Choice The nurse in a pediatric emergency department is concerned when parents bring a 9-month-old infant in for a possible injury. X-rays indicate the infant has a broken leg. Which information causes the nurse to report possible physical abuse to the nursing supervisor? Select all that apply. 1. The infant has been treated three times for injuries. 2. The parents insist on simple, noninvasive medical care. 3. The father states the infant climbed a stepladder and fell. 4. The infant buries his face in the mother's arm if the father talks. 5. The mother states she fell down the stairs with the baby.

1. The infant has been treated three times for injuries. Because of unexplained or repeated injuries such as welts, bruises, burns, fractured skull, broken bones, and especially spiral fractures, the nurse will report probable physical abuse to the nursing supervisor. 3. The father states the infant climbed a stepladder and fell. When the father states the infant climbed a stepladder and fell, the nurse will suspect physical abuse, because injury explanation is unlikely given the age or ability of the child. The nurse will report the situation to the nursing supervisor. 4. The infant buries his face in the mother's arm if the father talks. Fearful or detached behavior by the infant, especially when the father talks, is a probable sign of physical abuse. The nurse will report the behavior to the nursing supervisor. 5. The mother states she fell down the stairs with the baby. Disagreement or inconsistency in the parent/caregiver explanation of the injury can be an indication of physical abuse. The nurse can seek clarification about details of the accident and/or inquire about injury to the mother during the fall. The nurse is likely to report probable physical abuse of the infant.

Ch 8 Multiple Choice The parent of an infant reports to the nurse a suspicion that the babysitter is neglecting the infant. The parent states, "I saw some disturbing things on a hidden nanny-cam." The nurse will support the decision to replace the babysitter if which behavior is observed? Select all that apply. 1. The infant is in the crib and ignored until time for the parent to arrive home. 2. The babysitter takes the infant out in the stroller for 1 hour on a cool day. 3. The infant cries and is given a bottle, which is propped up in the crib. 4. When the infant drops toys on the floor, the sitter tosses them back into the crib. 5. Prescribed medication is not given to the infant according to written instructions.

1. The infant is in the crib and ignored until time for the parent to arrive home. Consistent failure to respond to the child's need for stimulation, nurturing, encouragement, and protection, or failure to acknowledge the child's presence, is indicative of neglect. This observation would warrant support from the nurse to replace the babysitter. 5. Prescribed medication is not given to the infant according to written instructions. Failure to provide the infant with prescribed medication according to written instructions is considered neglect and warrants replacement of the babysitter.

Ch 7 Multiple Choice A widowed man and parent of two children informs the nurse of an upcoming marriage to a woman who has three children. The expressed intention is to adopt the three stepchildren. Which definition of family will the nurse apply? Select all that apply. 1. A nuclear family, after the adoption of the stepchildren 2. A nonnuclear family, after the marriage has taken place 3. A blended family, after the marriage of the adults occurs 4. A nuclear family, before adoption if all children live in the home 5. A blended family, after the intention of marriage is expressed

1. The nuclear family is composed of a mother, a father, and a biological or adopted child or children. 2. The term nonnuclear family describes family forms other than traditional, such as single-parent homes, grandparents functioning in the role of parents, same-sex parents with a child or children, and blended families. 3. Blended families are those in which families from divorce are joined together by remarriage. This can also occur when a spouse has died and the remaining spouse remarries.

Ch 11 The nurse is preparing information for an adolescent patient regarding a prescribed medication regimen. Which information does the nurse present to the patient? 1. The nurse directly verbalizes medication warnings to the patient. 2. The patient will receive administration clarification by the pharmacist. 3. Most medications are metabolized faster by adolescent patients. 4. Symbols or phrases are sufficient to warn adolescents of medicine-related risks.

1. The nurse directly verbalizes medication warnings to the patient. Adolescents have the best understanding of medication warnings when directly informed verbally by health care personnel.

Piaget: Formational Operational Defined

11 years to adulthood > Cognition to its final form > Individual no longer requires concrete objects to make rational judgments > Individual capable of hypothetical and deductive reasoning > Teaching for adolescents may be wide-ranging because they can consider many possibilities from several perspectives

Kohlberg: Postcoventional Autonomous Level

12 years and older Social Contract and individual rights Universal principles Constructs a personal and functional value system independent of authority figures and peers

Erikson's: Identity vs. Role Confusion

12-18 years > Children of this age are preoccupied with how they are seen in the eyes of others > They are working to establish their own identity > They are trying out new roles to see what fits them best > If they are unable to provide a meaningful definition of self, they are at risk for role confusion in one or more roles throughout life > some confusion is good and will result in self-reflection and self-examination

Kohlberg: Preconventional

2-7 years Obedience and punishment orientation Individualism and Exchange Follows rules that are set by those in authority Adjusts behavior according to good/bad and right/wrong thinking

Ch 9 A nurse is teaching a group of mothers about the signs and symptoms of respiratory distress. Which statement by the parent indicates the teaching is understood? 1. "Nasal flaring is normal since my son has asthma." 2. "Retractions are when I can see my son's ribs when takes a breath in." 3. "Tachypnea is when my son's breathing is much slower than normal." 4. "Tripod position is when my son's shoulders are up, and his head is down."

2. "Retractions are when I can see my son's ribs when takes a breath in." Retractions are the ability to see ribs during inhalation.

Ch 11 Nurses in pediatric emergency departments attend an educational program about identifying victims of human trafficking. Which characteristics have the nurses learned to identify? Select all that apply. 1. Women 2. Age less than 18 years 3. Frequent urinary tract infections (UTIs) and STIs 4. Minors who are pregnant 5. Appearing relaxed and calm

2. Age less than 18 years 3. Frequent urinary tract infections (UTIs) and STIs 4. Minors who are pregnant 2. About 25% of human trafficking victims are minors. The average age is 12 to 14 years. 3. Poor health conditions among this population include STIs; urinary tract infections; multiple pregnancies, abortions, and/or miscarriages; injuries, skin conditions, burns, dental disease, malnutrition, and mental health issues with depression, anxiety, posttraumatic stress disorder (PTSD) and suicide attempts. 4. Many young women will have had multiple pregnancies, abortions, and miscarriages.

Ch 11 The nurse in an acute pediatric care setting is providing care for a 15-year-old patient. The patient is recovering from abdominal surgery. Which nursing intervention is appropriate for this patient? 1. Offer to play a video game with the patient. 2. Ask if the patient wants to learn how to care for the incision. 3. Tell the patient that intramuscular (IM) injections will feel like a small pinch. 4. Discourage long visits by peers by reinforcing the need for rest.

2. Ask if the patient wants to learn how to care for the incision. It is appropriate for the nurse to encourage the adolescent's active participation in meeting health-care needs. Because the patient may be involved in wound care after discharge, this is a prime time for the nurse to provide appropriate patient education.

Ch 8 The nurse is providing care for a newborn who has delivered at 34 weeks gestation. The nurse understands the newborn is at a greater risk for death or chronic care needs. Which recommendation does the nurse make to the parent to prevent the newborn from developing a common complication? 1. Strictly limit the newborn's exposure to persons outside the family for 6 months. 2. Start a series of palivizumab prophylaxis immunization as advised by the pediatrician. 3. Strongly express the need for more frequent pediatric visits to prevent complications 4. Reinforce not allowing the premature newborn to cry for more than 10 minutes.

2. Start a series of palivizumab prophylaxis immunization as advised by the pediatrician. The prevention for respiratory syncytial virus (RSV; a common complication for premature neonates) is palivizumab (Synagis) prophylaxis immunization; there are significant benefits to premature infants and infants who are less than 35 weeks. Palivizumab is given in no more than five monthly doses during RSV season (late October to late January).

Ch 8 Multiple Choice The nurse is providing care for a hospitalized infant who is 4 months of age. While making a plan of care for the patient, which interventions specific to the patient's age will the nurse include? Select any that apply. 1. Encourage caregivers to go home to rest and sleep. 2. Suggest a favorite or comfort item be brought from home. 3. Plan for invasive procedures to be performed in a treatment room. 4. Monitor the infant for behaviors and cues indicating separation anxiety. 5. Educate caregivers to leave the side rails of the crib down during the day.

2. Suggest a favorite or comfort item be brought from home. Even at 4 months, a familiar item from home provides comfort to the infant. The caregiver needs to bring a favorite toy or blanket. 3. Plan for invasive procedures to be performed in a treatment room. The nurse will make arrangements in the plan of care to perform all painful or invasive procedures in a treatment room. Performing such procedures at the crib site will create anxiety for the infant whenever the nurse approaches.

Ch 9 The nurse in a pediatric office is performing physical assessments on multiple patients. Which patient will the nurse specifically report to the health-care provider because of physical assessment findings? 1. The 4-year-old patient with a blood pressure of 110/75 mm Hg, pulse of 98 beats/min 2. The 3-year-old patient with a history of prematurely closed fontanels who has a headache 3. The 2-year-old patient with asthma who exhibits abdominal breathing at 26 breaths/min 4. The 3-year-old patient with a soiled diaper, at the 70th percentile of weight and height

2. The 3-year-old patient with a history of prematurely closed fontanels who has a headache The 3-year-old patient with a history of prematurely closed fontanels has a condition that will affect the growth of the head. The presence of a headache is an indicator of possible increased intracranial pressure. Because there is a potential for brain damage, the nurse will report this finding specifically (and immediately) to the health-care provider.

Ch 8 Multiple Choice The nurse is providing counseling to the caregivers of a 4-year-old child who was born with a genetic condition that interferes with physical and psychosocial development. The child has had multiple hospitalizations for illnesses and infections related to the genetic condition. For which reasons will the nurse suggest the caregivers consider placement in a pediatric medical home? Select all that apply. 1. The caregivers will be relieved of care needed for 24 hours every day. 2. The home is set up to provide pediatric care from birth to adulthood. 3. The child's medical history indicates health risks related to family care. 4. The model is designed to reflect care standards suggested by pediatricians. 5. Care is coordinated by an interdisciplinary team that includes the caregivers.

2. The home is set up to provide pediatric care from birth to adulthood. The pediatrician-designed model of the pediatric medical home involves providing care to patients from birth to adulthood. 4. The model is designed to reflect care standards suggested by pediatricians. The AAP developed the pediatric medical home model to deliver primary care to the child and family in a coordinated and comprehensive approach. 5. Care is coordinated by an interdisciplinary team that includes caregivers. A medical home integrates and coordinates care through interdisciplinary coordination with the child, family, primary health-care providers, specialists, hospitals, health-care systems, public health, and the community.

Ch 7 Multiple Choice The nurse is performing a clinic assessment on a 1-month-old new patient. During the interview, the mother shares personal information. Which comments will cause the nurse concern about growth and development? Select all that apply. 1. " I was anemic during pregnancy and still take iron pills." 2. " Fat people are gross; I only gained 16 pounds during pregnancy." 3. " I don't think I even had a single cold during my pregnancy." 4. " During my pregnancy I never even took care of the cat." 5. " I really decreased my smoking habit during pregnancy."

2. The nurse is concerned by this comment on two levels. Poor nutrition in the mother can lead to low-birthweight babies, as well as slow development, compromised neurological performance, and impaired immune status. The mother's attitude about "fat people" may carry over through the lifetime of the infant and cause insufficient nutrition for growth and development and/or psychosocial issues. 5. Maternal smoking can result in infants with low birth weight and/or congenital anomalies such as cleft lip and cleft palate. The nurse needs to provide teaching about the effects of smoking during pregnancy, especially if another pregnancy is planned.

Ch 10 A school-aged child is being treated for an overdose of cough medicine administered by the parent. The child is 12 years of age and weighs 98 pounds. The label on the bottle states not to give the medication to children younger than 6 years, and provides a dosing chart that indicates an adult dose for children over 50 kg. For which reason does the nurse suspect the overdose occurred? 1. The cough continued after being medicated. 2. The parent misunderstood weight parameters. 3. The parent measured with a household spoon. 4. The parent attempted to induce sleep in the child.

2. The parent misunderstood weight parameters. The nurse suspects that the parent misunderstood the weight parameters for the medication. The parent may have thought 50 kg was another way of indicating 50 pounds and given the child an adult dose. Multiple doses caused an overdose.

Ch 9 The nurse is asking a parent of a toddler at age 18 months if there are any particular parenting challenges at this time. Which advice will the nurse offer if the parent shares issues with separation anxiety? 1. The parent needs to just leave quickly and ignore the toddler's protests. 2. The parent needs to keep reassuring the toddler that the parent will return. 3. The toddler is to be left only with family members until the fear subsides. 4. The parent needs to plan leaving times to coincide with the toddler's naps.

2. The parent needs to keep reassuring the toddler that the parent will return. The nurse will advise the parent to repeatedly reassure the toddler that the parent will be back. After the toddler is reassured, the parent needs to leave quickly.

Ch 7 The pediatric nurse is providing care for a 14-year-old female patient. After the patient's parents leave the hospital, the patient begins to cry. The nurse explores the patient's feelings using therapeutic communication. Which information causes the nurse to report suspected sexual abuse? 1. The patient is frequently denied access to needed health care 2. The patient reports frequent episodes of genital irritation 3. The patient admits to multiple incidences of skipping school 4. The patient states that an older brother frequently "hurts" her

2. The patient reports frequent episodes of genital irritation Frequent episodes of genital irritation is indicative of possible sexual abuse and should be reported as such.

Ch 8 The nurse in a community pediatric clinic screens for conditions that cause concern for possible infant abuse or neglect. Which situation will prompt the nurse to recommend parenting education? 1. The stay-at-home mother of four children (ages 4 to 16 years) who is bringing home a newborn 2. The teenage couple with a newborn who live apart, but the father babysits during the day so the mother can attend school 3. The newly relocated couple with a young infant who are now 12 hours away from family and friends 4. The parents of an infant who live apart because the father of the infant is married and has a family with his spouse

2. The teenage couple with a newborn who live apart, but the father babysits during the day so the mother can attend school The teenage couple with a newborn will cause the nurse the greatest concern about infant abuse or neglect. Because the couple live apart, the father is not exposed to the infant except when he is babysitting; unfamiliarity with the infant's behaviors or needs can lead to neglect. Frustration related to a lack of knowledge and/or immaturity places the infant at risk for abuse. The nurse needs to strongly recommend a program such as daddy boot camp to this couple.

Ch 8 The nurse in the neonatal care unit notices that a term neonate has a respiratory rate of 66 breaths/min and exhibits pallor and lethargy. Which action does the nurse take immediately? 1. Unwraps the neonate and assesses for the presence of hypotonia 2. Wraps the neonate in an additional blanket and puts a knitted cap on the neonate. 3. Takes the neonate to the mother and assesses sucking reflex during a feeding. 4. Contacts the neonate's health-care provider and seeks permission to take a rectal temperature.

2. Wraps the neonate in an additional blanket and puts a knitted cap on the neonate. The initial assessment findings of the neonate are indicative of cold stress. Immediately, the nurse needs to take actions that will conserve body temperature. A knitted cap will cover the largest exposed area for heat loss; wrapping an additional blanket around the neonate will preserve heat.

Erikson's: Initiative vs. Guilt

3-6 years > The preschool child is exposed to new people and new activities; the child becomes involved and very busy > The child learns about the environment through play > The child learns new responsibilities and can act based upon established principles > The child develops a conscience > If the child is constantly criticized for his or her actions, this can lead to guilt and a lack of purpose > Play at this stage, is known as associative play

Freud's: Phallic

3-6 years Preoccupation with the genitals Curious about childbirth, masturbation, and anatomic differences Girls experience penis envy and wish they had one, boys suffer from castration anxiety (fear of losing their penis) Children develop strong incestuous desire for caregiver of opposite gender > Oedipal complex > Electra complex Children need to identify with caregiver of same gender to for male or female identity

Ch 9 The nurse finishes a series of parenting classes on the topic of tantrums and discipline. Which comment by an attending parent causes the nurse concern? 1. "We have learned to ignore her and she stops." 2. "I will give a snack and a nap if he is that grumpy." 3. "He plays and then suddenly screams for no reason." 4. "She is learning that a tantrum means a time-out alone."

3. "He plays and then suddenly screams for no reason." The nurse is aware that some tantrum triggers may indicate a problem related to mental, physical, or emotional issues. The child that is playing and suddenly screams for no reason will cause the nurse concern.

Ch 11 The nurse is gathering health data on an adolescent who is 16 years of age. Which comment by the adolescent will cause the nurse to seek additional information? 1. "I have to be the clumsiest kid in the world. Always tripping over my own feet." 2. "Some days I just hate school. I want to get out and on to a job or college." 3. "I try to keep my distance from a kid in my class who coughs all day long." 4. "I know that I have always been a skinny kid, but wish I could gain weight."

3. "I try to keep my distance from a kid in my class who coughs all day long." When the adolescent expresses trying to stay away from someone who is constantly coughing, the nurse seeks additional information and may recommend TB testing for the patient.

Ch 8 The nurse is assessing an infant at 1 month of age. At birth the infant weighed 7 pounds 10 ounces. Which is the minimum weight the nurse will expect during this assessment? 1. 8 pounds 2 ounces 2. 8 pounds 10 ounces 3. 8 pounds 14 ounces 4. 9 pounds 6 ounces

3. 8 pounds 14 ounces Birth to 1 month, the infant is expected to gain a minimum of 5 ounces weekly. The minimum expected weight for the infant weighing 7 pounds 10 ounces at birth is 8 pounds 14 ounces.

Ch 11 The nurse in a pediatric clinic is assessing a female adolescent who is 15 years of age. When the nurse performs a sexuality assessment, the patient states, "I have never had anything but safe sex." Which approach does the nurse take next? 1. Provide birth-control options. 2. Ascertain the number of sex partners. 3. Ask the patient to define "safe sex." 4. Inquire about treatment of a sexually transmitted infection (STI).

3. Ask the patient to define "safe sex." Given the patient's comment about having only safe sex, the nurse needs to determine the patient's definition of the term. Engagement in oral/anal sex is often considered "safe" by adolescents. If this defines the patient's sexual practice, the nurse needs to educate the patient about risks such as acquiring STIs via oral and anal routes.

Ch 9 The nurse in a pediatric clinic is assessing the motor development of a 2-year-old patient. The nurse reviews the toddler's last assessment results prior to determining changes. Which new development does the nurse expect to find during assessment? 1. Draws squares, circles, and triangles 2. Throws objects overhand 3. Can turn doorknobs 4. Climbs stairs without assistance

3. Can turn doorknobs A 2-year-old is expected to be able to turn doorknobs.

Ch 10 Select All The emergency department nurse manager receives a call that a school-age patient will be arriving shortly. The nurse is instructed to have a chaplain and social worker available for the family. The nurse manager is likely to anticipate which possible conditions of the arriving patient? Select all that apply. 1. Pneumonia 2. Terminal cancer 3. Car accident 4. Child abuse 5. Sports injury

3. Car accident 5. Sports injury The nurse is aware that unintentional injuries and cancer are the leading causes of death for children between the ages of 5 to 14 years. A car accident can be a source of serious body and head injuries, prompting the need for a chaplain and the services of a social worker. This is correct. School-age children are at risk for unintentional injuries; sports are activities that can result in injuries requiring emergency medical attention. The request for a chaplain and social worker may be indicative of serious injury.

Ch 10 The nurse is preparing to administer medications to school-aged patients. The nurse is aware the pediatric patient doses are different than medication doses for adults. Which factor does the nurse apply to administering pediatric medications? 1. Children's bodies are smaller and need half of the adult dose. 2. The metabolic rate of a child is slower and can cause overdosing. 3. Doses of medications are ordered according to the child's weight. 4. The first dosage consideration is based on the age of the child.

3. Doses of medications are ordered according to the child's weight. This is correct. Basing medication dosage on weight gives an accurate and safe dose for each patient.

Ch 8 The nurse in a pediatric clinic is preparing to assess an infant at the age of 9 months. The nurse is aware that this well-baby checkup will involve assessment for developmental delays or disabilities. Which finding causes the nurses the nurse to suspect a developmental delay? 1. Displays sucking reflex when presented with bottle or pacifier 2. Cries and reaches for the parent when placed on the examination table 3. Loses interest in a toy that is dropped out of sight by the nurse 4. Waves or shakes the head in response to verbal cues "bye-bye" and "no"

3. Loses interest in a toy that is dropped out of sight by the nurse When a 9-month-old infant loses interest in an object that is dropped out of sight by the nurse, the nurse is concerned by a possible developmental delay. At 9 months of age the infant is expected to know where to look for an object that has been dropped.

Ch 10 Select All The nurse in a pediatric clinic is preparing to assess an older school-aged child. Which behavior by the child prompts the nurse to ask if the parent should leave the room? Select all that apply. 1. Acknowledges that the parent is aware of adolescent's sexual activity 2. Refers some of the nurse's questions about health history to the parent 3. Makes attempts to keep their body covered during physical assessment 4. Looks tense and anxious when asked about body functions and changes 5. Does not respond to questions relating to thoughts, feelings, and opinions

3. Makes attempts to keep their body covered during physical assessment 4. Looks tense and anxious when asked about body functions and changes 5. Does not respond to questions relating to thoughts, feelings, and opinions 3. This is correct. When the nurse notices the adolescent's attempts to keep his or her body covered, the nurse should inquire if the patient wants the parent to leave the room. 4. This is correct. When the adolescent looks tense and anxious at any time during the examination, the nurse should inquire if the patient wants the parent to leave the room. 5. This is correct. When the nurse notices the adolescent's lack of response to questions related to thoughts, feelings, and opinions, the nurse should ask if the patient wants the parent to leave the room.

Ch 10 The nurses in a local health department are scheduled to perform screenings at a public elementary school. Which printed information will the nurses most likely send home with the students after the screening? 1. Importance of keeping immunizations up to date 2. Procedure for handwashing to prevent illnesses 3. Methods of treating and avoiding lice infestation 4. Proper way to cover up when coughing or sneezing

3. Methods of treating and avoiding lice infestation Infestations of head lice are prevalent among school-age children. The health department nurses will perform on-site screenings for the presence of the problem. Infected students will receive notifications about positive identification. All students will receive printed material about the treatment and prevention of lice infestation.

Ch 11 The nurse working in the emergency department of a pediatric care facility is receiving an adolescent patient with a gunshot wound to the head. The patient is unconscious but exhibiting signs of life-threatening deterioration. Which action does the nurse take? 1. Keep attempting to reach the parents. 2. Determine whether the patient is emancipated. 3. Prepare the patient for surgery. 4. Call the facility's legal advisor.

3. Prepare the patient for surgery. Under the Emergency Medical Treatment and Active Labor Act of 1986, adolescents who require emergency care may be treated regardless of whether caregiver consent has been obtained. The nurse will prepare the patient for surgery.

Ch 11 Select All An adolescent who is 12 years of age is a year into treatment for a malignant brain tumor. For which psychosocial and spiritual care will the nurse plan? Select all that apply. 1. Remind the patient that achieving a vocation/career is not likely. 2. Encourage parents to remain hopeful about the adolescent's future. 3. Promote self-esteem and confidence with praise for accomplishments. 4. Assess the patient for indications of fear from facing a premature death. 5. Use developmental age because there may be some developmental delays.

3. Promote self-esteem and confidence with praise for accomplishments. 4. Assess the patient for indications of fear from facing a premature death. 5. Use developmental age because there may be some developmental delays. 3. This is correct. The nurse needs to allow for the adolescent's completion of tasks as able. Then, the nurse needs to promote self-esteem and confidence with sincere praise of accomplishments. 4. This is correct. The possibility of a premature death can be especially difficult for an adolescent patient. The nurse needs to assess for fear of facing their own premature death. 5. This is correct. The nurse needs to use developmental rather than chronological age when caring for chronically ill adolescents, because there may be some developmental delays.

Ch 10 Select All The nurse is making a home visit for a child who is 9 years of age and currently unable to attend school because of an illness causing immunosuppression. The child seems depressed and tells the nurse, "I miss my friends and all the fun we had." Which interventions will the nurse add to the plan of care to meet the child's psychosocial needs? Select all that apply. 1. Have the parents take videos of friends for the child to view. 2. Allow friends to visit from the doorway of the child's room. 3. Provide instructions on how to visit friends on a computer. 4. Suggest that the child and friends send letters to each other. 5. Ask parents to arrange daily time for telephone visiting with friends.

3. Provide instructions on how to visit friends on a computer. 5. Ask parents to arrange daily time for telephone visiting with friends. School-age children are very technology savvy and most of them have access to computers. Providing instructions about how the child and friends can visit safely in current time will help meet the child's psychosocial needs. Verbal communication is a good way to help the isolated child keep in touch with friends. Daily telephone conversations will help meet the child's psychosocial needs.

Ch 7 The school nurse in a high school setting expresses concern to school administration regarding the increase in student complaints about bullying, physical violence, and rejection. Which concern related to psychosocial development does the nurse share as being most important? 1. Students are preoccupied with how they are seen in the eyes of others 2. Students who are bullied will develop issues related to sexual orientation 3. Students may be unable to provide a meaningful definition of self 4. Students who are aggressive will develop a strong sense of guilt as adults

3. Students may be unable to provide a meaningful definition of self The nurse's concern is focused on the possibility the students involved in any aspect of bullying, physical violence, and rejection will be unable to provide a meaningful definition of self, which places them at risk for role confusion in one or more roles throughout life.

Ch 9 The nurse is involved in a clinic screening for the kindergarten readiness of preschoolers. Primarily the children being screened are between the ages of 4 and 5 years. Which child does the nurse recognize as being ready to attend school? 1. The 4-year-old who points correctly to three different colors and voices reluctance to start school. 2. The 5-year-old who is unhappy about being told there is a 5-minute wait and then refuses to count. 3. The 4-year-old who counts to 10, recalls part of a story, and asks questions about the screening. 4. The 5-year-old who insists a parent stay with him, counts to 10, knows five colors, and recalls a story.

3. The 4-year-old who counts to 10, recalls part of a story, and asks questions about the screening. A 4-year-old who can count to 10, recall part of a story, and asks questions about the screening exhibits a readiness for school.

Ch 9 A parent has brought a toddler to a new pediatric clinic for a routine visit. The nurse will obtain a health history from the parent. Which information is most important for the nurse to gather? 1. Chief complaint 2. Family medical history 3. Toddler medical history 4. Social history

3. Toddler medical history The most important health history information is the toddler's medical history, which will include childhood illnesses, hospitalizations, surgeries, immunizations, and results of vision/hearing/developmental screens.

Ch 7 The nurse is visiting the home of a new mother and a 2-month-old infant. The nurse notices the infant vigorously sucking on the fist and whining but not crying. Which information does the nurse need to obtain from the mother? 1. If the mother is breast or bottle feeding 2. How long the infant sleeps at night 3. What type of feeding schedule is followed 4. If the infant draws up the legs when crying

3. What type of feeding schedule is followed Normal development requires not depriving oral gratification, such as weaning too soon or a rigid feeding schedule. Because of the infant's vigorous fist sucking, the nurse needs to ascertain what type of feeding schedule is being followed.

Ch 7 The nurse is teaching a parenting class being held in a community clinic. The nurse is focusing on behaviors that will assist in increasing the number of children who score well in kindergarten readiness screening. Which comment by a parent indicated the need for additional information? 1. "I am not athletic, but the kids would love an outdoor play area." 2. " Practicing counting with the kids while traveling is a good idea." 3. " I like the suggestion to label basic items for word recognition." 4. " In our family we watch TV; books are a waste of money."

4. " In our family we watch TV; books are a waste of money." The nurse needs to provide additional information to the parent who thinks books are a waste of money. The parent needs to be aware of community agencies that will supply books to children and of programs that provide reading/story times.

Ch 11 A 13-year-old patient is being seen for an annual exam. During the exam, the nurse screens for depression and suicidal ideation. Which response by the client is of greatest concern? 1. "Sometimes I feel sad or down, especially when I'm stressed out." 2. "Some nights I have trouble falling asleep, but once asleep, I stay asleep." 3. "I have been staying home a lot. I started a new school this year and don't really know anyone." 4. "A lot of the time, I think everyone would be better off if I'd never been born."

4. "A lot of the time, I think everyone would be better off if I'd never been born." This statement indicates the child may be thinking about suicide or self-harm. This is the greatest concern and requires immediate follow-up.

Ch 11 A nurse is teaching a group of overweight adolescents about healthy lifestyle choices. Which statement by an adolescent indicates that more teaching is needed? 1. "I should eat foods high in fiber and low in fat." 2. "I should eat at the table instead of in front of the television." 3. "I should eat a balanced meal instead of taking dietary supplements." 4. "I should get 30 minutes or more of moderate-intensity activity daily."

4. "I should get 30 minutes or more of moderate-intensity activity daily." It is recommended to get 60 minutes or more of moderate intensity activity daily. This adolescent requires further teaching.

Ch 10 The nurse in a pediatric office is preparing to remove stitches from an 8-year-old child's arm. Which approach by the nurse before the procedure is most effective? 1. Provide information in advance of how the procedure is performed. 2. Tell the patient, "I will be back in 15 minutes to take out your stitches." 3. Have a coworker in the room to assist if the patient becomes uncooperative. 4. Bring the instruments to the room and announce, "Let's get those stitches out."

4. Bring the instruments to the room and announce, "Let's get those stitches out." This is correct. If a procedure must be performed, have the instruments ready and inform the child immediately before the procedure. The action will keep the patient from becoming more anxious. The nurse needs to use a friendly and calm manner to help reduce patient stress.

Ch 9 The nurse is gathering assessment information from the parent of a 5-year-old child. The parent states, "I am very frustrated. She insists on doing things alone even if it is a struggle to do it right, and gets angry if I redo the task." Which information will the nurse share with the parent to promote greater understanding? 1. Assure the parent that the child will become more compliant as she matures. 2. Suggest how the parent can critique the child's actions without hurting feelings. 3. Encourage the parent to set aside time each week to teach the child the correct way to do things. 4. Explain the child's interest in new things, the need to be independent, and pride in her abilities.

4. Explain the child's interest in new things, the need to be independent, and pride in her abilities. The behavior of this preschooler reflects the milestones related to social and emotional development. The nurse should explain behaviors in a positive way and encourage the parent to support expected growth and development.

Ch 7 The caregiver of a 9-month-old infant asks the nurse about what toys are age appropriate. Using Piaget's theory of development, which toy does the nurse recommend? 1. Building blocks 2. Colorful mobiles 3. Picture books 4. Musical Rattles

4. Musical rattles At 8 months, the infant should be in Piaget's stage 4: coordination of secondary schemata. To achieve a desired effect, the infant will repeat an action, such as repeatedly shaking a rattle to make sounds. The nurse will recommend a variety of rattles as appropriate toys for this patient.

Ch 11 The nurse is providing care for an adolescent patient who is hospitalized following a grand mal seizure. The condition has existed for 5 years and resulted in multiple hospitalizations. Which nursing intervention is appropriate for this client? 1. Ask the patient and family to consider homeschooling. 2. Arrange for home care and regular nursing visitations. 3. Explain methods to minimize the chronic medical events. 4. Refer patient and family to applicable Internet resources.

4. Refer patient and family to applicable Internet resources. The adolescent patient is likely to have an interest and the ability to do research on the Internet. To promote understanding through valid and applicable resources, the nurse needs to refer the patient and family to reliable Web sites.

Ch 9 The nurse works in the pediatric unit of a hospital and is currently providing care for a 1-year-old patient. Which action by the nurse is most important for maintaining the safety of this patient? 1. Question about the presence of smoke and carbon monoxide detectors in the home. 2. Check the temperatures of water, food, and drinks to prevent burns. 3. Provide caregiver education on basic home, outdoor play, and car safety measures. 4. Regularly check equipment in the crib environment for potential safety hazards.

4. Regularly check equipment in the crib environment for potential safety hazards. The nurse in an acute care setting is most focused on safety during the hospitalization of a pediatric patient. The nurse needs to check equipment regularly, with special attention to wire and cord placement to minimize entanglement, suction availability at crib side, and minimal equipment and crib attachments to decrease choking and suffocation hazards.

Ch 9 The nurse is evaluating the language skills of a 2-year-old patient. Which assessment finding causes the nurse to suspect a developmental delay? 1. States, "Want mommy!" 2. Points to objects named by the nurse 3. Converses using two short sentences 4. Repeats sounds but not words said by the nurse

4. Repeats sounds but not words said by the nurse Toddlers like to repeat words that are overheard. The expectation is for the toddler at 2 years of age to repeat a single word spoken by the nurse. The inability to perform this action may cause the nurse to suspect a developmental delay or a hearing defect.

Ch 10 The nurse is examining a 10-year-old child brought to the clinic because of episodes of shortness of breath, headaches, and stomach upset. The nurse notices bruises in various stages of resolution on the upper arms and upper legs. Which additional information is most important for the nurse to obtain? 1. Ask about the duration of the presenting symptoms. 2. Ascertain if there is a change in school performance. 3. Ascertain whether there has been a change in mood or behavior 4. Seek information about the cause of the bruises.

4. Seek information about the cause of the bruises. The most important information for the nurse to obtain is the source of the bruising. The child may have a valid explanation, or the explanation may increase the nurse's concern. The nurse will evaluate the child's response and act accordingly.

Ch 8 The nurse is providing care for a neonate who is identified as being at risk for neonatal abstinence syndrome. Which assessment finding causes the nurse to expect pharmacological interventions for this neonate? 1. Central and autonomic nervous system irritability and dysfunction are present. 2. There is evidence of opioids in the neonate's meconium 3. Symptoms are not alleviated with swaddling, comforting, and feeding. 4. The Finnegan neonatal abstinence score is 10 at 3 hours after birth

4. The Finnegan neonatal abstinence score is 10 at 3 hours after birth The Finnegan neonatal abstinence score of 10 at 3 hours after birth is the strongest indicator of the need for pharmacological interventions for this neonate. Pharmacological interventions are with morphine sulfate or methadone adjusted based appropriately for scores greater than 8.

Freud's: Latency

6-11 years Sexual drives submerged Energy focus on socialization and increasing problem-solving abilities Appropriate gender roles adopted Oedipal or Electra conflicts resolved Identifies with same-gender peers and same-gender caregiver Superego developed to a point where it keeps ID under control

Erikson's: Industry vs. Inferiority

6-12 years > The child develops interests and takes pride in accomplishments > The child enjoys working in groups and forming social relationships > Projects are enjoyable > The child follows rules and order > Developing a sense of industry provides the child with purpose and confidence in being successful > If a child is unable to be successful, this can result in a sense of inferiority > A child must learn balance, an understanding that he or she cannot succeed at everything and that there is always more to learn > Play at this stage is known as cooperative play

Piaget: Concrete Operational Defined

7-11 years > Shows increase in accommodation skills > Develops an ability to think abstractly, and to make rational judgments about concrete or observable phenomena > In teaching, give the opportunity to ask questions and explain things back to the nurse. This allows the child to mentally manipulate information.

Kohlberg: Conventional

7-12 years Good interpersonal relationships Maintaining the social order Seeks conformity and loyalty Follows rules Maintains social order

Erikson's: Trust vs. Mistrust

Birth-1 year An infant requires basic needs are met: Food, Clothing, Touch and Comfort If these needs are not met, the infant will develop mistrust of others If a sense of trust is developed, the infant will see the world as a safe place Play is usually considered psychosocial activity. During this stage play is referred to as solitary

Piaget: Sensorimotor Defined As

Birth-2 years Child learns through motor and reflex actions and begins to understand that he or she is separate from the environment and from others

Piaget: Sensorimotor - Object Permanence

Important part of sensorimotor stage that the child now knows that an object exists even when it cannot be seen or heard ** Great time to introduce the game Peekaboo By the end of this stage the child will understand that you did not disappear just because your hands are over your face

Piaget: Sensorimotor - Stage 1

Reflexes - birth to 2 months The child understands the environment purely through inborn reflexes such as sucking

Key stages of Piaget's Cognitive Development

Sensorimotor Preoperational Concrete Operational Formational Operational

Piaget: Sensorimotor -Stage 5

Tertiary circular reactions - 12-18 months The child begins trial and error approaches Example: Making a sound to see whether it will get attention from the caregiver

Kohlberg and Social-Moral Development

Theorized that children acquire moral reasoning in a specific developmental sequence Established on the premise that at birth, we are void of morals and ethics; therefore, moral development occurs through social interaction with the environment around us

Erikson's Psychosocial Development Stages

Trust vs. Mistrust Autonomy vs Shame and Doubt Initiative vs. Guilt Industry vs. Inferiority Identify vs Role Confusion