2911 Exam 3 practice

The nurse is providing teaching about preventing poisoning. Which statement by the mother would warrant further discussion?

"All medicine in our bathroom is in childproof containers." The nurse should emphasize that while childproof caps on medications are important, all medications including those with childproof caps should still be kept locked. (Vitamins are medications.

The father of a preschool boy reports concerns about the short stature of his son. The nurse reviews the child's history and notes the child is 4 years old and is presently 41 in (104 cm) tall and has grown 2.5 in (6.35 cm) in the past year. Which response by the nurse is most appropriate?

"Both your son's height and rate of growth are within normal limits for his age." The average 4-year-old child is 40.5 in (103 cm). The average rate of growth per year is between 2.5 and 3 in (6.35 and 7.62 cm). The child in the scenario demonstrates normal stature and growth patterns.

The nurse is counseling an overweight, sedentary 15-year-old girl. The nurse is assisting her to make appropriate menu choices. Which statement indicates the adolescent understands how to make appropriate dietary selections?

"I need to eat plenty of fruit each day." The sedentary teen needs to consume approximately 1,600 calories each day. A balanced diet includes plenty of fresh fruit and a small amount of fat. To avoid all fat could place the child's health at risk. Protein intake is important for the development of tissue. The teen will need about 5 ounces of protein daily.

The nurse is teaching a group of school-age children about physical development. Which statement made by one of the children indicates the correct understanding of the teaching?

"I will grow an average of 2.5 in (6.5 cm) per year." During the school-age years, the child will grow an average of 2.5 in (6.5 cm). As puberty approaches, there will be significant differences in development between boys and girls. As development occurs, weight does increase, but it is not directly related to fat production. This is an area where much education needs to occur with young girls because "dieting" can be detrimental to the child's health and increased size is tied to the child's body image and self-esteem. By 10 years of age, brain growth is complete, and fine motor coordination is refined.

The mother of an 18-month-old girl voices concerns about her child's social skills. She reports that the child does not play well with others and seems to ignore other children who are playing at the same time. What response by the nurse is indicated?

"It is normal for children to engage in play alongside other children at this age." The social skills of the toddler at this age include parallel play. During parallel play children will play alongside each other rather than cooperatively. There is no indication that the aggression level of the child needs to be investigated. There is no indication the child needs increased socialization with other children.

The parents of a 10-year-old tell the clinic nurse that they are concerned because they noticed that their child has gained about 10 pounds over the past 2 years. What is the best response by the nurse?

"Normal growth and development for this age results in an average weight gain of 7 pounds per year." Children of school-age grow an average of 2.5 inches (6 to 7 centimeters) per year and gain an average of 7 pounds per year; therefore, the 10 pounds over 2 years is normal and it is important for the parents to know this, regardless if they are not overweight

A mother of a 10-month-old states to the nurse, "I brush my child's teeth every day with flavored kids' toothpaste." Which is the most appropriate response by the nurse?

"Toothpaste is not necessary; it is the scrubbing that is required." Toothpaste for infants is not required. The important health technique is the removing of plaque, and that is accomplished through scrubbing of the teeth.

A 5-year-old girl is pretending to be a crocodile during a physical examination. Her mother just smiles and rolls her eyes at the nurse. What would be the best response for the nurse to give the child?

"What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile." Parents sometimes strengthen a fantasy role without realizing it. A preschooler might be pretending she is a crocodile. If the nurse plays along, the child may be frightened she has actually become a crocodile. A better response is to support the imitation—this is age-appropriate behavior and a good way of exploring roles—by saying, "What a nice crocodile you're pretending to be." This both supports the fantasy and reassures the child she is still herself.

A 7-year-old child has taken money from a sibling's dresser on two occasions. When counseling the parent about this behavior, what would the nurse advise?

"You may need to remind your child about property rights." Antisocial behaviors develop during the school-age years. Between the ages of 6 and 8 years, the child has difficulty understanding the concept of ownership and property rights. At this age, children often take things because they like the look of an item. By age 9, children learn to respect other's possessions and property. Buying a more secure bank may keep the child from taking the money, but it does not take into consideration the child's developmental level. The behavior is a developmental issue and not an emotional issue of having too much pressure.

The infant measures 21.5 in (54.6 cm) at birth. If the infant is following a normal pattern of growth, what would be an expected height for the infant at the age of 6 months?

27.5 in (70 cm) Infants gain about 0.5 to 1 in (1.25 to 2.5 cm) in length for each of the first 6 months of life. Therefore, a 21.5-in (54.6-cm) infant adding 6 in (15 cm) of growth would be 27.5 in (70 cm). Infants grow the fastest during the first 6 months of life and slow down the second 6 months. By 12 months of age, the infant's length has increased by 50%, making this infant 32 in (81 cm) at 1 year old.

The mother of a newborn reports she does not think her baby likes his formula since he spits up after only taking a small amount. Which response by the nurse is most appropriate?

"Your baby's stomach is small and can only hold about 0.5 to 1 oz at birth." At the time of birth, an infant's stomach can only hold 0.5 to 1 oz ounce. This will gradually increase. While it is true that the infant does not eat much, this does not meet the educational needs of the mother and is not the best response. Burping is a part of normal newborn feeding practices but is not the best response. There is no indication there is a milk intolerance from the information reported.

While observing a 13-month-old and her parents in the playroom of the hospital unit, the nurse notes that the toddler is using her index finger to point towards a toy. What should the nurse say to the parents?

"Your daughter is demonstrating fine motor skills appropriate to her age by pointing with her index finger." At 12 to 15 months of age the toddler should be feeding herself finger foods and using her index finger to point to objects. Turning the pages of books would not be expected until the age of 18 months.

The nurse is caring for an 18-month-old child who has had surgery. The medical record indicates the child weighs 23 pounds (10.45 kg). When monitoring his urinary output the nurse is aware that normal hourly output should be what value?

10 ml/hr The normal urinary output for a toddler is approximately 1 ml/kg/hr. This child weighs 23 pounds. This is 10.45 kg. This is approximately 10 ml/hr.

The nurse is preparing to catheterize an 11-year-old child. The nurse correctly recognizes the child's approximate bladder capacity is what amount?

13 ounces The formula for bladder capacity is age in years plus 2 ounces. If a child is 11 years of age, this would be approximately 13 ounces.

The nurse is assessing a 1-year-old at the well-child annual visit and notes the child is meeting the growth parameters. After noting the birth weight was 8 pounds (3.6 kg) and length was 20 inches (50.8 cm) long, which measurements reflecting height/weight would the nurse expect to document for this visit?

24 pounds (10.8 kg) and 30 inches (75 cm) By 1 year of age, the infant should have tripled his or her birth weight and grown 10 to 12 inches (25 to 30 cm). If this infant was 8 pounds (3.6 kg) at birth, at 1 year, this child should weigh 24 pounds (8 x 3 = 24) and grown to 30 to 32 inches (20 + 10 to 12 = 30 to 32 inches). Most of the growing occurs during the first 6 months with the infant's birth weight doubling and height increasing about 6 inches (15 cm). Growth slows slightly during the second 6 months but is still rapid.

By what age should the child know his/her own gender?

3 years Toddlers observe differences in both male and female body parts. They question their parents about the differences. By 3 years of age, toddlers can say their name, their age and their gender. This age group begins to understand and mimic social gender differences. A 1-year-old or 2-year-old child would be too young to make this distinction because these children are just identifying their own body parts. By 4 years of age the child should be able to identify body parts. If not, there may be some delay with the child.

The nurse at an elementary school is explaining the concept of industry versus inferiority to a group of nursing students. What is part of this stage of Erikson's theory?

A sense of competence, mastery, and worth Erikson states that school-agers receive satisfaction from developing new skills and successfully using them to accomplish goals (industry). Failing (without adult support) or being unable to meet expectations that are set too high can result in feelings of inferiority.

The nurse is teaching the mother of a 5-month-old boy who is concerned about thumb sucking. What should be included in the teaching plan? Select all that apply. Advising the mother this behavior is a form of self-comfort Assuring the mother this behavior won't cause malocclusion Informing the mother that thumb sucking occurs more often during periods of stress Telling the mother this behavior usually decreases by 6 to 9 months of age

Advising the mother this behavior is a form of self-comfort Assuring the mother this behavior won't cause malocclusion (teeth aren't aligned) Informing the mother that thumb sucking occurs more often during periods of stress Telling the mother this behavior usually decreases by 6 to 9 months of age

Which nursing action will best assist a 15-year-old client accomplish the developmental task according to Erikson?

Allow the client's friends to visit while the client is hospitalized The developmental task of adolescence is to develop a sense of identity, or deciding who and what kind of person one is. Friends and peers are important to facilitating the adolescent in determining one's identity. Permitting the client to make decisions assists in developing autonomy, which is a toddler task. Praising facilitates initiative, which is a preschool task. Independently performing tasks assists in developing industry, which is a school-age task.

The nurse is caring for an 18-month-old child. The nurse is aware that the child is which stage according to Erikson?

Erikson defines the toddler period as a time of autonomy versus shame and doubt. Erikson defines Initiative versus guilt as the preschool period. Erikson defines trust versus mistrust as the infancy period and industry versus inferiority as the school age period.

An infant is breastfed. When assessing the stools, which findings would be typical?

Less constipation than bottle-fed infants The first stool of the infant is meconium. It is the result of digestion of amniotic fluid and it is black-green color and sticky. Following that, in 1 to 2 days the infant's stools change to a yellowish-tan color. The stools of breastfed infants tend to be yellow-tan. They are looser in texture and appear "seedy." The stool of a bottle-fed baby has the consistency of peanut butter. The stools of breastfed babies generally have no odor since all milk is digested. Some babies will have a bowel movement with every feeding but it is small. Bottle-fed babies have less stools each day but they are larger and more likely to have an associated odor.

What anticipatory guidance can the nurse provide the girl who has noted the development of breast buds?

Menarche should follow in about 2 years. Menarche usually follows within 2 years of the first signs of breast development. Peak height velocity (PVH) in girls occurs 6 to 12 months following menarche. It does not follow immediately. Breast development progresses through several stages and will not be complete until late puberty. Adult height is not reached at the time of menarche but about 6 to 12 months following menarche.

The school nurse is performing a vision screening for a 7-year-old child. Which finding should trigger a referral?

Misalignment of the eyes (strabismus) interferes with vision and eye development. Amblyopia (vision loss) can result. Lack of alignment of the eyes needs referral and treatment. The rest represent normal visual findings in a 7-year-old.

The nurse is supervising a play group of children on the unit. The nurse expects the toddlers will most likely be involved in which activity?

Playing with the plastic vacuum cleaner and pushing it around the room Playtime for the toddler involves imitation of the people around them such as adults, siblings, and other children. Push-pull toys allow them to use their developing gross motor skills. Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. The school-age child enjoys group activities and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities they can participate in with their peers.

The nurse is working with a group of 8-year-olds who are learning about the concept of conservation of numbers. Which activity will help teach this concept to these school-aged children?

Rearranging a group of coins first into a circle, then a triangle and then a square In understanding the concept of conservation of numbers, the child understands that the number of objects does not change even though they may be rearranged. Conservation of weight can be accomplished by weighing different objects. Conversation of mass is demonstrated by forming vases out of clay.

At what age would it be okay to introduce carrots to an infant's diet?

Solid food can be introduced at 4 to 6 months of age. The tongue extrusion reflex is present until the infant is 4 to 6 months of age. After this reflex disappears then solid food may be introduced. The infant's ability to swallow solid foods is not completely functional until this age nor are the enzymes present which are needed to process foods. The infant must be ready to handle spoon-feeding. By 7 months onward, the baby should be eating solid foods regularly and drinking from a cup in addition to breast or bottle feeds.

The pediatric nurse is planning quiet activities for a hospitalized 18-month-old. What would be an appropriate activity for this age group?

Stacking blocks At 18 months the child can stack four blocks. The 24-month-old can paint (but not by number), scribble, and color, and put round pegs into holes.

The nurse is assessing a healthy 2-year-old client. Which assessment finding most concerns the nurse?

The child speaks in one-word sentences. A 2-year-old child not using at least two-word sentences is a sign of a potential developmental delay. Normal development for a 2-year-old child is standing on tiptoes and pointing to named body parts. Having difficulty with stairs is considered a potential delay in a 3-year-old, not a 2-year-old child.

The home health nurse is visiting a 2-year-old client's home. Which finding will cause the nurse to intervene?

The family's medications are located in a kitchen drawer. Poisoning is at peak incidence during the toddler period. Special precautions need to be taken against poisoning at this time. This includes keeping all medications in a high, locked cabinet. It is appropriate for all windows to be locked to prevent a toddler from exiting the home out a window. The toddler may go to the bathroom alone once toilet training is well established. Not allowing the toddler in the kitchen during meal preparation will prevent accidental burns from hot foods and surfaces.

The nurse is completing a developmental assessment on a 6-month-old infant. Which findings indicate the need for additional follow-up? The infant babbles. The infant does not pay attention to noises behind him. The infant has frequent episodes of crossed eyes. The infant seems disinterested in the surrounding environment. The infant is unable string together 2 word sentences.

The infant does not pay attention to noises behind him. The infant has frequent episodes of crossed eyes. The infant seems disinterested in the surrounding environment. Warning signs that may indicate problems with sensory development include the following: young infant does not respond to loud noises; child does not focus on a near object; infant does not start to make sounds or babble by 4 months of age; infant does not turn to locate sound at age 4 months; infant crosses eyes most of the time at age 6 months. Language development at this stage of development does not include stringing together 2-word sentences.

The student nurse is reviewing the chart of a newborn. The document indicates the newborn is in the quiet alert state. Which is the best description of this sleep phase?

The newborn's eyes are open and no body movements are noted. The normal newborn moves through 6 stages of consciousness. The quite alert state is when the infant's eyes are open but the body is calm. Open eyes accompanied by body movements is characteristic of the active alert state.

The nurse is assessing speech development in the 2-year-old toddler whose family uses two languages in the home. What finding is of concern?

The toddler speaks 15 words between the two languages. Of concern is the toddler speaking only 15 words between the two languages spoken in the home. At 20 months, the bilingual child should use 20 words. The other findings fit the norms for a bilingual child.

The clinic nurse is collecting vital signs on a 4-year-old client being seen for a yearly well check-up. Which measurements should the nurse collect?

height and weight Height and weight are the standard measurements at every yearly visit. The nurse should understand that head circumference is not routinely measured past 2 years of age and abdominal girth is only collected in infants.

Parents and their nearly 3-year-old child have returned to the clinic for a follow-up appointment. Which of the findings may signal a speech delay?

Uses two-word sentences or phrases A child nearly 3 years of age should speak in three- to four-word sentences. The other findings indicate normal expressive language for the age.

A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia. The child's condition has improved, and the child is much more active and eager to play. Which toy should the nurse offer the child?

large piece puzzle An appropriate toy for a 3-year-old child is a large piece puzzle. Board games are more appropriate for preschool and school-aged children; fabric books and squeaky toys are more appropriate for older infants and younger toddlers (10 to 18 month of age).

The nurse is providing teaching about good nondairy sources of calcium for preschoolers. Which of these fruits contains the most calcium?

orange A medium orange contains 50 mg of calcium and is a good nondairy choice. The other fruits are healthy choices but do not contain as much calcium.

Which piece of equipment is most helpful in determining airway obstruction in the client with asthma?

A peak flow meter The peak flow meter provides the most reliable early sign of an asthma episode. Most episodes begin gradually, and a drop in peak flow can alert the client to begin medications before symptoms actually are noticeable. A nebulizer and inhaler treat symptoms. An incentive spirometer is used for lung expansion, especially after surgery.

A 3-year-old child is seen at the clinic for a checkup. When collecting information, the child's parent reports concern about the child's stools because sometimes the child passes what appears to be undigested food. What response by the nurse is appropriate?

"At this age, the digestive tract is not completely mature and children may pass undigested food." The digestive systems of 3-year-old children are not fully mature and they may sometimes pass pieces of undigested food. This is a normal occurrence. The reason for this occurrence should be explained to the child's parent. When the nurse asks the parent "Why," this is demonstrating poor therapeutic communication skills and will cause the parent to become defensive. The symptoms of pain or straining would be indicative of constipation, not passing undigested food. There is no indication that the diet being ingested is not appropriate.

The nurse is performing a well-child assessment on a 2-week-old male infant. The mother asks why her baby only breathes out of his nose and does not seem to mouth breathe. What information can the nurse provide to the mother?

"Babies are nose breathers for about the first 4 weeks of life." Newborns are obligatory nose breathers until at least 4 weeks of age. The young infant cannot automatically open his or her mouth to breathe if the nose is obstructed. The nares must be patent for breathing to be successful while feeding. Newborns breathe through their mouths only while crying.

The nurse is caring for a child with heart failure related to a congenital heart defect. One of the nursing diagnoses identified includes "Excess fluid volume." During a family care planning conference. the parents ask why this diagnosis applies to their child. What is the best response by the nurse?

"Cardiac problems cause the heart to not pump effectively, which causes swelling in the body and fluid in the lungs." This response best explains the meaning of the nursing diagnosis and it's cause. Although there are standardized care plans as a guide, each care plan must be individualized to the client. Stating, "The heart is a pump and it isn't pumping effectively" does not explain the nursing diagnosis. Telling the parents not to worry does not help in educating them.

The nurse is taking a respiratory history of a newly admitted child. While documenting the symptoms the child has, what other item is important to document when taking a history on an altered respiratory status?

The triggers in the environment When assessing a respiratory history, it is very important for the nurse to find out what in the environment worsens the child's symptoms. These are called "triggers." The other choices would be part of a general health history.

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is most accurate regarding the diagnosis of rheumatic fever?

"Children who have this diagnosis may have had strep throat." Rheumatic fever is precipitated by a streptococcal infection, such as strep throat, tonsillitis, scarlet fever, or pharyngitis, which may be undiagnosed or untreated. Rheumatic fever is a chronic disease of childhood, affecting the connective tissue of the heart, joints, lungs, and brain. There is no immunization to prevent rheumatic fever. The onset of rheumatic fever is often slow and subtle.

A community health nurse is conducting a parenting class on respiratory syncytial virus (RSV). What statement made by a parent indicates that the teaching has been successful?

"Exposure to second- or thirdhand smoke increases the risk for developing RSV." An infant exposed to second- or thirdhand smoke is at risk for developing respiratory syncytial virus (RSV). RSV season runs from September through April. Current treatment recommendations for RSV do not include antibiotics. Infants are susceptible to RSV much more than older children.

A 4-week-old infant is diagnosed with acute bronchiolitis. The parent states, "I do not know how the baby got this!" How should the nurse respond?

"Has your infant been around any crowds?" Acute bronchiolitis is caused by a viral infection, most often, respiratory syncytial virus. Viruses are often spread between groups of people in close contact. Hereditary and environmental complications do not relate to this disorder.

During the assessment of a 15-year-old female, the nurse notes a new body piercing in the navel. Which statements by the nurse would be appropriate in regard to this new piercing?

"I notice you have a new piercing. Be sure to clean it twice a day so you don't get an infection." "Did they tell you when you got your piercing how important cleaning it is? Infections can take up to a year to heal in a naval piercing." Informing the client about infection risks and prevention are appropriate responses by the nurse when noticing a new body piercing. Judgmental responses and personal responses are not appropriate from the nurse.

The nurse is caring for a 10-year-old girl with cystic fibrosis who receives pancreatic enzymes. Which comment by a parent demonstrates understanding of the instructions regarding the medication?

"I should give the enzymes before each meal or snack." The enzymes are necessary for appropriate digestion and absorption of food and nutrients. There is no interaction between enzymes and antibiotics. Large, malodorous stools are a sign of no pancreatic enzyme activity. Pancreatic enzymes must be given each time the child eats, usually in smaller doses for snacks than for meals.

The mother of a 9-year-old female voices concern to the nurse about her daughter developing breasts "at such a young age." How should the nurse respond?

"I understand your concern, but girls typically enter puberty around the age of 9 or 10." Voicing empathy regarding the mother's concern conveys support, and letting her know that this is normal growth and development helps ease her concerns. The other responses don't address her concerns or show genuine empathy.

The nurse is auscultating the lungs of a lethargic, irritable 6-year-old boy and hears wheezing. The nurse will most likely include which teaching point if the child is suspected of having asthma?

"I'm going to have this hospital worker take a picture of your lungs." The nurse should teach the child using terms a 6-year-old will understand. A chest x-ray is usually ordered for the assessment of asthma to check for hyperventilation. A sputum culture is indicated for pneumonia, cystic fibrosis, and tuberculosis; fluoroscopy is used to identify masses or abscesses as with pneumonia; and the sweat chloride test is indicated for cystic fibrosis.

The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse conducting an assessment of the child what causes the disease. What is the nurse's best response?

"ITP is primarily an autoimmune disease in which the immune system attacks and destroys the body's own platelets, for an unknown reason." Idiopathic thrombocytopenic purpura (ITP) is primarily an autoimmune disease, which is an acquired, self-limiting disorder of hemostasis characterized by destruction and decreased numbers of circulating platelets. The child will exhibit symptoms of excessive petechiae, purpura, and bruising. Hemophilia A and hemophilia B are distinguished by the particular procoagulant factor that is decreased, absent, or dysfunctional. Iron-deficiency anemia occurs when the body's iron stores are depleted. Hereditary spherocytosis (HS) is characterized by loss of surface area on the red blood cell membrane.

The nurse is providing education to a client newly diagnosed with asthma. Which statement by the parents indicates additional teaching is needed?

"It is okay for our child to do chores such as sweeping the floor." Sweeping the floor can trigger a child's asthma by making environmental allergens and irritants airborne, causing upper respiratory infections. The nurse will intervene if the parents make this statement. An inhaler should be with the child at all times in case of an asthma attack. Smoke and pet allergens can trigger an attack and exposure should be avoided. Other triggers are exercise, weather changes, air pollution, foods, and certain medications.

A client who is breastfeeding asks the nurse if she can give the newborn a pacifier. Which nursing response is most appropriate?

"It is recommended to wait until breastfeeding is well-established before introducing a pacifier." It is recommended to wait to introduce a pacifier once breastfeeding is well-established, which can take about 1 month. This is to limit nipple confusion and promote an adequate milk supply. Stating other people have done this does not provide education to the client, nor does it address this specific client's situation. While the decision is up to the newborn's parents, this response does not address the client's concern. Requesting a lactation consultant come does not address the client at this moment. The nurse can provide education now, and also request the consultant for follow-up information.

In working with the toddler, which statement would be most appropriate to say to the toddler to decrease the behavior known as negativism?

"It is time for lunch. I am going to put your bib on." Negativism is very typical of the toddler years. It is best to avoid questions with a yes or no answer because the answer will always be no. Limiting the number of questions asked of the toddler and making a statement, rather than asking a question or giving a choice, is helpful in decreasing the number of negative responses from the child. Instead of asking questions like "Do you want help getting in your chair?" make the statement "Get in your chair." The toddler years are also ones where the child becomes a picky eater or "grazes" instead of eating a full meal so the toddler may not actually know if he or she is hungry.

The nurse is providing parental anticipatory guidance to promote healthy emotional development in a 12-month-old boy. Which statement best accomplishes this?

A regular routine and rituals will provide stability and security. Toddlers benefit most from routines and rituals that help them anticipate events and teach and reinforce expected behaviors. Knowing that a child can move from calm to temper tantrum very quickly, understanding the benefit of limited choices, and realizing that hitting and biting are common behaviors in toddlerhood provide information but not a guiding concept.

The school nurse has just completed a presentation about normal adolescent physical growth to a group of adolescent students. Which comments by the adolescents indicate understanding of the nurse's presentation?

"It's strange how girls start getting taller before boys start getting taller." "Since I'm a 15-year-old guy, I still have a chance to get taller over the next couple of years." "Since I just had my first period and I am 14 years old, I probably haven't reached by peak height yet." "It doesn't seem fair that girls typically have more fat than boys." "Our hormones are sure going to cause us to change a lot over our teenage years." All of these statements demonstrate understanding of normal physical growth during adolescence. The rapid growth during adolescence is secondary only to that of the infant years and is a direct result of the hormonal changes of puberty. Boys' growth spurt occurs later than girls' and usually begins between the ages of 10½ and 16 years and ends sometime between the ages of 13½ and 17½ years. Peak height velocity occurs at approximately 12 years of age in girls or at about 6 to 12 months after menarche. Muscle mass increases in boys and fat deposits increase in girls

The father of a child with mononucleosis is concerned with his child's fever and cough. The father asks when antibiotic therapy will begin. What is the best response by the nurse?

"Mononucleosis is a viral infection so an antibiotic isn't used. We address the symptoms with appropriate therapy." Antibiotics are only used for bacterial infections, not viral infections unless a secondary bacterial infection develops from the virus. Treatment for viral infections is aimed at treating the client's symptoms.

The nurse is teaching a group of caregivers of school-age children about the importance of setting a consistent bedtime for the school-age child. Which statement made by a caregiver indicates an understanding of the sleep patterns and needs of the school-age child?

"My child sleeps between 11 and 12 hours a night." Sleep for the school-age child varies with the age of the child. A child between the ages 6 to 8 years needs 12 hours of sleep each night. The child between the ages of 8 to 10 years needs 10 to 12 hours of sleep each night. The 10 to 12 year old needs 9 to 10 hours of sleep each night. Staying up late after taking an after-school nap, not knowing when the child is tired, and sleeping more than a teenager when compared with a school-age child refer to sleep behaviors and needs of children of younger and older ages.

A 17-year-old male adolescent on the high school swim team tells the nurse that during swim season he cuts the carbohydrates in his diet to 30% to help his swim times. What responses by the nurse are appropriate?

"Since you are so active, your carbohydrate intake should comprise 45% to 65% of your daily diet." "Can you tell me the reason you feel the need to cut your carbohydrates when your activity level is high?" Teenage boys who are moderately active require between 2,200 and 2,800 calories per day and 45% to 65% should come from carbohydrates. Carbohydrates should not be cut, especially during an athletic season when energy use is increased. Asking the student why he or she is cutting carbohydrates is appropriate in order to help the nurse address the issue effectively.

The parents are concerned their 14-year-old child is always eating. The child weighs 54 kg and is 65 inches (165 cm) tall. What is the best explanation the nurse can give the parents?

"The calories help his body increase muscle mass." Adolescents grow rapidly and mature dramatically during the period from ages 13 to 20 years. An adolescent needs an increased number of calories to support the rapid body growth that occurs. Foods must come from a variety of sources to supply the necessary amounts of carbohydrates, vitamins, protein, and minerals. Boys typically gain about 15 to 55 pounds (7 to 25 kg) during their teenage years. The calorie intake will not predispose him to future obesity unless it is continuously excessive. The majority of adolescents eat as part of their development, not as an emotional need.

The clinic nurse is assessing a 14-year-old client. The client states "I am worried I have a brain tumor. I am so clumsy when I play sports now that it is totally embarrassing." Which response by the nurse is appropriate?

"You are experiencing rapid and uneven growth now which can interfere with coordination." Uneven growth of soft tissues and bones during growth spurts can cause decreased coordination for boys. The age of 14 years is usually the time of peak height velocity (PHV). The nurse would let the client know this is expected to alleviate the client's fears. There is no need to request an MRI. The nurse would not ask yes/no questions as these do not provide insightful information. Stating the nurse understands why the client is worried indicates the client has reason to fear a brain tumor.

The nurse is assessing a 14-year-old male client when the client's parent jokes about the changes in the client's voice and the hair under his armpits. Which response by the nurse to the client's parent is most appropriate?

"Your child can become modest and self-conscious and teasing may cause embarrassment." It is never appropriate to discuss what is happening with a client in a way that is demeaning and hurtful. A 14-year-old adolescent is experiencing many bodily changes and is very self conscious. The nurse can share experiences with the client and the family, but it should not be in a way that the adolescent is embarrassed. Parents can share their experiences with the child, but they have to be open to this discussion or it can lead to an awkward experience for the adolescent. Reminding the parent of how the child is feeling and the possible feelings that can come from their interactions will bring the parent's attention to a delicate situation and is most appropriate. Simply stating these are expected findings does not address the joking manner of the parent.

A nurse is examining a 10-year-old girl who has a heart murmur. On auscultation, the nurse finds that the murmur occurs only during systole, is short, and sounds soft and musical. When she has the girl stand, she can no longer hear the murmur on auscultation. Which statement should the nurse make to the girl's mother in response to these findings?

"Your daughter has an innocent heart murmur, which is nothing to worry about." The symptoms described indicate an innocent heart murmur. Although innocent murmurs are of no consequence, parents need to be told when their child has one because this finding will undoubtedly be discovered again at a future health assessment or during a febrile illness, anxiety, or pregnancy. Activities need not be restricted when a child has an innocent murmur and the child requires no more frequent health appraisals than other children. If a murmur is present as the result of heart disease or a congenital disorder, it is an organic heart murmur.

The nurse is caring for children at a local hospital. Which child warrants immediate attention from the nurse?

1-week-old newborn whose oxygenation is not improving with oxygen A newborn whose oxygenation is not improving with oxygen warrants immediate attention. Congenital heart disease needs to be suspected in the cyanotic newborn who does not improve with oxygen administration. In infants, peripheral edema occurs first in the face, then the presacral region, and then the extremities. This is an abnormal assessment finding that warrants follow-up but does not warrant immediate action. Clubbing is also an abnormal finding and warrants follow-up but not immediate action. It implies chronic hypoxia due to severe congenital heart disease. A temporal temperature of 101°F (38.3°C) is an abnormal assessment finding and warrants follow-up but not immediate action. Fever would suggest a possible infection.

The nurse takes an infant's apical pulse before administering digoxin. What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8-month-old infant?

100 beats per minute Digoxin is a cardiac glycoside that works by increasing the contractility of the heart muscle. It decreases conduction and increases the force of the heart beat. The result is a slowing of the heart rate. An 8-month-old infant has a normal range of heart rate of 80 to 150 beats per minute while awake and resting, and 80 to 130 beats per minute while sleeping. The accepted practice for this age child is to withhold the digoxin if the heart rate is 90 beats per minute or less. It would be safe to administer the drug if the heart rate is 100 beats per minute. If the child has a heart rate of 150 beats per minute, further assessment should be made prior to administering the drug.

While observing a group of 9-year-old children at school, the nurse is concerned that one of the children is not cognitively developing according to Piaget's stage of concrete-operational thought processes. With which activity is the nurse concerned?

does not understand the phrase "slow as molasses" when used by the teacher

A 3-year-old child with asthma and a respiratory tract infection is prescribed an antibiotic and a bronchodilator. The nurse notes the following during assessment: oral temperature 100.2°F (37.9°C), respirations 52 breaths/minute, heart rate 90 beats/minute, O2 saturation 95% on room air. Which action will the nurse take first?

Administer the bronchodilator via a nebulizer. The nurse would first administer the bronchodilator to open the child's airway and facilitate breathing. Once the airway was open, the nurse could administer oxygen, if indicated. At this time, the child's saturation level is normal but it should be monitored. The nurse would then administer the antibiotic medication. The heart rate is within normal range for a child of this age (65 to 110 beats/minute); therefore, a cardiac monitor is not needed at this time.

A chronically ill adolescent is readmitted to the hospital with an infected wound requiring long-term dressing changes. What is the best way the nurse can encourage independence for this client?

Allow the adolescent to choose the time for the dressing change. Achieving a sense of identity may be difficult for adolescents who have a chronic illness. Some of the nursing actions which encourage identity in the chronically ill adolescent include the following: respecting food preferences; allowing the adolescent to choose the time for the dressing changes; teaching the name, actions, and possible side effects of medication; and respecting modesty. The school can provide homework so the adolescent does not get further behind in school work, and the teen can go to the teen room each day. These provide a good emotional outlet, but they do not promote independence. Teaching the parents to do the dressing changes makes the adolescent dependent on the parents. If the dressings are at a location the adolescent can reach and dexterity is not limited, then the adolescent should be allowed self-care.

What would be most effective in helping promote initiative and nutritional health for a preschooler?

Allowing the child to spread soft cheese on crackers

An 8-year-old girl presents with drooling and a complaint of painful swallowing. She has a high fever and is lethargic. On examination the nurse sees that her palatine tonsils are bright red and swollen. The girl's mother says that she has never had these symptoms before. A throat culture indicates a streptococcus infection. What is the course of treatment that the nurse would expect in this situation?

Antipyretic, analgesic, and antibiotic These symptoms are consistent with bacterial tonsillitis. Therapy for bacterial tonsillitis includes an antipyretic for fever, an analgesic for pain, and a full 7- to 10-day course of an antibiotic such as penicillin or amoxicillin. If the cause is viral, no therapy other than comfort or fever reduction strategies is necessary. Tonsillectomy is removal of the palatine tonsils. Adenoidectomy is removal of the pharyngeal tonsils. In the past, tonsillectomy was recommended for children after an episode of tonsillitis. This is no longer recommended as tonsillar tissue is an important component of the immune system.

The nurse is caring for a 5-year-old client and notes respiratory rate of 45 breaths per minute, blood pressure 100/70 mm Hg, heart rate 115, temperature 101°F (38.3°C), and oxygen saturation 86%. Which diagnostic test is priority for the nurse to complete?

Arterial blood gas (ABG) The most useful diagnostic test in respiratory distress is an ABG. Knowing normal blood gas values for children is very important for evaluation and proper treatment.

The nurse is assessing an infant and notes brachial pulses of 2+ and femoral pulses of 1+. Which action will the nurse perform first?

Assess blood pressure in all extremities. An infant with decreased pulse strength in the lower extremities may have coarctation of the aorta. Assessing blood pressures in all extremities is most helpful in assisting the nurse with gathering assessment data prior to contacting the health care provider. The nurse does not have enough information to apply oxygen at this time or prepare the newborn for balloon angioplasty.

The nurse is carefully assessing the infant diagnosed with bacterial pneumonia whose respiratory status is declining. Which nursing findings are reported immediately to the charge nurse and health care provider?

Assessment findings which need to be reported immediately (as they indicate a declining respiratory status) include flaring of the nostrils, circumoral cyanosis and intercostal retractions. A temperature of 104°F (40°C) is also reported. A respiratory rate of 44 breaths/min is within normal limits for an infant.

A client has confided in a nurse that her 13-year-old daughter has recently changed dramatically in her social interactions with others. What is a social behavior most likely to be exhibited by a girl at this age?

Banding together with other girls and dressing like them In early adolescence, girls tend to band together with girls. They dress identically with other members of their group: jeans and sweatshirts, special jackets, or whatever the fashion may be. On the surface, this makes adolescents appear to be losing their identities rather than finding them.

What is a symptom of bacterial pharyngitis?

fever Bacterial pharyngitis is most often caused by group A streptococcus. Fever is a symptom of bacterial pharyngitis. Other symptoms are an elevated WBC count, abrupt onset, headache, sore throat, abdominal discomfort, enlargement of tonsils, and firm cervical lymph nodes. It must be treated with an antibiotic. Penicillin is the drug of choice. Symptoms of rhinitis, a normal WBC count, and slow onset are indicative of viral pharyngitis.

A nurse is caring for an infant diagnosed with bronchiolitis due to respiratory syncytial virus (RSV) infection. The infant is scheduled to be discharged home and the nurse is preparing discharge instructions for the parents. What information should the nurse include in the instructions?

Be aware that your infant may continue to cough for up to 2 weeks. It is important for all family members to wash their hands frequently. Contact the health care provider if you notice signs of worsening disease. Good hand hygiene, notifying the health care provider of signs of worsening condition, and the possibility that the infant may have a cough for up to 2 weeks are all important to include in the discharge instructions. Follow-up with the health care provider should be within 48 hours of discharge, not 2 weeks. There is no need to isolate the infant at home for 2 weeks.

What information would be included in the care plan of an infant in heart failure

Begin formulas with increased calories. Infants with heart failure need increased calories for growth. The infants are typically given smaller, more frequent feedings to decrease the amount given and to help conserve energy for feeding. They often are given a higher-calorie formula. The infant should be placed in an upright position or in a car seat to increase oxygenation. The infant should not have any pressure on the diaphragm while in this position. Vomiting is a sign of digoxin toxicity and this should be considered before administering.

The nurse is caring for an infant whose oxygen saturation levels frequently drop below 90%. Which data is most important to relate to the health care provider?

Blood gases Infants may respond to low blood oxygen levels with increased respirations followed by a period of apnea. Conditions such as bronchopulmonary dysplasia (chronic lung disease), pneumonia, and bronchiolitis can put infants at risk. The health care provider needs to be kept updated on blood oxygen levels. Vital signs, respiratory depth, and pattern, and breath sounds are basic nursing assessments that provide helpful data on the respiratory system, but these data are not as important as the laboratory results.

Parents of an 8-year-old client report the child struggles with the chore of cleaning their bedroom. What advice will the nurse give to assist with this challenge for a child at this stage of development?

Break the chore into smaller tasks that the child can accomplish more easily. In the early school-age years, children have the developmental task of achieving a sense of industry. Breaking the job into smaller tasks that they can feel accomplished about provides a "reward" to assist them in completing a larger job.

Which suggestion by the nurse meant to promote good dental health in the 15-month-old is inappropriate?

Brush your child's teeth with a pea-sized amount of fluoride-containing toothpaste. Using fluoride toothpaste prior to age 2 years promotes development of fluorosis. The first dental visit should be made at 1 year. This check-up is overdue. Continual snacking and bottle drinking keep the teeth in contact with cariogenic substances for extended periods.

The nurse is providing anticipatory guidance for violence prevention to a group of parents with adolescents. Which parental action should the nurse include as the most effective in preventing suicide?

Checking for signs of depression or lack of friends.

The nurse is about to see a 9-year-old girl for a well-child checkup. Knowing that the child is in Piaget's period of concrete operational thought, which characteristic should the child display?

Consider an action and its consequences.

To help prevent obesity, which intervention would the nurse include in an adolescent's plan of care?

Describe a normal serving size. Some adolescents may be unaware that their food intake is excessive because they have been told they need excess nutrients for healthy adolescent growth and everyone in their family eats large portions. Health teaching with these adolescents may need to begin with a discussion of "normal" weight and standard food portions. If adolescents eat a diet too low in protein for any length of time, they can develop a negative nitrogen balance, which can lead to impaired growth. Therefore, a diet of fewer than 1,400 to 1,600 calories a day can rarely be tolerated by adolescents. Teenage girls who are moderately active require about 2,000 calories per day and teenage boys who are moderately active require between 2,200 and 2,800 calories per day. Eating in excess can lead to obesity and should be avoided.

The nurse is administering medications to the child with congestive heart failure (CHF). Large doses of what medication are used initially in the treatment of CHF to attain a therapeutic level?

Digoxin The use of large doses of digoxin at the beginning of therapy to build up the blood levels of the drug to a therapeutic level is known as digitalization. During the 24 hours digitalization is occurring, the child should be on a cardiac monitor and the nurse should monitor the PR interval and a decreased ventricular rate. The other listed medications are not administered in this manner. Albuterol is inhaled for asthma treatment and used primarily for exacerbations. Ferrous sulfate is give for iron-deficiency anemia, and spironolactone is a diuretic.

The nurse is teaching the caregivers of a child with cystic fibrosis. What is most important for the nurse to teach this family?

Encourage everyone in the family to use good handwashing techniques. The child with cystic fibrosis has low resistance, especially to respiratory infections. For this reason, take care to protect the child from any exposure to infectious organisms.

The nurse is assessing a teenage client and notes his lower front teeth are slightly crossed over. The nurse points out to his caregiver that he should see an orthodontist about this to prevent which potential situation?

Even slight malocclusions make chewing and jaw function less efficient. Dental malocclusion (improper alignment of the teeth) is a common condition that affects the way the teeth and jaws function. Correction of the malocclusion with dental braces improves chewing ability and appearance. Crooked teeth do not lead to more cavities, nor do they lead to infection and tooth loss. While appearance and acceptance in society is important to the adolescent, that is not the most important reason for orthodontic care for the adolescent.

A nurse admits an infant with a possible diagnosis of congestive heart failure. Which signs or symptoms would the infant most likely be exhibiting?

Feeding problems The indications of CHF vary in children of different ages. Signs in the infant may be hard to detect because they are subtle, but in infants, feeding problems are often seen. In infants and older children, tachycardia is one of the first signs of CHF. In a child with CHF, tachypnea would be seen, not bradypnea. The heart beats faster in an attempt to increase blood flow. Failure to gain weight, weakness, and an enlarged liver and heart are other possible indicators of CHF but are not as common as tachycardia and may take longer to develop.

The nurse is caring for a child immediately following a tonsillectomy. The child requests something to drink. Which action by the nurse is best?

Give the child a few ice chips to consume. Ice chips are soothing and appropriate for the child at this time. The child should not consume anything red to limit confusion between red coloring and blood. Otherwise, a popsicle would be allowed. The child does not have to wait hours following the procedure to drink. Once the child is awake, ice chips may be offered and the diet increased as tolerated, based on the prescription. The nurse would not assess the gag reflex; nothing should be placed in the child's mouth/throat as this would increase the risk of hemorrhage and infection.

The nurse is caring for a 6-week-old with symptoms of irritability, nasal stuffiness, difficulty drinking and occasional vomiting. Which assessment finding produces important information regarding the medical and nursing treatment plan?

Obtain testing for respiratory syncytial virus. The symptoms presented are of acute nasopharyngitis. Many times this is viral in nature and can be common in the very young from respiratory syncytial virus (RSV). RSV is tested by obtaining nasal secretions and sending to the lab. A 6-week-old may rub his/her face but is too young for the "allergic salute," which is done to relieve itching and open nasal pathways. Vital signs can be helpful to note the beginning of an infectious process.

The school nurse is developing a school wellness program to promote healthy eating habits and regular physical activity. What is the most important element to emphasize to maximize compliance, healthy habits, and long-term change?

Include both parents and children in the wellness program. Every campaign to support good nutrition and daily physical activity must include parents and their children as active members of the learning community. Although the other actions can accomplish in-school enhancements to health, long-term change tends to be more likely when the programs implemented involve the family. Programs implemented without a family-centered approach often fail when the child's home life and school life are disconnected.

A nurse is assessing a 3-month-old infant during a pediatric clinic visit. The nurse believes the infant is demonstrating mild manifestations of respiratory distress. Which clinical manifestation(s) lead the nurse to suspect this distress? Select all that apply.

Mild signs of respiratory distress in an infant include fussiness, nasal congestion, and no interest in feeding. Moderate distress presents with nasal flaring, grunting, retractions, mild tachypnea and mild tachycardia. Signs of severe respiratory distress included cyanosis, diaphoresis, dehydration, severe tachypnea and severe tachycardia, as well as exhaustion from respiration effort.

What statement is the most accurate regarding the structure and function of the newborn's respiratory system?

Most infants are nasal breathers rather than mouth breathers. Newborns are obligatory nose breathers until at least 4 weeks of age. The diameter of the infant and child's trachea is about the size of the child's little finger. The respiratory tract grows and changes until the child is about 12 years of age. During the first 5 years of life, infants and young children have larger tongues in proportion to their mouths.

At which age do children have a trachea 4 mm in width?

Newborn Pediatric airways are much smaller in diameter and shorter in length than in adults. A newborn trachea is 4 mm wide compared to an adult of 20 mm. Because the trachea is so narrow even small amounts of mucus or edema can cause significant resistance to airflow. The trachea continues to grow and develop as the child grows so the toddler, school age child, and adolescent would all have a trachea width larger than 4 mm.

A 6-month-old infant who was born premature is being seen for a follow-up examination. The child is to receive an intramuscular injection monthly through the winter and spring season. Which drug would the nurse expect to be ordered?

Palivizumab Palivizumab is a monoclonal antibody used for prevention of serious lower respiratory syncytial virus (RSV) disease. RSV bronchiolitis occurs most often in infants and toddlers, with a peak incidence around 6 months of age. Infants born prematurely are more at risk. The peak occurrence of bronchiolitis is in the winter and spring. Nedocromil decreases the frequency and intensity of allergic reactions. Amantadine is used to treat and prevent influenza A. Zanamivir is used to treat and prevent influenza A.

The caregivers of a child who was diagnosed with cystic fibrosis 5 months ago report that they have been following all of the suggested guidelines for nutrition, fluid intake, and exercise, but the child has been having bouts of constipation and diarrhea. The nurse tells the caregiver to increase the amount of which substance in the child's diet?

Pancreatic enzymes Adequate nutrition helps the child resist infections. Pancreatic enzymes must be administered with all meals and snacks. If the child has bouts of diarrhea or constipation, the dosage of enzymes may need to be adjusted. The child's diet should be high in carbohydrates and protein with no restriction of fats. The child may need 1.5 to 2 times the normal caloric intake to promote growth. Low-fat products can be selected if desired. The child also may require additional salt in the diet. Increased caloric intake compensates for impaired absorption.

The nurse is planning a presentation to an adolescent group. What recommendations would the nurse include in the presentation?

Participate in 60 minutes of moderate to vigorous physical activity each day.

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see?

Peeling hands and feet; fever Kawasaki disease is an acute systemic vasculitis. Symptoms begin with very high fevers. One of the signs of Kawasaki disease is the peeling hands and feet and in perineal region. The child is usually tachycardic and laboratory values would indicate increased platelets and decreased hemoglobin. Another classic sign of Kawasaki is the strawberry tongue. The other symptoms are not necessarily characteristic of Kawasaki disease. The child should be evaluated if there are impalpable pulses because this could indicate a heart defect or some other serious illness.

The nurse is caring for a child with thickened pulmonary secretions. Which action(s) would the nurse use to assist the child breathe with less effort?

Perform chest physiotherapy Encourage oral fluids Thickened pulmonary secretions occur with many respiratory disorders and illnesses. Encouraging oral liquids helps to thin the secretions so the child can easily cough them out. Chest physiotherapy is done to mobilize the secretions; therefore, the secretions are easier for the child to expectorate (spit out). Oxygen, if in use, should be humidified to avoid drying out the mucosa. The child should be observed for cyanosis and have pulse oximetry readings taken more frequently than every 12 or 24 hours. Often, the child is observed hourly or more.

A nurse is giving discharge instructions to the parents of a newborn with a congenital heart disorder. What should the nurse instruct the parents to do in the event that the child becomes cyanotic?

Place him in a knee-chest position Before parents leave the hospital with a newborn who has a congenital heart disorder, be certain they have the name and number of the health professional to call if they have a question about their infant's health. Review with them the steps to take if their child should become cyanotic, such as placing the child in a knee-chest position. "Hands on" CPR is not recommended for children as it is for adults. Remind parents that children with many types of congenital heart disorders or rheumatic fever need prophylactic low-dose aspirin therapy to avoid blood clotting; although it is becoming a controversial practice, antibiotic therapy such as oral amoxicillin may be prescribed before oral surgery.

Which test in a child with cystic fibrosis would help monitor airway function?

Pulmonary function The pulmonary function tests help measure airway function, lung volumes, and gas exchange. Bronchoprovocation provokes bronchospasms to determine airway constriction. Peak flow measurement measures lung velocity. Pulse oximetry monitors blood level oxygen saturation.

The nurse is caring for a child who has been admitted with a diagnosis of asthma. What laboratory/diagnostic tool would likely have been used for this child?

Pulmonary functions test Pulmonary function tests are valuable diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs. Purified protein derivative tests are used to detect TB. Sweat sodium chloride tests are used for determining the diagnosis of cystic fibrosis. Blood culture and sensitivity is done to determine the causative agent as well as the anti-infective needed to treat an infection.

A parent brings an infant in for poor feeding and listlessness. Which assessment data would most likely indicate a coarctation of the aorta?

Pulses weaker in lower extremities compared to upper extremities With coarctation of the aorta there is a narrowing causing the blood flow to be impeded. This produces increased pressure in the areas proximal to the narrowing and a decrease in pressures distal to the narrowing. Thus, the infant would have decreased systemic circulation. The upper half of the body would have an increased B/P and be well perfused with strong pulses. The lower half of the body would have decreased B/P with poorer perfusion and weaker pulses. Coarctation is not a cyanotic defect. The cyanosis would be associated with tetralogy of Fallot.

During an assessment, a child exhibits an audible high-pitched inspiratory noise, a tripod stance and intercostal retractions. Using SBAR communication, the nurse notifies the health care provider and states which breath sounds that are congruent with the clinical presentation of the child?

Respiratory stridor Stridor is a high-pitched, readily audible inspiration noise that indicates an upper airway obstruction. The child presents in severe respiratory compromise and struggles to breathe. A wheeze is a high-pitched sound heard on auscultation, usually on expiration. It is due to obstruction in the lower trachea or bronchioles. Rales are crackling sounds heard on auscultation when the alveoli become fluid filled. Rhonchi is a snoring sound heard throughout the lung field when inflammation occurs.

The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis?

Slightly yellow sclera In sickle-cell anemia, eye scleras become icteric or yellowed from the release of bilirubin from the destruction of the sickled cells. Mandibular and long bone growth and depigmentation are not manifestations of this health problem.

The nurse is reinforcing teaching about medications with the parents of a 2-year-old who has cystic fibrosis. The nurse suggests that pancreatic enzymes may be given by which method?

Sprinkled onto the food Pancreatic enzymes are used in the treatment of cystic fibrosis and are given by opening the capsule and sprinkling the medication on the child's food. If the child with cystic fibrosis has an infection, IV medications may be given, but this is not on a daily basis. Most children do not have a gastrostomy tube. Many of these drugs used in the treatment of asthma can be given either by a nebulizer (tube attached to a wall unit or cylinder that delivers moist air via a face mask) or a metered-dose inhaler [MDI], which is a hand-held plastic device that delivers a premeasured dose.

The nurse is caring for a child who has been admitted with a possible diagnosis of cystic fibrosis. Which laboratory/diagnostic tools would most likely be used to help determine the diagnosis of this child?

Sweat sodium chloride test Sweat sodium chloride tests are used for determining the diagnosis of cystic fibrosis. Purified protein derivative tests are used to detect TB. Blood culture and sensitivity is done to determine the causative agent as well as the anti-infective needed to treat an infection. Pulmonary function tests are diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs.

The nurse is trying to pick a method to teach a 4-year-old with cystic fibrosis a good way to exercise her lungs. Which would be the developmentally correct strategy to help this client?

Teach the client to blow bubbles. A helpful exercise for the client would be to blow bubbles, a horn, or a pinwheel. This would help her exercise her lung capacity and is age-appropriate for early childhood. The other exercises are all normal activities for school-aged children.

The nurse is educating a 17-year-old adolescent after a new diagnosis of diabetes. What does the nurse understand about teaching an adolescent?

The adolescent will likely have the greatest influence on one's own decisions. In late adolescence, the client likely has the greatest influence on his or her own decision making. While offering teaching to the parents and healthy cooking classes to the siblings are options, the adolescent will most benefit from being the one to make choices about care. Focusing on more recent concerns rather than the idea of future complications with the adolescent will gain more credibility.

The nurse is caring for an adolescent athlete who is being seen for a fractured arm. The parent reports that this is the third sports injury in the past 2 years. The parent asks the nurse why the adolescent—who is healthy overall— continues to have injuries. How should the nurse respond?

The bones, joints, and tendons of adolescents are vulnerable to injury due to their rapid state of growth. Rapidly growing bones, muscles, joints, and tendons are more vulnerable to unusual strains and fractures. While some people may seem to be accident-prone, this adolescent's injuries are most likely the result of the stage of physical growth. There is no evidence the adolescent has any underlying medical conditions.

The nurse sees a 3-year-old child in the ambulatory setting for localized wheezing on auscultation. Which statement by the parent would be most important to report to the health care provider?

The child was eating peanuts yesterday. Aspiration can cause airway mucosal inflammation. When aspiration from a small object occurs, the child may cough and gasp for a few seconds to a few minutes. Following that, the child may not be symptomatic for a day or longer. The aspiration of a foreign body may mimic an asthma attack, but an asthma attack would have generalized wheezing. Localized wheezing suggests only a small portion of a lung is involved, such as occurs following aspiration. Allergic situations cause early symptoms such as rash development and are generally not genetic or inherited in nature. The US Centers for Disease Control and Prevention recommends children receive pneumococcal vaccine series before 2 years of age, usually at 2, 4, and 6 months.

The nurse is assisting in the development of a plan of care for a child with asthma. In planning care, many goals would be appropriate for this child and/or family caregiver. Which two goals would be the highest priority for this child or family?

The child will maintain a clear airway. The child will have adequate fluid intake. Treatment and management of asthma centers around avoiding triggers and controlling inflammatory episodes. Keeping the airway open is always the priority (ABCs). The next physiologic need is adequate fluid intake. These are priorities over psychosocial considerations such as connecting with other families. Pain is not normally an issue. The family does not need to understand every available pharmacologic option. They need to understand the action plan for their child.

Which infants are at high risk for acquiring the respiratory syncytial virus (RSV) infection?

The infant of an adult with an upper respiratory infection The infant who has lung disease The infant who had a transplant The infant receiving chemotherapy The following infants are at high risk for acquiring RSV: the infant exposed to a respiratory virus; an infant whose lungs are compromised; an infant who has a diminished immune system such as a transplant or chemotherapy client. Preterm infants are at risk, not post-term infants.

A nurse is caring for an infant admitted with a diagnosis of bronchiolitis. After completing an assessment, the nurse creates a plan of care for the infant. Which client goal would be priority in the plan of care?

The infant's airway will remain clear and free of mucus. Keeping the infant's airway clear is the top priority. An O2 saturation of 90% on room air is minimally acceptable. It is important that the infant's breathing be less labored and that there is decreased nasal stuffiness, but having the airway clear and free of mucus is most important.

When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. What would most likely explain this assessment finding?

The liver size increases in right-sided heart failure. The liver increases in size due to right-sided heart failure. This is one of the cardinal signs of congestive heart failure. The spleen is in the upper left quadrant of the abdomen and would increase in size under certain circumstances, but this is asking for the upper right quadrant information. There are certain medications that can affect the liver, but this would not be the most likely reason for hepatomegaly.

The physician has made a notation in the medical record of a 17-year-old that the teen is not demonstrating successful completion of Erikson's stages of development. What behavior would be consistent with this assessment?

The teen is uncertain and frequently unable to make decisions. According to Erikson's stages of development, the teen develops a sense of identity. Failure to successfully complete this stage will result in a lack of self confidence and an inability to see one's self as in independent being. The establishment of the ability to trust is completed in an earlier stage of psychosocial development. A desire to move away from the parental home is not uncommon and is not a sign of impaired navigation of this level of psychosocial development.

The nurse is teaching a growth and development class to parents of school-age children. What does the nurse teach the parents about the cognitive abilities of their children?

They are able to classify objects. The period from 5 to 11 years is a transitional stage where children undergo a shift from preoperational thought to concrete operational thought. During this stage, children decenter (have the ability to project one's self into other people's situations), accommodate (develop an understanding there can be more than one reason for people's actions), conserve (the ability to appreciate a change in shape does not necessarily mean a change in size), and develop class inclusion (the ability to understand objects can belong to more than one classification). Class inclusion is necessary for learning mathematics and reading. Children do not develop abstract thinking until adolescence. Cognitive development includes the child's ability to reason through any problem he or she can actually visualize.

The father of a 15-year-old daughter is concerned she is not getting adequate nutrition to play high school basketball. Her games are on Friday nights. Which suggestion should the nurse point out will best suit the needs of this adolescent?

Three daily meals that include choices from each of the food groups; Friday's lunch eaten around 2 p.m. with a small amount of fat and a somewhat larger than usual portion of complex carbohydrates. A meal that is low in fat and high in complex carbohydrates, eaten 3 to 4 hours before an event, is appropriate for the teen athlete. Carbohydrate-loading, which some practice during the week before an athletic event, increases the muscle glycogen level to 2 to 3 times normal and may hinder heart function. The other suggested menus would not provide the additional muscle glycogen needed for optimal functioning.

.The nurse is caring for a child admitted to the hospital for an open fracture of the femur following a motor vehicle accident. The nurse notes the following lab values: white blood cells 10,000/mm3, hemoglobin 7.9 g/dl (79 g/L), hematocrit 28%, platelets 151,000/mm3. Which nursing action is priority?

Transfuse 1 unit of packed red blood cells. In a situation where the child exhibits signs of anemia related to acute hemorrhage, the nurse should anticipate administering a transfusion of packed red blood cells to improve oxygenation and circulation. Administration of antibiotics, pain assessment, and family education can be performed after the beginning the blood transfusion.

The nurse hears wheezing when auscultating a 4-year-old. Which condition would the nurse most likely rule out based on the assessment findings?

Upper respiratory infection Wheezing typically is not associated with upper respiratory infection. Wheezing is caused by an obstruction of the bronchioles that may be caused by bronchiolitis, asthma, cystic fibrosis, or chronic lung disease.

A new mother reports that she is exhausted and that the little sleep she gets is determined by her baby. Which suggestion should the nurse prioritize to help the mother establish healthy sleeping patterns in her infant?

Use the crib for sleeping only, not for play activities. A consistent bedtime routine is usually helpful in establishing healthy sleeping patterns and in preventing sleep problems. Using the crib for sleeping only helps the child associate the bed with sleep. Depriving the baby of sleep during the afternoon or evening will make the baby over-tired and less able to establish a healthy sleeping pattern. While letting a baby cry for a while is acceptable, this does not promote consistency in the baby's sleeping pattern.

A 4-year-old girl has begun stuttering. Which practice by the parents will the nurse discourage?

asking the girl to slow down and to think before she talks Many preschool-age children stutter as thinking races ahead of their ability to articulate ideas. Most of this stuttering, when not made an issue, will resolve on its own. Calling attention to the dysfluency often exacerbates it. All the other practices are helpful.

The nurse is educating an adolescent female who needs to increase dietary iron but has expressed concern about weight gain. What dietary choices would the nurse recommend?

chicken, whole-wheat bread, watermelon Chicken, whole-wheat bread, and watermelon are all foods high in iron. The calorie content will not promote weight gain. All the other options do not include good sources of iron but are nutritious foods. The calorie content is also acceptable.

The nurse is collecting data on a child being evaluated for rheumatic fever. The caregiver reports that over the past several weeks the child seems to have lack of coordination, facial grimaces and repetitive involuntary movements. Based on these symptoms the nurse would suspect what condition?

chorea Rheumatic fever affects the heart, the central nervous system, skin and subcutaneous tissue. It causes carditis, arthritis, and chorea. Chorea is a disorder characterized by emotional instability, purposeless movements, and muscular weakness. The onset of chorea is gradual, with increasing incoordination, facial grimaces, and repetitive involuntary movements. Polyarthritis means there is arthritis in multiple joints which is common in rheumatic fever, but this is not a symptom of chorea. Arthralgia is a very common symptom of rheumatic fever. It is pain in the joints but again not a symptom of chorea. The heart muscle is affected in rheumatic fever as are the valves but not included in the symptoms of chorea.

The student nurse is collecting data on a child diagnosed with cystic fibrosis and notes the child has a barrel chest and clubbing of the fingers. In explaining this manifestation of the disease, the staff nurse explains the cause of this symptom to be:

chronic lack of oxygen. In the child with cystic fibrosis the development of a barrel chest and clubbing of fingers indicate chronic lack of oxygen. Impaired digestive activity may occur due to a lack of pancreatic enzymes. The high sodium concentration makes the child taste salty, but is not related to the barrel chest and clubbing of the fingers. Respiratory issues are a concern, but the barrel chest and clubbing of the fingers are not because of the child's respiratory capacity.

A nurse is assessing a 3-month-old infant during a pediatric clinic visit. The nurse believes the infant is demonstrating mild manifestations of respiratory distress. Which clinical manifestation(s) lead the nurse to suspect this distress?

decreased intake nasal congestion fussiness Mild signs of respiratory distress in an infant include fussiness, nasal congestion, and no interest in feeding. Moderate distress presents with nasal flaring, grunting, retractions, mild tachypnea and mild tachycardia. Signs of severe respiratory distress included cyanosis, diaphoresis, dehydration, severe tachypnea and severe tachycardia, as well as exhaustion from respiration effort.

The nurse is developing a teaching plan for the parents of a 12-year-old boy with cystic fibrosis. For which piece of equipment should the nurse prioritize education?

flutter valve device A flutter valve device is used to assist with mobilization of secretions for older children and adolescents with cystic fibrosis. While some medications may be administered via nebulizer, not all older children with cystic fibrosis may use them. Meter dosed inhalers and peak flow meters are typically used for asthma therapy.

The nurse is talking to a 13-year-old boy about choosing friends. Which function do peer groups provide that can have a negative result?

following role models Peers serve as role models for social behaviors, so their impact on an adolescent can be negative if the group is using drugs, or the group leader is in trouble. Sharing problems with peers helps the adolescent work through conflicts with parents. The desire to be part of the group teaches the child to negotiate differences and develop loyalties and stability.

The nurse is observing a 3-year-old boy in a day care center. Which behavior might suggest an emotional problem?

has persistent separation anxiety Separation anxiety should have disappeared or be subsiding by 3 years of age. The fact that it is persistent suggests there might an emotional problem. Emotional lability, self-soothing by thumb sucking, or the inability to share are common for this age.

The nurse is conducting a psychosocial assessment of a child with asthma brought to the physician's office for a checkup. Which psychosocial issues may be assessed?

health insurance coverage transportation to health care facilities school's response to the chronic illness Comprehensive health supervision includes frequent psychosocial assessments. Issues to be covered include health insurance coverage, transportation to health care facilities, financial stressors, family coping, and the school's response to the chronic illness. These are often stressful and emotionally charged issues. Past medical history, future treatment plans, and health maintenance needs would also be assessed; however, these are not psychosocial issues.

A child with a suspected airway obstruction is brought to the emergency room. He produces a harsh, strident sound on inspiration (stridor). Where is the obstruction likely to be located based on this information?

in the larynx When the vibrations produced as air are forced past obstructions such as mucus in the nose or pharynx, the noise produced is a snoring sound (rhonchi). If the obstruction is at the base of the tongue or in the larynx, a harsher, strident sound on inspiration (stridor) occurs. If an obstruction is in the lower trachea or bronchioles, an expiratory whistle sound (wheezing) occurs.

Teachers are in a class on drug use taught by the school nurse. The nurse instructs the teachers to observe for which physical symptoms from misuse of cough medications with codeine?

lack of coordination excessive itching confusion Adolescents who misuse cough medications with codeine can have a drunken appearance, a lack of coordination, confusion, and excessive itching. They may also be found with empty bottles of cough medications. Enlarged pupils would be seen with marijuana use. Excessive giggling and silliness can be seen with stimulant ingestion.

A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child?

lower extremities Edema of the lower extremities is characteristic of right ventricular heart failure in older children. In infants, peripheral edema occurs first in the face, then the presacral region, and the extremities.

When caring for a child with Kawasaki disease, the nurse would know that:

management includes administration of aspirin and IVIG. Kawasaki disease is an acute systemic vasculitis. It is the most common form of acquired heart disease in children. The treatment is directed to reduce the inflammation in the walls of the coronary arteries and prevent thrombosis. Children are given high-dose aspirin therapy four times a day and they receive an infusion of IV immunoglobulins (IVIG) to prevent cardiac complications. Joint pain is common but not necessarily a permanent problem associated with Kawasaki disease. Antibiotics and steroid creams are not used to treat this disorder.

The nurse is caring for a 3-year-old girl who is cyanotic and breathing rapidly. Which intervention is best to relieve these symptoms?

oxygen administration Oxygen administration is indicated for the treatment of hypoxemia. Suctioning removes excess secretions from the airway caused by colds or flu. Saline lavage loosens mucus that may be blocking the airway so that it may be suctioned out. Saline gargles are indicated for relieving throat pain as with pharyngitis or tonsillitis.

When preparing the room for an infant with bronchiolitis, which equipment is most important?

oxygen tubing and facemask Bronchiolitis is an acute inflammatory process in the bronchioles and small bronchi. The treatment is supportive oxygen therapy, suctioning, and hydration. Rarely is a tracheostomy set needed for care. An infant is not able to use a metered dose inhaler but nebulized bronchodilators may occasionally be needed. Bronchiolitis is most commonly associated with the respiratory syncytial virus (RSV), thus antibiotics would not be warranted in the treatment plan.

A 9-year-old child is feeling conflict from seeing other children in her class engaging in behaviors she senses are not appropriate. When making decisions about what actions are most appropriate, a child of this age will rely most heavily on which party of influence?

parents All the above have an influence on the actions of the school-age child. The parents have the highest degree of influence on the school-age child's ultimate actions

The nurse is implementing the plan of care for a child with acute rheumatic fever. What treatment(s) would the nurse expect to administer if prescribed? Select all that apply.

penicillin corticosteroids nonsteroidal anti-inflammatory drugs A full 10-day course of an antibiotic, such as penicillin or equivalent, is used. Anti-inflammatory agents, such as corticosteroids and nonsteroidal anti-inflammatory drugs, are also used in the treatment of acute rheumatic fever. Digoxin, an antiarrhythmic agent, a is used to treat heart failure, atrial fibrillation, atrial flutter, and supraventricular tachycardia. Intravenous immunoglobulin, an immunoglobulin therapy, is used to treat Kawasaki disease.

What is a complication of cystic fibrosis?

pneumothorax Cystic fibrosis (CF) is a genetic disorder causing thickened tenacious secretions of the sweat glands, gastrointestinal tract, pancreas, respiratory tract and exocrine tissues. The treatment is aimed at minimizing pulmonary complications, maximizing lung function, preventing infection, and facilitating growth. A pneumothorax is a complication of CF. A rupture of the subpleural blebs through the visceral pleura takes place. There is also a high reoccurrence rate and incidence increases with age. Crohn disease is a gastrointestinal disorder that is not associated with cystic fibrosis. Urinary tract infection and kidney disease are also not associated with CF. Most of the problems and complications associated with CF relate to the respiratory system, the gastrointestinal system, and infectious disorders.

The nurse is caring for an 11-year-old child with pneumonia who is exhibiting an increased work of breathing. Which intervention is the priority?

positioning the child in Fowler position Positioning the child in Fowler position helps to open the airway and provide more room for lung expansion, resulting in more effective breathing patterns while supplemental oxygen and intravenous fluids are administered. Administering intravenous fluids and administering oxygen are appropriate actions after the child is placed in a comfortable position. Analgesics may be prescribed and administered if the child is experiencing pain from coughing.

The nurse is assisting a child to the bed after tonsillectomy. How will the nurse place the child until fully awake?

right lateral recumbent After a tonsillectomy and until fully awake, the nurse will place the child in a side-lying (right lateral recumbent) or face-down (prone) position to facilitate safe drainage of secretions. Once alert, the child may prefer to sit up (Fowler position) or have the head of the bed elevated (semi-Fowler position). If the child lays flat on the back (supine position), the child will need to be monitored for fluid drainage into the throat or lungs.

The nurse is assessing a 7-year-old boy with pharyngitis. What assessment finding would suggest the child has developed a peritonsillar abscess?

shifting uvula Peritonsillar abscess may be noted by asymmetric swelling of the tonsils and shifting of the uvula to one side. Difficulty swallowing, sore throat, and headache are consistent with pharyngitis, as is the rash, which would be fine, red, and sandpaper-like (called scarlatiniform) but do not indicate a peritonsillar abscess.

The nurse is doing discharge teaching for a child who has had a tonsillectomy. The nurse tells the client and family that the child should have plenty of fluids. In addition, the nurse would explain to the child's caregiver that the child may:

vomit dark, old blood, but the caregiver should call the clinic if the child has bleeding between the fifth and seventh days postoperatively. Bleeding is most often a concern within the first 24 hours following surgery and between the fifth to seventh days postoperatively. Bright, red-flecked emesis or oozing indicates fresh bleeding. If at any time following the surgery there is bright red bleeding, frequent swallowing, or restlessness, the care provider should be notified. A mild earache may be expected around the third day. Encourage fluid intake but avoid irritating liquids such as orange juice. Be aware that milk and ice cream products tend to cling to the surgical site and make swallowing more difficult; thus they are poor choices despite the old tradition of offering ice cream after a tonsillectomy.

If there is a foreign body in the larynx, how will the client present?

with stridor A foreign body can be either solid or liquid and it can lodge in the upper or lower airways. If a child has symptoms of cough, wheezing and/or stridor, it is an indication the foreign body is obstructing the upper airway. The child with a foreign body obstruction is anxious, has difficulty talking, and may be drooling. Edema of the airways may have occurred but generalized edema is not present.

The school nurse has completed an educational program for parents at a local elementary school. Which statement by a parent would indicate the need for further education?

"It's okay for my 10-year-old to sit in the front seat of the car since he doesn't need a booster seat anymore." Children under 12 should ride in the back seat of the car, even if they do not need a booster seat.

The mother of a 6-week-old infant reports she doesn't know if her child recognizes her face yet. What response by the nurse is most appropriate?

"Since about 4 weeks of age your child has been able to recognize those who are around him often." At 1 month of age the infant can recognize by sight the people he or she knows best. Telling the child's mother that this will come with time is not correct as this developmental milestone has already occurred. Telling her not to worry minimizes her questions and concerns.

The nurse is providing anticipatory guidance to a parent of an 8-year-old girl whose weight is 65 lb (29.5 kg) and height is 50.5 in (128.3 cm). Which statement by the parent demonstrates the need for further teaching?

"Based on my child's weight and height, I should be concerned my child is overweight." An 8-year-old girl needs between 1400 and 1600 calories per day. Based on the child's weight and height, the child has a body mass index (BMI) of 17.9 (around 75th percentile). To calculate BMI use [wt in lb/{ht in inches}x{ht in inches}] x703. This child is not in the overweight or obese category (>85th percentile is classified as overweight). An 8-year-old needs 1000 mg calcium per day. Children should be encouraged to fill half their plate with fruits and vegetables, to make half of their grains whole grains, and to choose lean proteins and calcium-rich foods.

During a well-child visit, the caregiver expresses concern that the 3-year-old child often stutters when speaking. Which response should the nurse prioritize to best assist this family?

"Children of this age may stutter while they search for just the right word." Between ages 3 and 5, language development is generally rapid. Most 3-year-old children can construct simple sentences, but their speech has many hesitations and repetitions as they search for the right word or try to make the right sound. Stuttering can develop during this period but usually disappears within 3 to 6 months. Physical capability, hearing loss, or lack of being read to are not reasons stuttering occurs.

The parent of a 4-year-old is expressing concern that this child is not talking as much—or as well—as her other children did at that age. Which question should the nurse prioritize when assessing this preschooler for this concern?

"Has your child had their hearing tested?" Delays or other difficulties in language development may result from hearing impairment or other physical problems. Although reading to the child, having conversations with family members and other people, and praising and encouraging the child's efforts to communicate help the child develop language skills, most importantly a hearing concern would need to be assessed and treated.

A nurse is discussing safety measures with the parents of a toddler. What would the nurse emphasize to address the most frequent type of accident in toddlers?

"Keep all cleaning products and drugs out of the reach of your child." Although all the instructions are important, accidental ingestions (poisoning) are the most frequent accident in toddlers. Therefore, it is imperative to focus on keeping all poisonous substances, drugs, and small objects securely out of the reach of children. Burns, motor vehicle accidents, and falls such as from a tricycle occur frequently in toddlers. However, they occur less frequently than poisonings.

The nurse is observing several children interacting during a community health event. Which observed behavior would be indicative of a 4-year-old child?

"Look! I am a nurse, and I am helping people feel better!" Erikson's stage of initiative vs. guilt is prevalent in children between 3 and 6 years of age. This includes activities in which they act out the roles of other people (real or imaginary). Being competitive, learning sports, and comparing skills are important in the industry vs. inferiority stage (6 to 12 years of age) as seen in a child comparing the speed of running a race or playing a game. Staying true to a predefined set of values, such as not cheating in a game, would be typical of a child in the identity vs. role confusion stage (12 to 19 years of age).

The nurse is providing an in-service for parents of preschoolers regarding nutrition. Which comments by the parents demonstrate successful learning following the in-service? Select all that apply.

"My 4-year-old should be ingesting at least 700 mg of calcium through food daily to promote good bone health." "I generally give my child choices about foods within each food category, ensuring all food groups are represented." "We very rarely feed our child fast food and when we do we try to keep it as healthy as possible with no soda."

During a visit to the pediatric clinic the mother of a 2-year-old tells the nurse that her husband is concerned that their son isn't potty trained yet. The mother states, "There is no way he could be potty trained. His bladder is too small." How should the nurse respond?

"The bladder of a 2-year-old is actually the size of an adult's bladder, but there are a lot of variables to when a child is potty-trained." Bladder and kidney function reach adult levels by 16 to 24 months of age, but there are many factors that determine when a child is ready to be potty-trained. The other options are misleading the parent regarding potty-training.

A 13-month-old child is brought to the clinic for a well-child visit. The child's parent expresses concern that the child has not started to walk yet. What is the best action should the nurse take?

Explain that children can take their first steps as late as 18 months of age. Infants can begin walking as early as 8 to 9 months and as late as 18 months of age. Telling the parent that the child will start walking any day is true but not guaranteed. Asking if the child has been ill recently is an appropriate question during a well-child visit but does not address the parent's concerns. Since the child is on track developmentally, there is no indication to refer the child to a developmental specialist.

The nurse is providing anticipatory guidance to the parents of an 18-month-old child. Which recommendation should be the most helpful to the parents?

Describe proper behavior when the child misbehaves. Stopping the child when misbehaving and describing proper behavior sets limits and models good behavior. This will be the most helpful advice to the parents. At 18 months, the child is too young to use time out or extinction (ignoring the child's behavior) as discipline. Slapping the child's hand, even done carefully with two fingers, is corporal punishment, which has been found to have negative effects on child development.

The nurse is providing anticipatory guidance for a mother regarding the respiratory development of her 4-week-old daughter. Which action is accurate?

Explaining to the mother the risk for infection is high due to the lack of antibodies Attributing frequent infections to a lack of antibodies is accurate. The infant lacks IgA in the mucosal lining of the upper respiratory tract. The infant's respiratory rate drops to 20 to 30 breaths per minute by the end of the first year. Abdominal breathing persists until 6 to 12 years of age. The respiratory system matures by age 7 years.

A 17-year-old adolescent chats excitedly with the nurse about plans for college and a career. The adolescent states having checked out every college in the region and determined which one is the best fit and would give the adolescent the best career options. The nurse recognizes which developmental aspect in this client?

Formal operational thought The final stage of cognitive development, the stage of formal operational thought, begins at age 12 or 13 years and grows in depth over the adolescent years, though it may not be complete until about age 25. This step involves the ability to think in abstract terms and use the scientific method (deductive reasoning) to arrive at conclusions. With the ability to use scientific reasoning, adolescents can plan their future. They can create a hypothesis (What if I go to college? What if I do not?) and think through the probable consequences (In the long run, I will earn more money; I could begin earning money immediately). This scenario does not pertain to socialization, role identification, or sensorimotor development.

What is a true statement regarding the developmental milestones of the 30-month-old child?

Full set of primary teeth Developmental milestones of a 30-month-old child include acquiring a full set of primary or baby teeth. A child at this age is developing a sense of humor, can put on clothes, wash hands and brush teeth. The 12-month-old child should double the birth weight. The anterior fontanel (fontanelle) closes at 18 to 24 months. Head circumference equals chest circumference at 12 months.

Place the steps for using time-out as a disciplinary measure for a 4-year-old in proper order.

Parent knows the misbehavior was intentional. Warn the child there will be a time-out if the behavior does not stop. Move the preschool-age child to a boring spot. Set a timer for no more than 4 minutes. If the child gets up, return the child to the time-out location and restart the time.

A nurse is caring for a hospitalized 10-year-old child. What would be an appropriate activity for this child to meet the developmental tasks of this age group?

Participating in a craft project During this stage, the child is interested in how things are made and run. The child learns to manipulate concrete objects. The child likes engaging in meaningful projects and seeing them through to completion.

The nurse is discussing proper discipline with the parent of a 15-month-old toddler. Which teaching is most important?

Physical punishment such as spanking is discouraged. Because toddlers younger than 18 months of age are at increased risk for physical injury from spanking than other children, the nurse should prioritize discouraging its use. The American Academy of Pediatrics and the National Association of Pediatric Nurse Practitioners recommend against corporal or physical punishment, which includes spanking. The other teachings describe toddler characteristics accurately and are basic to good discipline, but are not the most important for this young toddler.

A nurse realizes safety teaching has been successful when the parents identify which action to help prevent the leading cause of death in preschoolers?

Placing the child in an approved car seat The leading cause of death in the preschool group is automobile accidents, followed by poisonings and falls. Placing the child in an approved car seat is a safety precaution to help prevent serious injury and even death

Which gross motor developmental milestone is least likely for a 2-year-old?

Rides a tricycle Gross motor developmental milestones for a 2-year-old include jumping in place, standing on tiptoes, kicking a ball, and running. At 3 years old, the child should be able to pedal a tricycle, run easily, and walk up and down the stairs with alternate feet. At 12 to 18 months of age, the child should be able to stand on one foot with help, walk independently, climb the stairs with assistance, and pull toys.

The nurse is assessing an infant at the 6-month well-baby check-up. The nurse notes that at birth the baby weighed 8 lb (3.6 kg) and was 20 in (50.8 cm) in length. Which finding is most consistent with the normal infant growth and development?

The baby weighs 18 lb (8.2 kg) and is 26 in (66.0 cm) in length. The average infant's weight doubles at 4 months and will triple at 1 year of life. The infant's length will increase by 50% by the first year.

The parents of 5-year-old boy are concerned about the how a recent motorcycle accident to his father will affect the child. Although the father has fully recovered, the child is very concerned if the father is away longer than expected; the child is not as talkative but appears withdrawn and quiet. The nurse should point out the child's behavior is likely related to which factor?

The boy believes he caused the accident by telling his father he "hoped he crashed" when the boy couldn't go along. Preschoolers have learned to think about something without actually seeing it: to visualize or imagine. This normal development, sometimes called magical thinking, makes it difficult for them to separate fantasy from reality. Preschoolers believe that words or thoughts can make things real, and this belief can have either positive or negative results. The child needs reassurance that the accident was not his fault. The other choices do not demonstrate the "magical thinking" that preschoolers tend to demonstrate later in life.

An 11-year-old child is preparing to see the dentist to have his teeth cleaned. Which finding would considered most appropriate for this age?

The child has 28 permanent teeth. School-aged children have lost their 20 primary teeth. These have been replaced by 28 permanent teeth. They do not have their third molars.

The parents of a 5-year-old call the nurse for advice about night terrors. The child has had them nightly for almost 2 weeks. What is the most appropriate intervention?

Wake the child up nightly 30 to 45 minutes after going to sleep. Awakening children early in their sleep cycle often interrupts the night terror events and should be continued nightly for about 7 days.

The nurse is assessing a 6-month-old infant in the clinic. Which characteristic represents normal language development for this age?

babbling Cooing begins in the first 4 weeks of life, productions of noises when spoken to and laughing out loud are seen later than 6 months of age. Infants begin to babble around 6 months of age

The nurse is assessing a 3-year-old at a well-child visit and the child appears to be progressing well. Which activity will the nurse ask the child to attempt to appropriately assess the fine motor skills of this preschooler?

buttons clothes The 3-year-old should be able to button his clothes and use a pencil or crayon. By the age of 4 to 5, the child should be able to use scissors, tie shoelaces, and print his first name.

The parent of 3 1/2-year-old preschooler tells the nurse that the child argues quite a bit and says that the child is always right. The nurse interprets this information as indicating:

centering At age 3 years, cognitive development is still preoperational. Although children during this period do enter a second phase called intuitional thought, they lack insight to view themselves as others see them or put themselves in another's place. This is called centering. Because preschoolers cannot make this kind of mental substitution, they feel they are always right and causes them to argue. Conservation is reflected in the child's ability to distinguish that two items of equal size are the same despite a change in form. Initiative is the developmental task of preschoolers and is reflected in the child attempting to learn as much as possible about the world around them by trying new activities or having new experiences. Guilt occurs if children are punished or criticized for attempts at initiative.

A father brings his 2-year-old son in for a well visit. The nurse assesses his growth since the last appointment. Which finding should concern the nurse?

child gained 15 pounds A child gains only about 5 to 6 lb (2.5 kg) and 5 in (12 cm) a year during the toddler period, much less than the rate of growth during the infant year. Because the weight gain of the boy in this scenario is so much greater than normal, the nurse should be concerned that the boy is overweight or obese. All of the other findings listed are normal for a 2-year-old.

When considering the psychosocial development of a school-aged child, which is the primary developmental task?

establishing a social network Erikson describes the task of the school-age years as industry versus inferiority. During this period, the child is developing his or her sense of self-worth by becoming involved in multiple activities at home, at school, and in the community, which develops his or her cognitive and social skills.

Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in middle-to-late adolescence?

nocturnal emissions Involuntary ejaculation during the night can be disturbing to the adolescent male who has little or no understanding of what is happening in the body. Lengthening of the penis begins to occur in early adolescence as does reddening of the scrotum and emergence of pubic hair.

The nurse assesses a 4-month-old child during a well-child visit (above). Which assessment finding should the nurse report to the primary health care provider

not smiling/tracking faces Preterm infants should be assessed developmentally based on their corrected age. For a 2-month-old infant, corrected waking at night, spitting up, and not rolling over are all normal findings. Not smiling or tracking faces are concerning findings that could indicate problems with vision. This requires follow-up by the health care provider.

The nurse pulls the 5-month-old to sitting position from supine and notes head lag. The nurse's response is to:

refer the infant for developmental and/or neurologic evaluation. There should be no head lag by 4 months. Head lag in the 5-month-old may indicate motor or neurologic problems and needs immediate follow-up. All other nursing actions indicate failure to recognize the problem.

The parents of a 3-year-old toddler tell the nurse that their child constantly says "no" to everything and they are very frustrated. The parents ask the nurse what they should do. Which response(s) by the nurse are appropriate? Select all that apply. "Have you tried using "time-outs" for negative behavior?" "Giving your toddler choices instead of posing 'yes' or 'no' questions may decrease the 'no' response." "An occasional light spank on the bottom is often helpful when your toddler continually says 'no.'" "Asking your toddler the reason why most responses are 'no' might help you understand this behavior." "This action is normal for this age. If measures to stop this behavior do not work, you should make the decision for your toddler to move on with the activity occurring."

"Have you tried using "time-outs" for negative behavior?" "Giving your toddler choices instead of posing 'yes' or 'no' questions may decrease the 'no' response." "This action is normal for this age. If measures to stop this behavior do not work, you should make the decision for your toddler to move on with the activity occurring."

The nurse is reviewing sleep and rest activities of a 16-month-old child with the parents. The father states, "I have told my wife it is unhealthy for our child to sleep with us. It's time for him to sleep in his own bed. What do you think?" What is the nurse's best initial response?

"It must be difficult for the two of you to both feel strongly about what is best for you and your child." Acknowledging the difference of opinion between the mother and father allows for open conversation about the sleeping arrangement, which may lead to an acceptable resolution. Stating the views of professionals about co-sleeping, while accurate, does not address the parent's voiced concerns, nor does noting the sleep activities in the chart. Suggesting the child sleep in his own bed is not up to the nurse to do, and it does not address the issue.

A school nurse has completed an educational program for parents of preschool children. Which statement by a participant indicates a need for further education?

"My 5-year-old son still needs me to dress and undress him." Dressing and undressing without assistance is an expected motor skill in a 5-year-old. Four-year-olds should be able to use scissors without assistance. Hopping on one foot is an expected motor skill for a 4-year-old. Learning to skate and swim are normal motor skills for 5-year-olds.

The nurse is interacting with several parents of infants. Which parent statement would alert the nurse to refer the infant for further evaluation by the health care provider?

"My 9-month-old infant is beginning to track objects when we show her favorite objects." Infants should be tracking objects by 7 months of age, so an older infant who is just "beginning to track objects" would warrant further evaluation. The newborn shows preference for items with contrast, such as black and white stripes so this is a normal finding. The newborn's eyes may cross and wander and this is a normal finding for this age. Distance vision develops by 7 months of age, so a younger child would not be expected to have developed distance vision yet.

The nurse is discussing nutritional issues and concerns with the caregivers of preschoolers. Which statement made by a caregiver best indicates a common aspect of the diet and nutrition of the preschool child?

"My child is so picky and eats the same thing every day for days on end!" The preschooler's appetite is erratic. At one sitting the preschooler may devour everything on the plate, and at the next meal he or she may be satisfied with just a few bites. Food jags, such as eating the same thing for days on end, are common in the toddler, not the preschooler. Preschooler's are picky eaters. They may eat only a limited variety of foods or foods prepared in only one way. Portions for preschoolers are smaller than adult-sized portions, so the child may need to have meals supplemented with nutritious snacks. Giving the child non-nutritious snacks may cause the child not to eat at mealtimes. The child eating as much as the adolescent sibling is being set up for obesity.

The nurse comes into an infant's room on the pediatric floor. The nurse wants to try to feed the infant for the first time since her surgery. How does the nurse know what state the infant is in by what the mother says, and that it's fine to try and feed the infant?

"She has been a chatterbox and smiles just like her brother." The best time to feed an infant is when the child is in the active alert state. This infant is talking and smiling, which shows she is calm and actively awake. In the active alert state the infant has normal respirations, limited movement, and eyes that are bright and shiny and attentive. The other choices put the infant in a crying state, quiet alert or deep sleep, or drowsing. These stages are not optimal for interacting with the child.

The parents of a 7-year-old girl report concerns about her seemingly low self-esteem. The parents question how self-esteem is developed in a young girl. Which response by the nurse is best?

"Your daughter's self-esteem is influenced by feedback from people they view as authorities at this age." Self-esteem is developed early in childhood. The feedback a child receives from those perceived in authority such as parents and educators impacts the child's sense of self-worth. As the child ages, the influence of peers and their treatment of the child begin to have an increasing influence on self-esteem.

A 15-year-old adolescent shows a pattern of gaining weight, not a large amount but a little more each visit. The adolescent is not active in any sports and eats out frequently with parents. What is the best way for the nurse to assess the adolescent's eating pattern?

Have the adolescent keep a food diary for 1 week. Having the adolescent keep a food diary over 1 week allows the nurse as well as the client to examine what the client eats and when the client is eating it. Keeping a food journal allows a discussion of the choices made and the substitutes that the client could possibly make. The times that the client eats may also lead to weight gain. Asking for recall of 3 days' intake would be difficult, and most information would be inaccurate due to forgetting some item of food intake or when the food was eaten. Most people have no idea how many calories are in a food item unless they are specifically counting calories for dieting or health reasons. An adolescent would have a difficult time demonstrating a healthy portion size unless it has been demonstrated first.

The nurse sees a 15-month-old at a health maintenance visit. Of the following assessments, which one is generally included in a 15-month checkup?

Height and weight measurements Because height and weight are such strong determinants of health, they are measured at every health assessment.

The caregivers of a 2-year-old are concerned the child is not learning how to share and play well with other children. While acknowledging their concern and devotion, the nurse should point out which activity would be best for this child's developmental level?

Mowing the lawn with a toy lawnmower Toddlers enjoy talking on a play telephone. They like pots, pans, and toys such as brooms, dishes, and lawnmowers that help them imitate the adults in their environment and promote socialization. Toys that involve the toddler's new gross motor skills, such as push-pull toys, rocking horses, large blocks, and balls are popular. Fine motor skills are developed by use of thick crayons, modeling clay, finger paints, wooden puzzles with large pieces, toys with pieces that fit into shaped holes, and cloth books. The toddler will not be interested in sharing toys until the later stage of toddlerhood; adults should not make an issue of sharing at this early stage.

Which gross motor skill would the 4-year-old child have most recently attained?

The child can hop on one foot. Gross and fine motor skills continue to develop rapidly in the preschool-aged child. Gross motor skills have to do with the development of large muscles. Balance improves around the age of 4, thus the child can hop on one foot and stand on one foot for 5 seconds. A 3-year-old child does not have the ability to accomplish these tasks. A 5-year-old child can button his/her own clothes, tie shoes, and cut his/her food.

Which behavior(s) involving a 11-year-old child warrants further education to the family? Select all that apply.

The child is allowed to sit in the front seat of the car. The child wears a lap belt when riding in the car. The child uses a backpack to carry books when riding their bike to and from school. When riding in the car children under the age of 12 should ride in the back seat and not the front seat. Safety belts consisting of a lap and shoulder harness should be employed. Front baskets on a bike should be used to carry heavy objects. Using a backpack can cause balance issues leading to a fall and should be avoided.

The nurse is reviewing the medical record for a child who is being seen for concerns about school attendance. The health care provider has noted the child has "school phobia." What behavior(s) may be noted in a child experiencing this phenomenon?

reports of fear during the time school is attended demonstrates negative behaviors before school chronically late for school or school activities School refusal (also called school phobia or school avoidance) has been defined as a refusal to attend school or difficulty remaining in school for an entire day. Behaviors include frequent absences, skipping classes, being chronically late for school, severe misbehavior before school, or attending school with great fear.

Which milestone would the nurse expect an infant to accomplish by 8 months of age?

sitting without support Physical development of infants occurs in a cephalocaudal fashion. That means they must learn to control and lift their heads first. This is followed by the ability to turn over. Once this occurs the remainder of development occurs quickly. Most infants are able to sit unsupported by 8 months. They are able to creep at 9 months and pull to a standing position by 10 months. At 12 months the infant is able to sit from a standing position and is learning to walk.

At a physical examination, a nurse asks the father of a 4-year-old how the boy is developing socially. The father sighs deeply and explains that his son has become increasingly argumentative when playing with his regular group of three friends. The nurse recognizes that this phenomenon is most likely due to:

testing and identification of group role. Although 4-year-olds continue to enjoy play groups, they may become involved in arguments more than they did at age 3, especially as they become more certain of their role in the group. This development, like so many others, may make parents worry a child is regressing. However, it is really forward movement, involving some testing and identification of their group role. Because 3-year-olds are capable of sharing, they play with other children their age much more agreeably than do toddlers, which makes the preschool period become a sensitive and critical time for socialization. The elementary rule that an odd number of children will have difficulty playing well together generally pertains to children at this age: two or four will play, but three or five will quarrel.

A mother expresses surprise to the nurse that her daughter has begun masturbating. The most important initial nursing response is that:

this is a normal and expected activity best treated matter-of-factly. Masturbation is a normal event to be done in private. Calling attention to the behavior may increase the frequency. Both girls and boys masturbate, and toilet teaching calls attention to the genital area. These two statements are accurate information but not the best first response. Excessive or public masturbation points to stress.