Chapter 5 Pediatrics

The nurse is providing teaching about preventing poisoning. Which of the following statements 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 other statements are correct.

The nurse is conducting a well-child exam of a 4-year-old boy. Which of the following statements would alert the nurse that the child is at risk for iron deficiency?

"He loves milk and drinks it every time he is thirsty." This is likely to result in a very high intake of milk. Excess milk drinking may lead to iron deficiency since the calcium in milk blocks iron absorption. The nurse needs to emphasize this fact and suggest an appropriate daily milk intake. The other statements all include iron-rich foods and would not point to a risk for iron deficiency.

The father of a 4r-year-old boy has contacted the nurse because he is concerned that his son is frequently touching his genitals. The nurse explains that this is normal during the preschool years. Which of the following statements by the father would indicate a need for further teaching?

"I will need to find an appropriate punishment for him if this continues." The nurse should remind the father that overreaction to this behavior may cause it to occur more frequently. Masturbation at this age should be treated matter-of-factly. The other statements are correct.

The nurse is doing a well-child exam of a 5r-year-old girl. Which of the statements by the mother would alert the nurse that further teaching is needed about healthy eating habits?

"Our family rule is that all children clean up their plates at each meal." Children should not be expected to always eat everything on their plates, nor should they be rewarded for doing so. Appropriate serving sizes are important here. Children need to learn to self-regulate and eat only until full. The other statements indicate knowledge of healthy eating habits and are useful in developing positive attitudes toward eating and toward trying different foods.

The mother and father of a 5-year-old boy are discussing bicycle safety with the nurse. What comment indicates further teaching is needed?

"We just got him a new bike he can grow into." The bicycle should fit the rider. The balls of his feet should reach both pedals while he is sitting on the seat and has both hands on the handlebars. The other comments describe no safety risk.

The nurse teaches parents of young children to prevent burns by setting water heater temperature at __________________ or less.

120F

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 preschoolers 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.

In assessing the bilingual 4-year-old's speech and language development, the nurse should find that the child will:

Be able to use each language as a separate system The ability to use both languages separately is developed by 4 years. Mixing the two languages occurred during toddlerhood. The other options are not related to bilingualism and are incorrect.

Parents say they have been using measures to lessen the struggle of getting their preschooler to bed at night and to sleep. Which practice will the nurse suggest they discontinue?

Consistent bedtimes and places for sleep promote good sleep habits. Caffeine (soft drinks) interferes with sleep. A nightlight can reduce fear of the dark common in preschoolers. Removing the TV from the child's room prevents viewing and screen light from keeping her awake. Twelve hours of sleep daily is an average amount for preschoolers.

Parents find responding to their preschooler's questions about sexuality uncomfortable. Sequence the points the nurse will discuss.

Find out what the child is really determine what the child already knows give only the information requested avoid long answer; use correct terms adress additional questions as they arise Preschoolers are curious and aware of their environment. Questions about sex and where babies come from are common at this age. Honest, direct responses are helpful.

Parents of a 3r-year-old indicate they spend time with grandparents who live near a lake. The nurse will emphasize:

Having the child wear a personal flotation device whenever near or on the water Preschool children are safe around water only when adult supervision is constant. Wearing a personal flotation device adds additional protection and should be as routine as "buckling up" in the car. At 5 years most preschoolers are mature enough to become swimmers; yet, knowing how to swim does not make the preschooler safe without supervision. CPR is a life-saving skill and using sunscreen will protect the skin, but neither will be a factor in preventing drowning.

A mother describes her 4-year-old girl's eating habits as "picky" and goes on to describe using wheedling, coaxing, and threatening measures to get her to eat. The nurse determines the child is growing normally. What interventions will be suggested? Select all that apply.

Ignore the pickiness. Approach mealtime matter-of-factly. Focus on quality, not quantity. Offer only nutritious between-meal snacks. Allow the child to decide how much she will eat. Offer a variety of healthy foods including those liked and refused. Preschoolers often become "picky" eaters but when given the opportunity to include a wider variety in their diet eventually do so. At 5 years of age, children become more receptive to different foods. Too much focus on eating may exacerbate the problem.

Parents tell the nurse their 3r-year-old refuses to eat meat but are pleased she drinks "lots of milk." What risk does the nurse identify?

Iron deficiency Meat is an important iron source while calcium in milk consumed in large quantities can block iron absorption. Alternate protein sources can replace the meat in the child's diet for growth. Excess milk intake that boosts calories consumed can be an obesity-causing factor. Lactose from milk in constant contact with the teeth can promote development of dental caries. However, these risks are slight, with the iron deficiency risk pronounced.

Johnny exhibits the following growth pattern. How should the nurse interpret or manage this data? Select all that apply. 3 yrs: Ht. 37 inches Wt. 32 pounds 4 yrs: Ht. 39 inches Wt. 39 pounds 5 yrs: Ht. 40 inches Wt. 46 pounds

Johnny is growing slowly in height but rapidly in weight. Johnny may be at risk for overweight or obesity. Johnny's height and weight should be plotted on a growth chart. The preschool child's growth is fairly even. The child should grow about 2r to 3 inches and gain around 5 pounds yearly. Johnny is not following this pattern. Plotting the child's height and weight on a growth chart would make it visually easy to follow his growth pattern and compare it to the norms.

The nurse is providing teaching about good nondairy sources of calcium for preschoolers. Which of the following is the highest calcium-containing fruit?

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.

The nurse is conducting a physical examination of a young preschooler and detects the odor of tobacco smoke on the parents' hair and clothing. How should the nurse respond?

Tell me about your child's exposure to tobacco smoke." The nurse needs to emphasize that parents should protect their child from all tobacco smoke. It is best to ask an open-ended question to determine who uses tobacco products or where exposure to tobacco smoke could be occurring. The nurse should not assume that the parents are smokers and telling them to stop is inappropriate. Telling the parent tobacco smoke can be linked to ear infection and behavioral difficulties is true but is unlikely to open a dialogue.

In counseling a group of parents regarding the development of school readiness in preschoolers, the nurse emphasizes:

The home environment The home environment is the foundation for the child's learning and is the most important element for developing school readiness. Values regarding learning originate at home. Parents are the first teachers and role models. Structure, proper behavior with others, and language skills are all developed at home and are essential for school success. The other options are important but not as vital as the home environment. A preschool experience can foster social skills and group interaction. Library story hour and books develop language skills, and visiting a kindergarten can help the child make the transition to school.

The nurse is caring for a 4-year-old girl following an appendectomy. The girl becomes fearful and starts to cry as soon as the nurse walks into the room. When the nurse asks about the crying, the girl says, "Nurses who wear shirts with flowers give shots." The nurse understands that the girl is demonstrating which of the following?

Transduction The nurse identifies transduction. Because the 4-year-old recently received an injection from a nurse in a flowered uniform, the girl believes that all nurses who wear flowered uniforms give shots. Transduction is reasoning by viewing one situation as the basis for another situation even though the two may or may not be causally linked. Magical thinking involves believing that one's thoughts are all-powerful. Animism is attributing life-like characteristics to inanimate objects. Empathy is the understanding of others' feelings.

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. Which of the following is the most appropriate intervention?

Wake the child up nightly 30 to 45 minutes after going to sleep.

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 doesnt stop remove the preschooler to a boring spot set a timer for no more than 4 min if the child gets up replace the timer & restart time Time-out is an extinction method of discipline that avoids reinforcing the unacceptable behavior with attention. One minute per year of age is the appropriate length of a time-out. Five minutes is the recommended maximum length.