Combo with "Peds Exam 3a" and 2 others

A significant secondary prevention nursing activity for lead poisoning is: a. chelation therapy. b. screening children for blood lead levels. c. removing lead-based paint from older homes. d. questioning parents about ethnic remedies containing lead.

ANS: B Screening children for lead poisoning is an important secondary prevention activity. Screening does not prevent the initial exposure of the child to lead. It can lead to identification and treatment of children who are exposed. Chelation therapy is treatment, not prevention. Removing lead-based paints from older homes before children are affected is primary prevention. Questioning parents about ethnic remedies containing lead is part of the assessment to determine the potential source of lead.

A 3-month-old infant dies shortly after arrival to the emergency department. The infant has subdural and retinal hemorrhages but no external signs of trauma. The nurse should suspect: a. unintentional injury. b. shaken baby syndrome. c. congenital neurologic problem. d. sudden infant death syndrome (SIDS).

ANS: B Shaken baby syndrome causes internal bleeding but may have no external signs. Unintentional injury would not cause these injuries. With unintentional injuries, external signs are usually present. Congenital neurologic problems would usually have signs of abnormal neurologic anatomy. SIDS does not usually have identifiable injuries.

Pertussis vaccination should begin at which age? a. Birth b. 2 months c. 6 months d. 12 months

ANS: B The acellular pertussis vaccine is recommended by the American Academy of Pediatrics beginning at age 6 weeks. Infants are at greater risk for complications of pertussis. The vaccine is not given after age 7 years, when the risks of the vaccine become greater than those of pertussis. The first dose is usually given at the 2-month well-child visit. The infant is highly susceptible to pertussis, which can be a life-threatening illness in this age-group.

Which muscle is contraindicated for the administration of immunizations in infants and young children? a. Deltoid b. Dorsogluteal c. Ventrogluteal d. Anterolateral thigh

ANS: B The dorsogluteal site is avoided in children because of the location of nerves and veins. The deltoid is recommended for 12 months and older. Ventrogluteal and anterolateral thigh sites can safely be used for the administration of vaccines to infants.

A child age 4 1/2 years sometimes wakes her parents up at night screaming, thrashing, sweating, and apparently frightened. Yet she is not aware of her parents' presence when they check on her. She lies down and sleeps without any parental intervention. This is most likely which of the following? a. Nightmare b. Sleep terror c. Sleep apnea d. Seizure activity

ANS: B This is a description of a sleep terror. The child is observed during the episode and not disturbed unless there is a possibility of injury. A child who awakes from a nightmare is distressed. She is aware of and reassured by the parent's presence. This is not the case with sleep apnea. This behavior is not indicative of seizure activity.

In terms of fine motor development, what could the 3-year-old child be expected to do? a. Tie shoelaces. b. Copy (draw) a circle. c. Use scissors or a pencil very well. d. Draw a person with seven to nine parts.

ANS: B Three-year-olds are able to accomplish this fine motor skill of copying (drawing) a circle. The ability to tie shoelaces, to use scissors or a pencil very well, and to draw a person with seven to nine parts are fine motor skills of 5-year-olds.

Parents tell the nurse they found their 3-year-old daughter and a male cousin of the same age inspecting each other closely as they used the bathroom. Which of the following is the most appropriate recommendation for the nurse to make? a. Punish children so this behavior stops. b. Neither condone nor condemn the curiosity. c. Get counseling for this unusual and dangerous behavior. d. Allow children unrestricted permission to satisfy this curiosity.

ANS: B Three-year-olds become aware of anatomic differences and are concerned about how the other sex "works." Such exploration should not be condoned or condemned. Children should not be punished for this normal exploration. This is age appropriate and not dangerous behavior. Encouraging the children to ask their parents questions and redirecting their activity is more appropriate than giving permission.

Which of the following is an important nursing consideration when caring for a child with herpetic gingivostomatitis (HGS)? a. Drink from a cup, not a straw. b. Apply topical anesthetics before eating. c. Wait to brush teeth until lesions are sufficiently healed. d. Explain to parents how this is sexually transmitted.

ANS: B Treatment for HGS is aimed at relief of pain. Topical anesthetics are useful for children who can keep 1 tsp of liquid in their mouth for 2 to 3 minutes, then expectorate. Drinking bland fluids through a straw helps avoid painful lesions. This will not help with foods. Mouth care is encouraged with a soft toothbrush. HGS is usually caused by herpes simplex virus type 1, which is not associated with sexual transmission.

A father calls the clinic because he found his young daughter squirting Visine eye drops into her mouth. Which of the following is the most appropriate nursing action? a. Reassure the father that Visine is harmless. b. Direct him to seek immediate medical treatment. c. Recommend inducing vomiting with ipecac. d. Advise him to dilute Visine by giving his daughter several glasses of water to drink.

ANS: B Visine is a sympathomimetic and if ingested may cause serious consequences. Medical treatment is necessary. Inducing vomiting is no longer recommended for ingestions. Dilution will not decrease risk.

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

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

Which if the following developmental achievements are demonstrated by a 4-year-old child? Select all that apply. a. Cares for self totally b. Throws a ball overhead c. Has a vocabulary of 1500 words d. Can skip and hop on alternate feet e. Tends to be selfish and impatient f. Commonly has an imaginary playmate

ANS: B, C, E, F Developmental achievements for a 4-year-old include throwing a ball overhead, having a vocabulary of 1500 words, tending to be selfish and impatient, and perhaps having an imaginary playmate. Caring for self totally and skipping and hopping on alternate feet are achievements normally seen in the 5-year-old age-group.

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

ANS: C The 17-month-old is in the fifth stage of the sensorimotor phase, tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Preoperations is the stage of cognitive development usually present in older toddlers and preschoolers. Concrete operations is the cognitive stage associated with the school-age child. Secondary circular reaction stage lasts from about ages 4 to 8 months.

Which of the following is an important nursing consideration when a child is hospitalized for chelation therapy to treat lead poisoning? a. Maintain bed rest. b. Maintain isolation precautions. c. Keep accurate record of intake and output. d. Institute measures to prevent skeletal fracture.

ANS: C The iron chelates are excreted though the kidneys. Adequate hydration is essential. Periodic measurement of renal function is done. Bed rest is not necessary. Often the chelation therapy is done on an outpatient basis. The chelation therapy is not infectious or dangerous. Isolation is not indicated. Skeletal weakness does not result from high levels lead.

Which of the following developmental characteristics does not occur until a child reaches age 2 1/2 years? a. Birth weight has doubled. b. Anterior fontanel is open. c. Primary dentition is complete. d. Binocularity may be established.

ANS: C Usually by age 30 months the primary dentition of 20 teeth is complete. Birth weight doubles at approximately ages 5 to 6 months. The anterior fontanel closes at ages 12 to 18 months. Binocularity is established by age 15 months.

The school nurse is concerned about an outbreak of chickenpox because two children at the school have cancer and are immunodeficient from chemotherapy. The nurse should recommend which of the following? a. No precautions necessary b. Acyclovir (Zovirax) to minimize symptoms of chickenpox c. Varicella-zoster immune globulin to prevent chickenpox d. Temporarily stopping chemotherapy to allow immune system to recover

ANS: C Varicella-zoster immune globulin is given to high-risk children to prevent the development of chickenpox. Precautions are necessary. In immunocompromised children, varicella can have significant morbidity and mortality. Acyclovir decreases the severity, not the incidence, of chickenpox. The children are already immunocompromised from the previous round of chemotherapy. Stopping the chemotherapy may allow their white and red blood cell counts to improve, but prophylaxis is necessary.

At a seminar for parents with preschool-age children the nurse has discussed anticipatory tasks during the preschool years. Which of the following statements by a parent would indicate a correct understanding of the teaching? a. "I should be worried if my 4-year-old child has an increase in sexual curiosity, since this is a sign of sexual abuse." b. "I should expect my 5-year-old to change from a tranquil child to an aggressive child when school starts." c. "I should be concerned if my 4-year-old child starts telling exaggerated stories and has an imaginary playmate, since these could be signs of stress." d. "I should expect my 3-year-old child to have a more stable appetite and an increase in food selections."

ANS: D A 3-year-old exhibits a more stable appetite than during the toddler years and is more willing to try different foods. A 4-year-old child is imaginative and indulges in telling "tall tales" and may have an imaginary playmate; these are normal findings, not signs of stress. Also a 4-year-old has an increasing curiosity in sexuality, which is not a sign of child abuse. A 5-year-old child is usually tranquil, not aggressive like the 4-year-old child.

Acyclovir (Zovirax) is given to children with chickenpox to: a. minimize scarring. b. prevent aplastic anemia. c. prevent spread of the disease. d. decrease the number of lesions.

ANS: D Acyclovir decreases the number of lesions; shortens duration of fever; and decreases itching, lethargy, and anorexia. Treating pruritus and discouraging itching minimizes scarring. Aplastic anemia is not a complication of chickenpox. Strict isolation until vesicles are dried prevents spread of disease.

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

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

The developmental task with which the child of 15 to 30 months is likely to be struggling is a sense of what? a. Trust b. Initiative c. Intimacy d. Autonomy

ANS: D Autonomy versus shame and doubt is the developmental task of toddlers. Trust versus mistrust is the developmental stage of infancy. Initiative versus guilt is the developmental stage of early childhood. Intimacy and solidarity versus isolation is the developmental stage of early adulthood.

Which of the following characteristics best describes the language skills of a 3-year-old child? a. Asks meanings of words b. Follows directional commands c. Can describe an object according to its composition d. Talks incessantly regardless of whether anyone is listening

ANS: D Because of the dramatic vocabulary increase at this age, 3-year-olds are known to talk incessantly regardless of whether anyone is listening. A 4- to 5-year-old asks lots of questions and can follow simple directional commands. A 6-year-old can describe an object according to its composition.

Probably the most important criterion on which to base the decision to report suspected child abuse is which of the following? a. Inappropriate response of child b. Inappropriate parental concern for the degree of injury c. Absence of parents for questioning about child's injuries d. Incompatibility between the history and injury observed

ANS: D Conflicting stories about the "accident" are the most indicative red flags of abuse. The child or caregiver may have an inappropriate response, but this is subjective. Parents should be questioned at some point during the investigation.

A young child is being treated for giardiasis. Which of the following should the nurse recommend to the child's parent? a. The child can swim in a pool if wearing diapers. b. Cloth diapers should be rinsed in the toilet before washing. c. The parasite is difficult to transmit, so no special precautions are indicated. d. Diapers must be changed as soon as soiled and disposed of in a closed receptacle.

ANS: D Diapers should be changed as soon as soiled and disposed of in a container that is not accessible to children. If a child with giardiasis is in a pool, contamination of the entire pool is a possibility. Disposable diapers should be used for the duration of the infection. When a cloth diaper is rinsed in the toilet, the parasite may be placed on the toilet seat or other area of the bathroom. The parasite can be transmitted to other family members. Treatment may be indicated for up to 1 month to treat parasites that have hatched since treatment began.

The nurse suspects that a child has ingested some type of poison. Which of the following clinical manifestations would be most suggestive that the poison was a corrosive product? a. Tinnitus b. Disorientation c. Stupor, lethargy, coma d. Edema of lips, tongue, pharynx

ANS: D Edema of lips, tongue, and pharynx indicates a corrosive ingestion. Tinnitus is indicative of aspirin ingestion. Corrosives do not act on the central nervous system.

During the preschool period the emphasis of injury prevention should be placed on which of the following? a. Limitation of physical activities b. Punishment for unsafe behaviors c. Constant vigilance and protection d. Teaching about safety and potential hazards

ANS: D Education about safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Limitation of physical activities is not appropriate. Punishment may make children scared of trying new things. Constant vigilance and protection is not practical at this age, since preschoolers are becoming more independent.

Which of the following is the causative agent of scarlet fever? a. Enteroviruses b. Corynebacterium organisms c. Scarlet fever virus d. Group A -hemolytic streptococci (GABHS)

ANS: D GABHS infection causes scarlet fever. Enteroviruses do not cause the same complications. Corynebacterium organisms cause diphtheria. Scarlet fever is not caused by a virus.

The psychosocial developmental tasks of toddlerhood include which of the following? a. Development of a conscience b. Recognition of sex differences c. Ability to get along with age-mates d. Ability to delay gratification

ANS: D If the need for basic trust has been satisfied, then toddlers can give up dependence for control, independence, and autonomy. One of the tasks that the toddler is concerned with is the ability to delay gratification. Development of a conscience and recognition of sex differences occur during the preschool years. The ability to get along with age-mates develops during the preschool and school-age years.

A young boy is found squirting lighter fluid into his mouth. His father calls the emergency department. The nurse taking the call should know that the primary danger is which of the following? a. Hepatic dysfunction b. Dehydration secondary to vomiting c. Esophageal stricture and shock d. Bronchitis and chemical pneumonia

ANS: D Lighter fluid is a hydrocarbon. The immediate danger is aspiration. Acetaminophen overdose, not hydrocarbons, causes hepatic dysfunction. Dehydration is not the primary danger. Esophageal stricture is a late or chronic consequence of hydrocarbon ingestion.

The nurse is assessing a 20-month-old toddler during a well-child visit and notices tooth decay. The nurse should understand that early childhood caries are caused by which of the following? a. Allowing the child to eat citrus foods at bedtime b. A hereditary factor that cannot be prevented c. Poor fluoride supply in the drinking water d. Giving the child a bottle of juice or milk at naptime

ANS: D One cause of early childhood caries is allowing the child to go to sleep with a bottle of milk or juice; as the sweet liquid pools in the mouth, the teeth are bathed for several hours in this cariogenic environment. Eating citrus fruit at bedtime and poor fluoride supply in drinking water do not cause early childhood caries. The problem is not hereditary and can be prevented with proper education.

The most common type of burn in the toddler age-group is: a. electric burn from electrical outlets. b. flame burn from playing with matches. c. hot object burn from cigarettes or irons. d. scald burn from high-temperature tap water.

ANS: D Scald burns are the most common type of thermal injury in children, especially 1- and 2-year-olds. Temperature should be reduced on the hot water in the house and hot liquids placed out of the child's reach. Electric burns from electrical outlets and hot object burns from cigarettes or irons are both significant causes of burn injury. The child should be protected by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electrical outlets when not in use. Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age-group, but not one of the most common types of burn.

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

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

The parents of a newborn say that their toddler "hates the baby. . . . He suggested that we put him in the trash can so the trash truck could take him away." The nurse's best reply is which of the following? a. "Let's see if we can figure out why he hates the new baby." b. "That's a strong statement to come from such a small boy." c. "Let's refer him to counseling to work this hatred out. It's not a normal response." d. "That is a normal response to the birth of a sibling. Let's look at ways to deal with this."

ANS: D The arrival of a new infant represents a crisis for even the best-prepared toddler. Toddlers have their entire schedule and routines disrupted because of the new family member. The nurse should work with parents on ways to involve the toddler in the newborn's care and to help focus attention on the toddler. The toddler does not hate the infant. This is an expected, normal response to the changes in routines and attention that affect the toddler. The toddler can be provided with a doll to imitate parents' behaviors. The child can care for the doll's needs at the same time the parent is performing similar care for the newborn.

A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. Which of the following is the most appropriate recommendation? a. Punish the child. b. Explain to child that this is wrong. c. Leave the child alone until the tantrum is over. d. Remain close by the child but without eye contact.

ANS: D The best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common during this age-group as the child becomes more independent and overwhelmed by increasingly complex tasks. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial. The presence of the parent is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over.

Which development is necessary for toilet training readiness for a 2-year-old? Select all that apply. 1. Adequate neuromuscular development for sphincter control 2. Appropriate chronological age. 3. Ability to communicate the need to use the toilet. 4. Desire to please the parents. 5. Ability to play with other 2-year-olds.

1, 3, 4. Readiness for toilet training is based on neurological, psychological, and physical developmental readiness. The nurse can introduce concepts of readiness for toilet training and encourage parents to look for adaptive and psychomotor signs such as the ability to walk well, balance, climb, sit in a chair, dress oneself, please the parent, and communicate awareness of the need to urinate or defecate. Chronological age is not an indicator for toilet training. Two-year-olds engage in parallel play, which is not an indicator of readiness for toilet training.

The parents of a preschooler ask the nurse how to handle their child's temper tantrums. Which of the following should the nurse include in the teaching plan? Select all that apply. 1. Putting the child in "time-out." 2. Telling the child to go to his bedroom. 3. Ignoring the child. 4. Putting the child to bed. 5. Spanking the child. 6. Trying to reason with the child.

1, 3. Some parents find that putting the child in time-out until control is regained is very effective. Others find that ignoring the behaviors works just as well with their child. Both suggestions are appropriate to include in the teaching plan. Sending the child to his bedroom means the child is being punished for having a tantrum. Spanking the child is never an option. Attempting to reason with a child having a temper tantrum does not work because the child is out of control. A more appropriate time to discuss it with the child is when the child regains control.

A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is which of the following? a. A sign the child is spoiled b. An attempt to exert unhealthy control c. Regression, which is common at this age d. Ritualism, an expected behavior at this age

ANS: D The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain the sameness and reliability. It provides a sense of structure and comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. This does not indicate the child has unreasonable expectations, but rather is part of normal development. Ritualism is not regression, which is a retreat from a present pattern of functioning.

When only one child is abused in a family, the abuse is usually a result of which of the following? a. Child is the firstborn. b. Child is the same gender as the abusing parent. c. Parent abuses child to avoid showing favoritism. d. Parent is unable to deal with the child's behavioral style.

ANS: D The child unintentionally contributes to the abuse. The "fit" or compatibility between the child's temperament and the parent's ability to deal with that behavior style is an important predictor. Birth order and gender can contribute to abuse, although there is not a specific birth order or gender relationship that is indicative of abuse. Being the firstborn or the same gender as the abuser is not linked to child abuse. Avoidance of favoritism is not usually a cause of abuse.

A parent asks the nurse about negativism in toddlers. The most appropriate recommendation is which of the following? a. Punish the child. b. Provide more attention. c. Ask child not to always say "no." d. Reduce the opportunities for a "no" answer.

ANS: D The nurse should suggest to the parent that questions should be phrased with realistic choices rather than yes or no answers. This provides a sense of control for the toddler and reduces the opportunity for negativism. Negativism is not an indication of stubbornness or insolence and should not be punished. The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. The toddler is too young to comply with requests not to say "no."

A mother tells the nurse that she does not want her infant immunized because of the discomfort associated with injections. The nurse should explain that: a. this cannot be prevented. b. infants do not feel pain as adults do. c. this is not a good reason for refusing immunizations. d. a topical anesthetic, EMLA, can be applied before injections are given.

ANS: D To minimize the discomfort associated with intramuscular injections, a topical anesthetic agent can be used on the injection site. These include EMLA (eutectic mixture of local anesthetic) and vapor coolant sprays. Pain associated with many procedures can be prevented or minimized by using the principles of atraumatic care. Infants have the neural pathways that will indicate pain. Numerous research studies have indicated that infants perceive and react to pain in the same manner as do children and adults. The mother should be allowed to discuss her concerns and the alternatives available. This is part of the informed consent process.

Which one of the following factors is most important in predisposing toddlers to frequent infections? a. Respirations are abdominal. b. Pulse and respiratory rates in toddlers are slower than those in infancy. c. Defense mechanisms are less efficient than those during infancy. d. Toddlers have a short, straight internal ear canal and large lymph tissue.

ANS: D Toddlers continue to have the short, straight internal ear canal of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose the toddler to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy.

The most common test for diagnosing pinworms in a child is which of the following? a. Lower gastrointestinal (GI) series b. Three stool specimens, at intervals of 4 days c. Observation of presence of worms after child defecates d. Tape placed in perianal area in the morning as soon as child awakens

ANS: D Transparent tape is used to collect pinworms and their eggs from the perianal area in the morning before the child defecates or bathes. Lower GI series is not helpful for diagnosing enterobiasis. Stool specimens are not necessary to diagnose pinworms. Worms will not be visible after child defecates.

A mother brings her 18-month-old to the clinic because the child "eats ashes, crayons, and paper." Which of the following information about the toddler should the nurse assess first? 1. Evidence of eruption of large teeth. 2. Amount of attention from the mother. 3. Any changes in the home environment. 4. Intake of a soft, low-roughage diet.

3. A craving to eat nonfood substances is known as pica. Toddlers use oral gratification as a means to cope with anxiety. Therefore, the nurse should first assess whether the child is experiencing any change in the home environment that could cause anxiety. Teething or the eruption of large teeth and the amount of attention from the mother are unlikely causes of pica. Nutritional deficiencies, especially iron deficiency, were once thought to cause pica, but research has not substantiated this theory. A soft, low-roughage diet is an unlikely cause.

An uncle is shopping for a toy to give his niece. He has no children of his own and asks his neighbor, a nurse, what would be the most appropriate toy to give a 15-month-old child. Which toy should the nurse recommend to facilitate learning and development? 1. A stuffed animal. 2. A music box. 3. A push-pull toy. 4. A nursery mobile.

3. A push-pull toy will aid in development of gross motor skills and muscle development. A stuffed animal is age appropriate for a toddler but is not the best toy to promote development. A music box is most appropriate to stimulate development for an infant. A nursery mobile is most appropriate to stimulate development for an infant.

To encourage autonomy in a 4-year-old, the nurse should instruct the mother to: 1. Discourage the child's choice of clothing. 2. Button the child's coat and blouse. 3. Praise the child's attempts to dress herself. 4. Tell the child when the combination of clothes is not appropriate.

3. At age 4, the child should be learning to dress without supervision. A child will feel more autonomous if allowed to try to take on tasks herself. Such attempts should be encouraged to increase self-esteem. Allowing choices encourages the child's capacity to control her behavior. Continued dependency may cause the child to doubt her own abilities. Telling the child that a combination of clothes is not appropriate may cause the child to doubt her abilities. Feelings of guilt can develop from not being able to accomplish what the child feels the adult expects of her.

A 2-year-old tells his mother he is afraid to go to sleep because "the monsters will get him." The nurse should tell his mother to: 1. Allow him to sleep with his parents in their bed whenever he is afraid. 2. Increase his activity before he goes to bed, so he eventually falls asleep from being tired. 3. Read a story to him before bedtime and allow him to have a cuddly animal or a blanket. 4. Allow him to stay up an hour later with the family until he falls asleep.

3. Behavior problems related to sleep and rest are common in young children. Consistent rituals around bedtime help to create an easier transition from waking to sleep. Allowing a child to sleep with his parents commonly creates more problems for the family and child and does not alleviate the problem or foster autonomy. Increasing activity before bedtime does not alleviate the separation anxiety in the toddler and causes further anxiety. Allowing him to stay up later than his normal time for bed will increase his anxiety, make it more difficult for him to fall asleep, and do nothing to lessen his fear.

After teaching a group of parents of preschoolers attending a well-child clinic about oral hygiene and tooth brushing, the nurse determines that the teaching has been successful when the parents state that children can begin to brush their teeth without help at which of the following ages? 1. 3 years. 2. 5 years. 3. 7 years. 4. 9 years.

3. Children younger than 7 years of age do not have the manual dexterity needed for tooth brushing. Therefore, parents need to help with this task until that time.

A child is admitted with a suspected diagnosis of Munchausen syndrome by proxy (MSBP). An important consideration in the care of this child is: a. monitor the parents whenever they are with the child. b. reassure parents that the cause of the disorder will be found. c. teach the parents how to obtain necessary specimens. d. support parents as they cope with diagnosis of a chronic illness.

ANS: A MSBP refers to an illness that one person fabricates or induces in another. The child must be continuously observed for development of symptoms to determine the cause. MSBP is caused by an individual harming the child for the purpose of gaining attention. Nursing staff should obtain all specimens for analysis. This minimizes the possibility of the abuser contaminating the sample. The child must be supported through the diagnosis of MSBP. The abuser must be identified and the child protected from that individual.

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

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

The parents of a 7-year-old boy tell the nurse that lately he has been cruel to their family pets and actually caused physical harm. The nurse's recommendations should be based on knowledge that this is: a. expected behavior at this age. b. a warning sign of a serious problem. c. harmless venting of anger and frustration. d. common in children who are physically abused.

ANS: B Cruelty to family pets is not an expected behavior. Hurting animals can be one of the earliest symptoms of a conduct disorder. Abusing animals does not dissipate violent emotions; rather the acts may fuel the abusive behaviors. Referral for evaluation is essential. This behavior may be seen in emotional abuse or neglect, not physical abuse

Which of the following is a clinical manifestation of acetaminophen poisoning? a. Hyperpyrexia b. Hepatic involvement c. Severe burning pain in stomach d. Drooling and inability to clear secretions

ANS: B Hepatic involvement is the third stage of acetaminophen poisoning. Hyperpyrexia is a severe elevation in body temperature and is not related to acetaminophen poisoning. Acetaminophen does not cause burning pain in stomach and does not pose an airway threat.

The parent of a 4-year-old boy tells the nurse that the child believes "monsters and bogeymen" are in his bedroom at night. The nurse's best suggestion for coping with this problem is which of the following? a. Let the child sleep with his parents. b. Keep a night light on in the child's bedroom. c. Help the child understand that these fears are illogical. d. Tell the child that monsters and bogeymen do not exist.

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

In terms of cognitive development, the 5-year-old child would be expected to do which of the following? a. Think abstractly. b. Use magical thinking. c. Understand conservation of matter. d. Understand another person's perspective.

ANS: B Magical thinking is believing that thoughts can cause events. An example would be that thinking of the death of a parent might cause it to happen. Abstract thought does not develop until school-age years. The concept of conservation is the cognitive task of school-age children, ages 5 to 7 years. A five-year-old child cannot understand another's perspective.

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

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

Which of the following is an appropriate recommendation in preventing tooth decay in young children? a. Substitute raisins for candy. b. Substitute sugarless gum for regular gum. c. Use honey or molasses instead of refined sugar. d. When sweets are to be eaten, select a time not during meals.

ANS: B Regular gum has high sugar content. When the child chews gum, the sugar is in prolonged contact with the teeth. Sugarless gum is less cariogenic than regular gum. Raisins, honey, and molasses are highly cariogenic and should be avoided. Sweets should be consumed with meals so that the teeth can be cleaned afterward. This decreases the amount of time that the sugar is in contact with the teeth.

An essential role of the school nurse regarding communicable diseases is: a. regularly screening for communicable diseases. b. notifying families about outbreaks. c. maintaining isolation procedures in the school. d. diagnosing and treating children with communicable disease.

ANS: B School nurses are responsible for warning parents about recent outbreaks of communicable diseases to prevent susceptible children's exposure to known cases. The nurse should have a high degree of suspicion for children with symptoms such as rashes and sore throats. Regular screenings would be time-consuming and would not likely identify many cases. It is not practical for certain types of isolation to be implemented in the school environment. Persons with diseases such as chickenpox that are spread through the airborne route should not be in school. The school nurse should identify likely cases and refer for diagnosis and treatment.

The mother of a preschooler reports that her child creates a scene every night at bedtime. The nurse and the mother decide that the best course of action would be to do which of the following? 1. Allow the child to stay up later one or two nights a week. 2. Establish a set bedtime and follow a routine. 3. Encourage active play before bedtime. 4. Give the child a cookie if bedtime is pleasant.

2. Bedtime is often a problem with preschoolers. Recommendations for reducing conflicts at bedtime include establishing a set bedtime; having a dependable routine, such as story reading; and conveying the expectation that the child will comply. Allowing the child to stay up late one or two nights interferes with establishing the needed bedtime rituals. Excitement, such as active play, just before bedtime should be avoided because it stimulates the child, making it difficult for the child to calm down and prepare for sleep. Using food such as a cookie as a reward if bedtime is pleasant should be avoided because it places too much importance on food. Other rewards, such as stickers, could be used as an alternative.

A 2-year-old child brought to the clinic by her parents is uncooperative when the nurse tries to look in her ears. Which of the following should the nurse try first? 1. Ask another nurse to assist. 2. Allow a parent to assist. 3. Wait until the child calms down. 4. Restrain the child's arms.

2. Parents can be asked to assist when their child becomes uncooperative during a procedure. Most commonly, the child's difficulty in cooperating is caused by fear. In most situations, the child will feel more secure with a parent present. Other methods, such as asking another nurse to assist or waiting until the child calms down, may be necessary but obtaining a parent's assistance is the recommended first action. Restraints should be used only as a last resort, after all other attempts have been made to encourage cooperation.

The mother of a 4-year-old expresses concern that her child may be hyperactive. She describes the child as always in motion, constantly dropping and spilling things. Which of the following actions would be appropriate at this time? 1. Determine whether there have been any changes at home. 2. Explain that this is not unusual behavior. 3. Explore the possibility that the child is being abused. 4. Suggest that the child be seen by a pediatric neurologist.

2. Preschool-age children have been described as powerhouses of gross motor activity who seem to have endless energy. A limitation of their motor ability is that in moving as quickly as they do, they are not always able to judge distances, nor are they able to estimate the amount of strength and balance needed for activities. As a result, they have frequent mishaps. This level of activity typically is not associated with changes at home. However, if the behavior intensifies, a referral to a pediatric neurologist would be appropriate. Children who have been abused usually demonstrate withdrawn behaviors, not endless energy.

After having a blood sample drawn, a 5-year-old child insists that the site be covered with a bandage. When the parent tries to remove the bandage before leaving the office, the child screams that all the blood will come out. The nurse encourages the parent to leave the bandage in place and tells the parent that the child: 1. Fears another procedure. 2. Does not understand body integrity. 3. Is expressing pain. 4. Is attempting to regain control.

2. The preschool-age child does not have an accurate concept of skin integrity and can view medical and surgical treatments as hostile invasions that can destroy or damage the body. The child does not understand that exsanguinations will not occur from the injection site. Here, the child is verbalizing a fear consistent with the developmental age. The child would most likely verbalize concerns of not wanting another procedure or exhibit other symptoms associated with pain if those were the underlying issues. If control was the main issue, the child would try to control more than just the bandage removal.

When planning a 15-month-old toddler's daily diet with the parents, which of the following amounts of milk should the nurse include? 1. ½ to 1 cup. 2. 2 to 3 cups. 3. 3 to 4 cups. 4. 4 to 5 cups.

2. Toddlers around the age of 15 months need 2 to 3 cups of milk per day to supply necessary nutrients such as calcium. A daily intake of more than 3 cups of milk may interfere with the ingestion of other necessary nutrients.

When assessing for pain in a toddler, which of the following methods should be the most appropriate? 1. Ask the child about the pain. 2. Observe the child for restlessness. 3. Use a numeric pain scale. 4. Assess for changes in vital signs.

2. Toddlers usually express pain through such behaviors as restlessness, facial grimaces, irritability, and crying. It is not particularly helpful to ask toddlers about pain. In most instances, they would be unable to understand or describe the nature and location of their pain because of their lack of verbal and cognitive skills. However, preschool and older children have the verbal and cognitive skills to be able to respond appropriately. Numeric pain scales are more appropriate for children who are of school age or older. Changes in vital signs do occur as a result of pain, but behavioral changes usually are noticed first.

When assessing a 2-year-old child brought by his mother to the clinic for a routine checkup, which of the following should the nurse expect the child to be able to do? 1. Ride a tricycle. 2. Tie his shoelaces. 3. Kick a ball forward. 4. Use blunt scissors.

3. A 2-year-old child usually can kick a ball forward. Riding a tricycle is characteristic of a 3-year-old child. Tying shoelaces is a behavior to be expected of a 5-year-old child. Using blunt scissors is characteristic of a 3-year-old child.

A mother of a toilet-trained 3-year-old expresses concern over her child's bed-wetting while hospitalized. The nurse should tell the mother: 1. "He was too immature to be toilet trained. In a few months he should be old enough." 2. "Children are afraid in the hospital and frequently wet their bed." 3. "It's very common for children to regress when they're in the hospital." 4. "This is normal. He probably received too much fluid the night before."

3. A child will regress to a behavior used in an earlier stage of development in order to cope with a perceived threatening situation. Readiness for toilet training should be based on neurological, physical, and psychological development, not the age of the child. Children are afraid of hospitalization but the bed-wetting is a compensatory mechanism done to regress to a previous stage of development that is more comfortable and secure for the child. Telling the mother that bed-wetting is related to fluid intake does not provide an adequate explanation for the underlying regression to an earlier stage of development.

The family of a 5-year-old, only child has just moved to a rural setting. At the well-child visit, the father expresses concern that his child seems prone to minor accidents such as skinning his elbow and knees or falling off his scooter. The nurse tells the father: 1. "Only children use accidents as a way to seek parental attention." 2. "Children who live in the suburbs typically have more accidents." 3. "Children frequently have more accidents when families experience change." 4. "We see a relationship between accidents and parental education."

3. Family changes and stresses (e.g., moving, having company, taking a vacation, adding a new member) can distract parents and contribute to accidents. Only children typically receive more attention than those with siblings. Thus, the risk would be less. Families who live in the suburbs frequently are more affluent and, therefore, better able to maintain a home less conducive to accidents. A parent's formal education is unrelated to accidents.

When developing the teaching plan about illness for the mother of a preschooler, which of the following should the nurse include about how a preschooler perceives illness? 1. A necessary part of life. 2. A test of self-worth. 3. A punishment for wrongdoing. 4. The will of God.

3. Preschool-age children may view illness as punishment for their fantasies. At this age children do not have the cognitive ability to separate fantasies from reality and may expect to be punished for their "evil thoughts." Viewing illness as a necessary part of life requires a higher level of cognition than preschoolers possess. This view is seen in children of middle school age and older. Perceiving illness as a test of self-worth or as the will of God is more characteristic of adults.

A nurse working in the nursery identifies a goal for a mother of a newborn to demonstrate positive attachment behaviors upon discharge. Which intervention would be least effective in accomplishing this goal? 1. Provide opportunities for the mother to hold and examine the newborn. 2. Engage the mother in the newborn's care. 3. Create an environment that fosters privacy for the mother and newborn. 4. Identify strategies to prevent difficulties in parenting.

4. Identifying ways to prevent difficulties in parenting would be helpful in reducing the incidence of child abuse and reducing the stress of child rearing. However, it would not help to develop positive attachment behaviors. Providing opportunities for the mother to hold and examine the newborn and help with care helps establish a positive emotional bond between the mother and newborn. Providing time for the mother to be alone with the infant further allows the mother and newborn to bond.

When observing the parent instilling prescribed ear drops prescribed twice a day for a toddler, the nurse decides that the teaching about positioning of the pinna for instillation of the drops is effective when the parent pulls the toddler's pinna in which of the following directions? 1. Up and forward. 2. Up and backward. 3. Down and forward. 4. Down and backward.

4. In a child younger than 3 years of age, the pinna is pulled back and down, because the auditory canals are almost straight in children. In an adult, the pinna is pulled up and backward because the auditory canals are directed inward, forward, and down.

The mother asks the nurse for advice about discipline for her 18-month-old. Which of the following should the nurse suggest that the mother use? 1. Structured interactions. 2. Spanking. 3. Reasoning. 4. Time-out.

4. Time-out is the most appropriate discipline for toddlers. It helps to remove them from the situation and allows them to regain control. Structuring interactions with 3-year-olds helps minimize unacceptable behavior. This approach involves setting clear and reasonable rules and calling attention to unacceptable behavior as soon as it occurs. Physical punishment, such as spanking, does cause a dramatic decrease in a behavior but has serious negative effects. However, slapping a child's hand is effective when the child refuses to listen to verbal commands. Reasoning is more appropriate for older children, such as preschoolers and those older, especially when moral issues are involved. Unfortunately, reasoning combined with scolding often takes the form of shame or criticism and children take such remarks seriously, believing that they are "bad."

A 2-year-old always puts his teddy bear at the head of his bed before he goes to sleep. The parents ask the nurse if this behavior is normal. The nurse should explain to the parents that toddlers use ritualistic patterns to: 1. Establish a sense of identity. 2. Establish control over adults in their environment. 3. Establish sequenced patterns of learning behavior. 4. Establish a sense of security.

4. Toddlers establish ritualistic patterns to feel secure, despite inconsistencies in their environment. Establishing a sense of identity is the developmental task of the adolescent. The toddler's developmental task is to use rituals and routines to help in making autonomy easier to accomplish. Ritualistic patterns do involve patterns of behavior, but they are not utilized to develop learning behaviors.

The nurse is providing guidance strategies to a group of parents with toddlers at a community outreach program. Which of the following statements by a parent would indicate a correct understanding of the teaching? a. "I should expect my 24-month-old child to express some signs of readiness for toilet training." b. "I should be firm and structured when disciplining my 18-month-old child." c. "I should expect my 12-month-old child to start to develop a fear of darkness and to need a security blanket." d. "I should expect my 36-month-old child to understand time and proximity of events."

ANS: A A 24-month-old toddler starts to show readiness for toilet training; it is important for the parent to be aware of this and be ready to start the process. At 18 months of age, a child needs consistent but gentle discipline, since the child cannot yet understand firmness and structure with discipline. Development of fears and need for security items usually occurs at the end of the 18- to 24-month stage. A 36-month-old child does not yet understand time and proximity of events, so the parent needs to understand that the toddler cannot "hurry up or we will be late."

A toddler, age 16 months, falls down a few stairs. He gets up and "scolds" the stairs as if they caused him to fall. This is an example of which of the following? a. Animism b. Ritualism c. Irreversibility d. Delayed cognitive development

ANS: A Animism is the attribution of lifelike qualities to inanimate objects. By scolding the stairs, the toddler is attributing human characteristics to them. Ritualism is the need to maintain the sameness and reliability. It provides a sense of comfort to the toddler. Irreversibility is the inability to reverse or undo actions initiated physically. He is acting in an age-appropriate manner.

According to Piaget, magical thinking is the belief that: a. thoughts are all-powerful. b. God is an imaginary friend. c. events have cause and effect. d. if the skin is broken, the insides will come out.

ANS: A Because of their egocentrism and transductive reasoning, preschoolers believe that thoughts are all-powerful. Believing God is an imaginary friend is an example of concrete thinking in a preschooler's spiritual development. Cause-and-effect implies logical thought, not magical thinking. Believing that, if the skin is broken, the insides will come out is an example of concrete thinking in development of body image.

The nurse is caring for a child with suspected ingestion of some type of poison. Which of the following actions should the nurse take next after initiating cardiopulmonary resuscitation (CPR)? a. Empty the mouth of pills, plants, or other material. b. Question the victim and witness. c. Place child in side-lying position. d. Call poison control.

ANS: A Emptying the mouth of any leftover pills, plants, or other ingested material is the next step after assessment and initiation of CPR if needed. Questioning the victim and witnesses, calling poison control, and placing the child in a side-lying position are follow-up steps.

What is the leading cause of death during the toddler period? a. Injuries b. Infectious diseases c. Childhood diseases d. Congenital disorders

ANS: A Injuries are the most common cause of death in children ages 1 through 4 years. It is the highest rate of death from injuries of any childhood age-group except adolescence. Congenital disorders are the second leading cause of death in this age-group. Infectious and childhood diseases are less common causes of death in this age-group.

Parents tell the nurse that their toddler eats little at mealtime, only sits at the table with the family briefly, and wants snacks "all the time." Which of the following should the nurse recommend? a. Give her nutritious snacks. b. Offer rewards for eating at mealtimes. c. Avoid snacks so she is hungry at mealtimes. d. Explain to her in a firm manner what is expected of her.

ANS: A Most toddlers exhibit a physiologic anorexia in response to the decreased nutritional requirement associated with the slower growth rate. Parents should assist the child in developing healthy eating habits. The toddler is often unable to sit through a meal. Frequent nutritious snacks are a good way to ensure proper nutrition. To help with developing healthy eating habits, food should be not be used as positive or negative reinforcement for behavior. The child may develop habits of overeating or eat nonnutritious foods in response. A toddler is not able to understand explanations of what is expected of her and comply with the expectations.

Which of the following is descriptive of the nutritional requirements of preschool children? a. Quality of the food consumed is more important than the quantity. b. Average daily intake of preschoolers should be about 3000 calories. c. Nutritional requirements for preschoolers are very different from requirements for toddlers. d. Requirements for calories per unit of body weight increase slightly during the preschool period.

ANS: A Parents need to be reassured that the quality of food eaten is more important than the quantity. Children are able to self-regulate their intake when offered foods high in nutritional value. The average daily caloric intake should be approximately 1800 calories. Toddlers and preschoolers have similar nutritional requirements. There is an overall slight decrease in needed calories and fluids during the preschool period.

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

ANS: A The baby talk is a sign of regression in the toddler. Often toddlers attempt to cope with a stressful situation by reverting to patterns of behavior that were successful in earlier stages of development. It should be ignored, while praising the child for developmentally appropriate behaviors. Regression is children's way of expressing stress. The parents should not introduce new expectations and allow the child to master the developmental tasks without criticism.

The nurse is discussing with a parent group the importance of fluoride for healthy teeth. Which of the following should the nurse recommend? a. Determine whether water supply is fluoridated. b. Use fluoridated mouth rinses in children older than 1 year. c. Give fluoride supplements to infants beginning at age 2 months. d. Brush teeth with fluoridated toothpaste unless fluoride content of water supply is adequate.

ANS: A The decision about fluoride supplementation cannot be made until it is known whether the water supply contains fluoride and the amount. It is difficult to teach toddlers to spit out the mouthwash. Swallowing fluoridated mouthwashes can contribute to fluorosis. Fluoride supplementation is not recommended until after age 6 months and then only if the water is not fluoridated. Fluoridated toothpaste is still indicated if the fluoride content of the water supply is adequate, but very small amounts are used.

Which of the following is described as the time interval between infection or exposure to disease and appearance of initial symptoms? a. Incubation period b. Prodromal period c. Desquamation period d. Period of communicability

ANS: A The incubation period is the interval between infection or exposure and appearance of symptoms. The prodromal period is the interval between the appearance of early manifestations of disease and evidence of the overt clinical syndrome. Desquamation refers to the shedding of skin. The period of communicability is time or times during which an infectious agent may be transferred directly or indirectly from an infected person to another person.

The parent of 16-month-old Brian asks, "What is the best way to keep Brian from getting into our medicines at home?" The nurse should advise which of the following? a. "All medicines should be locked securely away." b. "The medicines should be placed in high cabinets." c. "Brian just needs to be taught not to touch medicines." d. "Medicines should not be kept in the homes of small children."

ANS: A The major reason for poisoning in the home is improper storage. Toddlers can climb, unlatch cabinets, and obtain access to high-security places. For medications, only a locked cabinet is safe. Toddlers can climb using furniture. High places are not a deterrent to an exploring toddler. Toddlers are not able to generalize that all the different forms of medications in the home may be dangerous. Keeping medicines out of the homes of small children is not feasible. Many parents require medications for chronic or acute illnesses. Parents must be taught safe storage for their home and when they visit other homes.

A boy age 4 1/2 years has been having increasingly frequent angry outbursts in preschool. He is aggressive toward the other children and the teachers. This behavior has been a problem for approximately 8 to 10 weeks. His parent asks the nurse for advice. Which of the following is the most appropriate intervention? a. Refer the child for a professional psychosocial assessment. b. Explain that this is normal in preschoolers, especially boys. c. Encourage the parent to try more consistent and firm discipline. d. Talk to the preschool teacher to obtain validation for behavior parent reports.

ANS: A The preschool years are a time when children learn socially acceptable behavior. The difference between normal and problematic behavior is not the behavior, but the severity, frequency, and duration. This child's behavior meets the definition requiring professional evaluation. Some aggressive behavior is within normal limits, but at 8 to 10 weeks this behavior has persisted too long. There is no indication that the parents are using inconsistent discipline. A part of the evaluation is to obtain validation for behavior the parent reports.

An infant age 4 months comes to the clinic for a well-infant check-up. Immunizations she should receive are DTaP (diphtheria, tetanus, acellular pertussis) and IPV (inactivated poliovirus vaccine). She is recovering from a cold but is otherwise healthy and afebrile. Her older sister has cancer and is receiving chemotherapy. Nursing considerations include which of the following? a. DTaP and IPV can be safely given. b. DTaP and IPV are contraindicated because she has a cold. c. IPV is contraindicated because her sister is immunocompromised. d. DTaP and IPV are contraindicated because her sister is immunocompromised.

ANS: A These immunizations can be given safely. Serious illness is a contraindication. A mild illness with or without fever is not a contraindication. These are not live vaccines so they do not pose a risk to her sister.

Which of the following statements is correct about young children who report sexual abuse? a. They may exhibit various behavioral manifestations. b. In more than half the cases the child has fabricated the story. c. Their stories should not be believed unless other evidence is apparent. d. They should be able to retell the story the same way to another person.

ANS: A Victims of sexual abuse have no typical profile. The child may exhibit various behavioral manifestations, none of which is diagnostic for sexual abuse. When children report potentially sexually abusive experiences, their reports need to be taken seriously. Other children in the household also need to be evaluated. In children who are sexually abused, it is often difficult to identify other evidence. In one study, approximately 96% of children who were sexually abused had normal genital and anal findings. The ability to retell the story is partly dependent on the child's cognitive level. Children who repeatedly tell identical stories may have been coached.

The nurse is preparing a staff education program about growth and development of an 18-month-old toddler. Which of the following characteristics should the nurse include in the staff education program? Select all that apply. a. Eats well with a spoon and cup b. Runs clumsily and can walk up stairs c. Points to common objects d. Builds a tower of three or four blocks e. Has a vocabulary of 300 words f. Dresses self in simple clothes

ANS: A, B, C, D Tasks accomplished by an 18-month-old toddler include eating well with a spoon and cup, running clumsily, walking up stairs, pointing to common objects such as shoes, and building a tower with three or four blocks. An 18-month-old toddler has a vocabulary of only 10 words, not 300. Toddlers cannot dress themselves in simple clothing until 24 months of age.

The nurse is caring for a child with a suspected diagnosis of erythema infectiosum. Which of the following clinical manifestations would the nurse expect to observe? Select all that apply. a. Slapped face appearance b. Discrete rose-pink macules c. High-pitched cough d. Koplik spots e. Maculopapular red spots

ANS: A, E Clinical manifestations associated with erythema infectiosum, or fifth disease, include a slapped face appearance and maculopapular spots. Discrete rose-pink macules are associated with exanthem subitum (roseola infantum); a high-pitched cough is associated with pertussis; and Koplik spots are a clinical manifestation of measles (rubeola).

The nurse is caring for a hospitalized 4-year-old boy. His parents tell the nurse they will be back to visit at 6 PM. When he asks the nurse when his parents are coming, the nurse's best response would be which of the following? a. "They will be here soon." b. "They will come after dinner." c. "Let me show you on the clock when 6 PM is." d. "I will tell you every time I see you how much longer it will be."

ANS: B A 4-year-old understands time in relation to events such as meals. Children perceive "soon" as a very short time. The nurse may lose the child's trust if his parents do not return in the time he perceives as "soon." Children cannot read or use a clock for practical purposes until age 7 years. "I will tell you every time I see you how much longer it will be" assumes the child understands the concepts of hours and minutes, which does not occur until age 5 or 6 years.

Which of the following is a person or animal that harbors an infectious agent without apparent clinical disease and serves as a potential source of infection? a. Host b. Carrier c. Contact d. Reservoir

ANS: B A carrier harbors the infectious agent without apparent clinical disease and serves as a potential source of infection. The host is defined as a person, or other living animal, that affords subsistence to an infectious agent under natural conditions. A contact is someone who has been in contact with an infected person or animal or a contaminated environment that may provide an infectious agent. The reservoir is the environment in which an infectious agent lives and multiplies and on which it depends for survival. Humans are the most common reservoir of infections that are capable of producing disease in other humans.

The single parent of a child who has just been diagnosed with chickenpox tells the nurse that she cannot afford to stay home with the child and miss work. The parent asks the nurse if some medication will shorten the course of the illness. Which of the following is the most appropriate nursing intervention? a. Describe the role of varicella-zoster immune globulin to treat chickenpox. b. Discuss the risks and benefits of acyclovir to treat chickenpox. c. Explain that no medication will shorten the course of the illness. d. Reassure the parent that it is not necessary to stay home with the child.

ANS: B Acyclovir is effective in reducing the number of lesions; shortening the duration of fever; and decreasing itching, lethargy, and anorexia. Varicella-zoster immune globulin is given only to high-risk children. Acyclovir lessens the severity of chickenpox. It is important for the parent to stay with the child to monitor fever.

An awake, alert 4-year-old child has just arrived at the emergency department after an ingestion of aspirin at home. The practitioner has ordered activated charcoal. The nurse administers charcoal in the following manner: a. give half of the solution, and then repeat the other half in 1 hour. b. mix with a flavorful beverage in an opaque container with a straw. c. serve in a clear plastic cup so the child can see how much has been drunk. d. administer through a nasogastric tube, since the child will not drink it because of the taste.

ANS: B Although the activated charcoal can be mixed with a flavorful sugar-free beverage, it will be black and resemble mud. When it is served in an opaque container, the child will not have any preconceived ideas about its being distasteful. The ability to see the charcoal solution may affect the child's desire to drink the solution. The child should be encouraged to drink the solution all at once. The nasogastric tube would be traumatic. It should be used only in children who cannot be cooperative or those without a gag reflex.

A toddler's parents have been using a rear-facing convertible car seat since she was born. The seat can be safely switched to the forward-facing position when she weighs how many pounds? a. 10 b. 20 c. 30 d. 40

ANS: B Although the transition point for switching to the forward-facing position is defined by the manufacturer, it is generally at 9 kg (20 lb); 4.5 kg (10 lb) is too small to be safe. Because of the relatively large head, this size child should be in the rear-facing position. It is usually safe to put children who weigh more than 20 lb in forward-facing convertible safety seats.

Which of the following is the most common form of child maltreatment? a. Sexual abuse b. Child neglect c. Physical abuse d. Emotional abuse

ANS: B Child neglect, which is characterized by the failure to provide for the child's basic needs, is the most common form of child maltreatment. Sexual abuse, physical abuse, and emotional abuse are individually not as common as neglect.

During a well-child visit the father of a 4-year-old boy tells the nurse that he is not sure if his son is ready for kindergarten. The boy's birthday is close to the cut-off date, and he has not attended preschool. Which of the following is the nurse's best recommendation? a. Start kindergarten. b. Observe a kindergarten class. c. Perform developmental screening. d. Postpone kindergarten and go to preschool.

ANS: C A developmental assessment with a screening tool that addresses cognitive, social, and physical milestones can help identify children who may need further assessment. A readiness assessment involves an evaluation of skill acquisition. Stating the child should start kindergarten or go to preschool and postpone kindergarten does not address the father's concerns about readiness for school. Observation of a class will provide information about what happens during the day. The father can use this to help determine if his son is ready.

The nurse is talking to the parent of a 5-year-old child who refuses to go to sleep at night. Which of the following interventions should the nurse suggest in helping the parent to cope with this sleep disturbance? a. Establish a consistent punishment if the child does not go to bed when told. b. Allow child to fall asleep in a different room, then gently move the child to his or her bed. c. Establish limited rituals that signal readiness for bedtime. d. Allow the child to watch television until almost asleep.

ANS: C An appropriate intervention for a child who resists going to bed is to establish limited rituals such as a bath or story that signal readiness for bed and consistently follow through with the ritual. Punishing the child will not alleviate the resistance problem and may only add to the frustration. Allowing the child to fall asleep in a different room or to watch television to fall asleep is not a recommended approach to sleep resistance.

A parent reports to the nurse that her child has inflamed conjunctivae of both eyes with purulent drainage and crusting of the eyelids, especially on awakening. These manifestations suggest: a. viral conjunctivitis. b. allergic conjunctivitis. c. bacterial conjunctivitis. d. conjunctivitis caused by foreign body.

ANS: C Bacterial conjunctivitis has these symptoms. Viral or allergic conjunctivitis has watery drainage. Foreign body causes tearing and pain and usually affects only one eye.

Which of the following is a characteristic of a toddler's language development at age 18 months? a. Vocabulary of 25 words b. Use of holophrases c. Increasing level of comprehension d. Approximately one third of speech understandable

ANS: C During the second year of life the comprehension and understanding of speech increase to a level far greater than the child's vocabulary. This is also true for bilingual children, who are able to achieve this linguistic milestone in both languages. The 18-month-old has a vocabulary of approximately 10 words. At this age the child does not use the one-word sentences that are characteristic of 1-year-olds. The child has a very limited vocabulary of single words that are comprehensible.

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

ANS: C During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. This is typical behavior for a toddler, who is only somewhat aware of a causal relation between events. Her cognitive development is appropriate for her age.

Which of the following serious reactions must the nurse be alert for when administering vaccines? a. Fever b. Skin irritation c. Allergic reaction d. Pain at injection site

ANS: C Each vaccine administration carries the risk of an allergic reaction. The nurse must be prepared to intervene if the child demonstrates signs of a severe reaction. Mild febrile reactions do occur after administration. The nurse includes management of fever in the parent teaching. Local skin irritation may occur at the injection site after administration. Parents are informed that this is expected. The injection can be painful. The nurse can minimize the discomfort with topical analgesics and nonpharmacologic measures.

Vitamin A supplementation is recommended for the young child who has which of the following? a. Mumps b. Rubella c. Measles (rubeola) d. Erythema infectiosum

ANS: C Evidence shows vitamin A decreases morbidity and mortality in measles. Mumps is treated with analgesics for pain and antipyretics for fever. Rubella and erythema infectiosum are treated similarly to mumps.

A 4-year-old child tells the nurse that she doesn't want another blood sample drawn because "I need all of my insides and I don't want anyone taking them out." Which of the following is the nurse's best interpretation of this? a. Child is being overly dramatic. b. Child has a disturbed body image. c. Preschoolers have poorly defined body boundaries. d. Preschoolers normally have a good understanding of their bodies.

ANS: C Preschoolers have little understanding of body boundaries, which leads to fears of mutilation. The child is not capable of being dramatic at this age. She truly has fear. Body image is just developing in the school-age child. Preschoolers do not have good understanding of their bodies.

The nurse is concerned with the prevention of communicable disease. Primary prevention results from which of the following? a. Hand washing b. Strict isolation c. Immunizations d. Early diagnosis

ANS: C Primary prevention rests almost exclusively with immunizations. Hand washing and isolation are control measures to prevent the spread of disease. Early diagnosis assists in instituting appropriate therapy when available and in preventing spread to others.

Which one of the following dysfunctional speech patterns is a normal characteristic of the language development of a preschool child? a. Lisp b. Echolalia c. Stammering d. Repetition without meaning

ANS: C Stammering and stuttering are normal dysfluency in preschool-age children. Lisps are not a normal characteristic of language development. Echolalia and repetition are traits of toddlers' language.