Growth and Development Practice Questions NSG 363

Four-month-old Jessie is being evaluated in the developmental clinic. Which of the following would be most concerning? a. He doesn't hold objects in his hands b. He doesn't rake objects with his hands c. He doesn't transfer objects from hand to hand d. He doesn't clap his hands

ANS: A A 3-month-old infant should grasp and hold objects in his hands. A 4-month-old infant should be developing the skill of raking objects with his hands and transferring objects from hand to hand. An infant develops the skill of clapping his hands between 10 and 12 months.

What is the most important consideration when telling a 4-year-old child about an upcoming procedure? a. Use simple terms b. Speak loudly and clearly c. Offer a toy to keep the child happy d. Include every detail

ANS: A The anterior fontanel closes between 12 and 18 months of age. So in a healthy 6-month-old, the nurse would expect it to be open. Both a sunken fontanel, a sign of dehydration, and a bulging fontanel, a sign of increased intracranial pressure, are abnormal findings in a healthy 6-month-old.

Which of the following assessments would be abnormal in a newborn? a. Closed posterior fontanel b. Red, flaky skin c. Crossed-eyes d. Vernix

ANS: A The anterior fontanel normally closes between 12 and 18 months of age. Prior to this time, the open anterior fontanel allows for brain growth and compensation of changes in intracranial pressure.

When performing a physical assessment of a 10-year-old girl, the nurse keeps in mind that the first sign of sexual maturity is: a. Breast bud development b. Pubic hair c. Axillary hair d. Menarche

ANS: A The first sign of puberty in females is breast budding (average age=10 years), followed by axillary and pubic hair development (average age=11 years), height spurt (average age=12 years), and finally menarche (average age=13-14 years).

Which is the first sign of puberty in males? a. Testicular enlargement b. Pubic hair development c. Growth spurt d. There is no specific order of events as puberty follows an individual development pattern

ANS: A The following is the progression of puberty in males. Testicular enlargement is first on average at 11 years of age. Pubic hair is second on average at 12 years of age. The height spurt is the last sign of puberty on average of 13-14 years of age.

The mother of one-year-old Rowan asks the nurse how many words she should have in her vocabulary. The nurse emphasizes that each child's vocabulary develops in a unique manner and tells the mother that most 12-month-olds have a vocabulary consisting of: a. 1-2 words b. 5 words c. 20 words d. 50 words

ANS: B Most 1-year-old children have a vocabulary of about 5 words. A vocabulary of 50 words is not usually developed until 18 months.

Jessica's physical reveals that her BMI is at the 90th percentile. You correctly explain to her mother: a. "A BMI in the 90th percentile indicates that Jessica is overweight, would you like to talk to a dietician?" b. "Jessica is perfectly healthy and is taller than most children her age." c. "A BMI in the 90th percentile indicates a risk of becoming overweight, we can discuss ways to reduce this risk." d. "A BMI in the 90th percentile indicates that Jessica is underweight, let's talk about her dietary intake."

ANS: A A BMI between 85% and 95% indicates that the child is overweight. A child is considered obese when the BMI is greater than 95%. A BMI of 90% does not indicate that the child is healthy and does not indicate that the child's height is above average. A child is considered underweight when the BMI is less than 5%.

The nurse is playing with an infant who has just had a PICC line placed. When the nurse hides a small toy under a blanket, the infant actively looks for it while lifting up the blanket. How old is this infant likely to be? a. 2 months b. 4 months c. 6 months d. 8 months

ANS: A A BMI between 85% and 95% indicates that the child is overweight. A child is considered obese when the BMI is greater than 95%. A BMI of 90% does not indicate that the child is healthy and does not indicate that the child's height is above average. A child is considered underweight when the BMI is less than 5%.

14-year-old Thalia is being treated for acute renal failure. In order to help meet her developmental needs, which of the following is important to include in her plan of care? a. Provide privacy and respect her need for modesty b. Promptly respond to her call light and reassure her that her needs will be met c. Encourage one of her parents to spend the night d. Provide opportunities for Thalia to participate in her care to encourage her sense of achievement

ANS: A Adolescents are in Erikson's stage of identity vs role confusion. It is important to respect their need for privacy and modesty as the child's body is rapidly changing. Although it is important to respond to every child's call light, consistently meeting a child's needs reflects the infant stage of trust vs mistrust. The adolescent may prefer to have a peer spend the night. Encouraging a sense of achievement is important for the school-age child.

Why does the nurse instruct the mother of an infant who is being introduced to baby foods for the first time to wait a few days before adding another new type of food to his diet? a. To determine if he has allergies to new foods b. To allow his digestive system to adjust to the new foods c. To determine which foods, he really likes d. To prevent food avoidance

ANS: A Baby foods are introduced one at a time in order to identify any potential reactions to a particular food. It is best to wait 4-7 days in between each new food type in order to identify a particular food that may be the source of an allergic reaction.

Four-year-old Erica is admitted today for treatment of pyelonephritis. You know that Erica is in which developmental stage according to Erikson? a. Initiative vs guilt b. Identity vs role confusion c. Industry vs inferiority d. Autonomy vs shame and doubt

ANS: A Erikson's theory describes the psychosocial development of children. each stage involves a core conflict or problem that must be resolved in order for healthy personality development to occur. Initiative vs guilt is the stage for children ages 3-6. Initiative is fostered by allowing the child to successfully achieve new skills and become more independent.

A preschooler's mother states she is concerned that her child has an imaginary playmate. Which of the following is the nurse's best response? a. "Many 4-year-old children have imaginary playmates, it really isn't cause for concern." b. "This is unusual, as she experienced stressful events lately?" c. "It really isn't cause for concern, as long as she doesn't talk to the imaginary friend." d. "Most children don't develop imaginary playmates until much later in childhood"

ANS: A Imaginary playmates are typical of the preschool-age child. Many children talk to their imaginary playmates. This is not a cause for concern.

The nurse would expect a 4-month-old to: a. Attempt to roll over b. Sit alone c. Begin to crawl d. Grasp feet and pull them to their mouth

ANS: A Infants begin to roll over beginning at 4 months, first from the stomach to back and then from back to stomach. Infants sit without support beginning at 5 months and eventually develop the ability to sit without support by 8 months. By 6 months the infant pushes up from the stomach onto the hands and knees and rocks back and forth in that position until eventually crawling by 9 months. Grasping feet and pulling them to the mouth occurs at 5 months.

The nurse is caring for 3-year-old Emily diagnosed with diabetes. Which of the following should be included in her plan of care? a. Allow Emily to handle and play with equipment being used in her care b. Avoid talking about the disease process c. Give Emily detailed explanations with pictures if possible d. Encourage participation in procedures such as finger sticks and insulin administration

ANS: A It is important to allow a preschooler the opportunity to handle and play with equipment being used in her care. Short simple explanations are most appropriate for a preschooler. Participation in procedures should be encouraged within age-appropriate limits. Finger sticks and insulin administration are not appropriate tasks for a 3-year-old to participate in.

Mrs. Garcia brings 5-year-old Jessie to a local museum where children are encouraged to interact with the attractions. She praises and helps him explore the museum. What kind of play is this known as? a. Mutual play b. Imaginative play c. Solitary play d. Parallel play

ANS: A Mutual play occurs when a parent offers praise and support while encouraging a child to explore their environment. Imaginative play occurs when children pretend. It is typical of preschool children. Solitary play occurs when children play without regard for what others around them are doing. It is typical of infancy and early toddlerhood. Parallel play occurs when children play side by side. It is typical of toddlers.

A healthy 6-month-old is brought to the well-baby clinic for a checkup. When assessing the infant's anterior fontanel, the nurse expects it to be: a. Open b. Sunken c. Closed d. Bulging

ANS: A The anterior fontanel closes between 12 and 18 months of age. So in a healthy 6-month-old, the nurse would expect it to be open. Both a sunken fontanel, a sign of dehydration, and a bulging fontanel, a sign of increased intracranial pressure, are abnormal findings in a healthy 6-month-old.

Which developmental milestone would you expect to see the 9-month-old developing: a. Pincer grasp b. Walking c. Speaking with intelligible words d. Sitting up without support

ANS: A The normally developing 9-month-old is developing the pincer grasp through activities such as picking up Cheerios or other small finger foods. While a 9-month-old may be walking, this is typically a developmental milestone for the child between 12 and 15 months. The 9-month-old typically says ma-ma and da-da in the correct context. Sitting up without support is achieved by 8 months.

The nurse is caring for a child who knows his first and last name, speaks in 3-4 word sentences, and knows his age. The child is at least how old? a. 3 years old b. 4 years old c. 5 years old d. 6 years old

ANS: A These skills are typically developed by the age of 3.

Two-year-old Maria's mother needs to briefly leave the hospital to pick up Maria's sister from preschool. She is worried about how Maria will react. The nurse's best suggestion is: a. "Tell Maria you need to get her sister and you will be back when lunch is over and Dora the Explorer comes on TV." b. "Tell Maria you need to leave to get her sister and if she doesn't cry you will bring her a surprise." c. "Wait until Maria takes her nap and then sneak out." d. "I will distract Maria while you leave, we will get her a toy to keep her entertained."

ANS: A Two-year-old children understand time in terms of routine. A toddler would comprehend that her mother is returning after lunch at the start of a favorite show. Although toddlers enjoy rewards it is inappropriate to discourage her from expressing her feelings. It is better, to be honest with a child. If the child was to wake up during the time when her parents were absent, she would most likely be more anxious.

You are the nurse at the community health clinic. The mother of a 2-year-old male expresses concern to you that her previously healthy child is non-verbal. Which of the following responses is most appropriate? a. "Try not to worry. Language milestones vary. Boys tend to lag behind girls." b. "Given your son's age, we should probably test his hearing to be sure that is not the source of his delayed language skills." c. "Autism is the most frequent reason why children as old as 2 years of age are non-verbal. We will likely consult a developmental pediatrician for an evaluation." d. "Let's look at your son's birth order as this is a significant predictor of language skills development."

ANS: B A 2-year-old should be speaking in 2-3-word sentences. Hearing deficit is the most common cause of a young child's failure to develop speech. Birth order does affect the development of language, but would not explain the failure of a 2-year-old to speak, it is far less common than a hearing deficit and would accompany other findings such as lack of eye contact, repetitive behavior, and lack of social interaction.

The nurse is preparing to provide education to a 9-year-old girl with asthma. Which of the following should be taken into consideration? a. The child should be the focus of the education b. The parent should be the focus of the education c. Information should be provided in written form only d. The parent should be encouraged to ask questions when the child is not present

ANS: B Although the child should be included in the education, the parent should still be the focus of the education. Information should be provided in a manner that addresses the learner's preferred learning style. Questions should be encouraged and not hidden from the child.

Ella is a 15-year-old admitted with a diagnosis of asthma. During the admission history, she admits that she is currently smoking. The nurse incorporates a long-term goal of smoking cessation in Ella's care plan. Which of the following interventions would be most effective in helping Ella quit smoking? a. Ask Ella open-ended questions about why she feels the need to smoke b. Have Ella attend a smoking cessation group led and attended by other teens c. Instruct Ella's parents to restrict her activity until she stops smoking d. Show Ella pictures of the inside of a smoker's lungs

ANS: B An adolescent is likely to identify and share values with other teens. Having her attend a peer-led group is the most effective manner of influencing and changing her behavior. Although open-ended questions are an effective means of communicating with teens, it is not the optimal way in which to encourage a teen to quit smoking. That option is likely to decrease communication. Although visual aids may be helpful, a peer-led group is the most influential motivator.

The mother of an infant tells the nurse, "Molly used to put her hands in her mouth but now she is placing her feet in her mouth." The nurse knows that this is an example of what concept of development? a. Proximodistal b. Cephalocaudal c. General to specific d. Stereognosis

ANS: B Cephalocaudal refers to the development that occurs from head to toe. A child that is playing with their upper extremities before their lower extremities is developing in a head-to-toe manner. Proximodistal refers to the development that occurs from the trunk outward to the extremities. General to specific is not represented in this scenario.

A group of preschool-age children are playing with dress-up clothes. This kind of play is known as: a. Imaginative play b. Dramatic play c. Parallel play d. Team play

ANS: B Dramatic play is typical of preschool-aged children. It often involves dressing up in clothes, hats, and shoes. Imaginative play involves pretending and is typical of preschool children. Parallel play occurs when children play side by side. It is typical of toddlers. Team play typically involves school-age children interacting and following specific rules.

6-year-old Josie is being seen in the emergency room after falling off her bike. The nurse is preparing to assist with suturing her scalp lacerations when Josie cries out, "I'm sorry I didn't wear my helmet, I promise I will be good next time, please don't hurt me!" Which of the following is the nurse's best response? a. "Helmets are very important and protect your head, make sure you wear one next time." b. "We need to fix your head, you are doing such a great job of trying to stay still." c. "You are right. You probably wouldn't be here if you had worn a helmet." d. "This won't take very long. You are lucky you weren't hurt really bad."

ANS: B It is important for the nurse to encourage the child to help her cope with a stressful and potentially painful procedure. Although it is important for the nurse to provide education, it is inappropriate to do so during a painful procedure. It is also important to dispel the child's feelings of guilt as she is experiencing magical thinking and likely thinks the sutures are punishment for not wearing her helmet. It is inappropriate to reinforce feelings of guilt. Actions should be geared toward encouraging the child and helping her cope.

The nurse is teaching a parenting class to a group of expectant parents. One of the parents asks at what age a child typically begins to develop modesty. Which of the following is the nurse's best answer? a. "Most children do not develop modesty until the adolescent years." b. "Most children develop modesty by age 4." c. "Most children develop modesty by the age of ten." d. "Most children develop modesty by 2."

ANS: B Most children develop modesty by the age of four. It is a good idea to reinforce body safety at this time by teaching preschoolers and young school-age children that "no one should look or touch where their bathing suit covers unless they are your mommy, daddy, doctor or nurse."

The nurse is watching a group of toddlers in the playroom. Which of the following types of play is typical of toddlers? a. Solitary b. Parallel c. Team play d. Mutual play

ANS: B Parallel play in which children play side by side is associated with the toddler years. Solitary play is associated with infancy and early toddlerhood. Team play is associated with school-age children. Mutual play is associated with children from infancy through school age. It is not seen in groups but occurs between caregiver and child.

A parent calls the clinic to express concern over her child's eating habits. She says the child eats very little and consumes only a single type of food for weeks on end. The nurse knows this behavior is characteristic of: a. Toddlers b. Preschool-age children c. School-age children d. Adolescents

ANS: B Pre-school children are known for their relatively small appetites and food jag-eating behaviors. Also, preschoolers have a relatively slow rate of growth and, therefore, require fewer calories for growth. Food jags generally disappear after this developmental phase. Generally, it is recommended that parents and caregivers avoid battles over food, particularly among toddlers and preschoolers.

At 18 months Jose is admitted for same-day surgery. What does the nurse anticipate as his biggest fear? a. Pain b. Separation anxiety c. Death d. Body integrity

ANS: B Separation anxiety is the greatest fear among toddlers. Fear of pain and invasion of body integrity are issues of concern for older preschoolers and particularly school-age children. Fear of death is a more common concern for the adolescent who is able to think abstractly.

When developing a plan of care for an adolescent, the nurse considers the child's psychosocial needs. During adolescence, psychosocial development depends on: a. Becoming industrious b. Establishing an identity c. Achieving intimacy d. Developing initiative

ANS: B The adolescent is in Erikson's developmental stage of Identity versus Role Confusion. If the adolescent successfully masters this phase, she will develop a sense of identity with regard to personal identity, beliefs and/or values, sexual identity, and goals for a future job or vocation.

Carlos is a healthy infant. His mother is concerned about starting him on baby foods. You know that the earliest time to start baby foods is: a. 3 months b. 4 months c. 6 months d. When the infant starts waking up at night

ANS: B The child is physiologically ready for the introduction of baby foods at 4 months when the tongue extrusion reflex disappears.

The nurse is caring for an infant who raises her chest when lying on her stomach, is beginning to babble, and follows an object 180 degrees with her eyes. Which of the following ages is she likely to be? a. 4 weeks b. 3 months c. 4 months d. 5 months

ANS: B The described skills are appropriate for a 3-month-old to be doing. The 4-week-old child is not likely to be displaying the above skills. The infant should have mastered the above skills prior to 4 and 5 months.

You are the nurse in the adolescent clinic caring for 14-year-old, Lisa, who experienced menarche one year ago. Lisa is concerned that she is short and wants to know if she will grow much taller. Based on your knowledge of growth and development you know that: a. In girls, menarche occurs early in puberty before the height spurt b. In girls, menarche occurs late in puberty after the height spurt c. In girls, the peak height velocity is usually around 15 years d. It is impossible to predict how much more Lisa will grow

ANS: B The height spurt occurs earlier in puberty among girls as compared to boys. The average peak height velocity among girls is 12 years. There is limited growth potential after menarche with an average of 2.5 cm. Girls have a shorter period of time in which to grow and a lower rate of growth during the pubertal height spurt as compared to boys.

Which of the following developmental milestones of the 5-month-old best reflects the principle of proximodistal growth and development? a. Babbling b. Raking objects c. Rolling over d. Eating solid foods

ANS: B The principle of proximodistal growth and development states that children develop from the trunk outward to the tips of the extremities. Raking objects, which develops at 4 months, involves the use of hands to "rake" objects prior to the development of the more specific pincer grasp occurring by 9 months of age.

When assessing a school-age child's development the nurse understands that a primary developmental task of this age group is: a. Learning to read b. Developing friends c. Learning to trust others d. Developing independence

ANS: B The school-age child is in Erikson's stage of Industry vs Inferiority. The primary job of the school-age child is to develop competence through achievement in school and the development of friendships. Important nursing assessment for the psychosocial, and personality development of the school-age child is the assessment of the adjustment and success in the school setting as well as the formation of friendships.

When assessing a toddler's growth and development, the nurse understands that a child in this age group displays behavior that fosters which developmental task? a. Initiative b. Autonomy c. Trust d. Industry

ANS: B The toddler between 1-2 years of age is in Erikson's developmental stage of Autonomy versus Shame and Doubt. The virtue that begins to develop is will. The toddler exerts his or her autonomy with statements like "Me do", "No" and "Mine". The toddler requires opportunities to accomplish independent tasks and respond to simple instructions, while supervised.

Which nursing action would be most important in the psychosocial support of a 2-year-old who is having an invasive procedure performed? a. Assuring her that it is not her fault b. Providing parental presence c. Providing adequate pain control d. Performing the procedure quickly

ANS: B The two-year-old is in Erikson's stage of Autonomy versus Shame and Doubt and Piaget's sensorimotor stage. Toddlerhood is a marked time of heightened separation anxiety with a marked fear of strangers. For a child of this age, the most appropriate psychosocial support is to promote the presence of the primary caregiver.

The mother of a two-year-old voices concern because her child does not share and uses the word "mine." You know that this is typical of which developmental stage according to Erikson: a. Trust vs mistrust b. Autonomy vs shame and doubt c. Initiative vs guilt d. Industry vs inferiority

ANS: B Toddlers' personality development is guided by Erikson's stage of Autonomy versus Shame and Doubt. Toddlers are inherently egocentric. It is normal for them to have difficulty sharing and to say "mine". This behavior will pass when the child becomes a preschooler and enters the preoperational stage where he/she begins to learn the concepts of sharing and the thoughts and feelings of others.

The nurse is caring for a 5-year-old with leukemia. When planning the care for this child, the nurse considers that the child is in which of the following of Erikson's stages? a. Trust vs mistrust b. Industry vs inferiority c. Initiative vs guilt d. Identity vs role confusion

ANS: C

A group of children are playing in the playroom. The children are tested on the concept of conservation. One child has just mastered this concept. How old is this child most likely to be? a. 4 years b. 6 years c. 8 years d. 12 years

ANS: C An 8-year-old child is considered to be in the concrete operations phase of cognitive development which is an appropriate time to understand the concept of conservation. 4 and 6-year-old children are considered to be in the preoperational phase and are not likely to understand the concept of conservation. A 12-year-old child is considered to be in the formal operations phase of cognitive development and likely to have mastered the concept of conservation years earlier.

Which of the following assessments would be most concerning in a 3-month-old? a. Closed posterior fontanel b. Inability to roll over c. Failure to track objects through visual fields d. Failure to laugh

ANS: C An infant develops the ability to track objects by 3 months of age, so the failure to do so is a concerning sign in a 3-month-old infant. The posterior fontanel closes by 2-3 months of age. The infant does not begin to roll over until 4 months of age, so this is not a developmental delay at this point. Laughing typically occurs at 4 months of age.

Evelyn, a 2-year-old admitted with RSV is which of the following stages of psychosocial development? a. Trust vs mistrust b. Autonomy vs guilt c. Autonomy vs shame and doubt d. Initiative vs guilt

ANS: C Autonomy vs shame and doubt is the developmental stage of toddlerhood.

The nurse is teaching a parenting class when a mother asks when a child develops a conscience. Basing her response on Erikson's theory of development, the nurse knows that this usually occurs during which of the following stages? a. By the end of the first year of life b. By the end of the toddler stage c. During the preschool stage d. During the school-age stage

ANS: C Children usually recognize an "inner voice" during the preschool years. The development of conscience does not occur during the infant or toddler years. Conscience development, however, should occur before the school-age years.

Which of the following statements concerning growth and development is true? a. Growth implies an increase in size and development b. Development refers to the maturation of structures of the body but does not include growth c. Development refers to the maturation of structures of the body and includes growth d. Growth and development usually progress from specific to general

ANS: C Development refers to the maturation of structures of the body and includes growth. Growth and development progress from general to specific. Growth implies an increase in size but does not necessarily include development.

Sam is a 2-month-old who weighed 8 pounds at birth. Based on your knowledge of pediatric growth and development you know that his weight at 1 year should be at least: a. 16 pounds b. 20 pounds c. 24 pounds d. 32 pounds

ANS: C Infants should minimally double their birth weight at 5-6 months and triple it by 1 year. After 1 year of age, weight gain is attributable to the environment, genetics, and whether or not the child has a chronic condition.

Nine-year-old Jordan is being seen in the diabetes clinic. He tells the nurse that he is responsible for testing his own blood sugar and administering his own insulin based on a sliding scale. Which of the following is the most appropriate action for the nurse? a. Praise and encourage Jordan to continue as he has done a good job with increased responsibility b. Contact a social worker as Jordan is assuming too much responsibility for his age c. Gather more information about Jordan's diabetic care from his parents d. Tell Jordan that someone his age is unable to take on this much of his care

ANS: C It is essential to gather more information prior to forming a plan of care. The nurse should praise Jordan but should gather more information before encouraging him to continue. Based on the information provided, it appears that he is taking on too much responsibility for his age. The nurse should gather more information before contacting a social worker.

The nurse is observing a group of children playing at a park. She notes one child is running and overhears her mother's state, "Look at Cindy go! She just learned how to run." The nurse correctly estimates her age to be: a. 12 months b. 18 months c. 24 months d. 36 months

ANS: C Most children develop the skill of running at 24 months

The mother of an infant asks the nurse at what age she can give her Cheerios as a snack. Which of the following ages represents the age at which pincer grasp is developed? a. 3 months b. 6 months c. 9 months d. 12 months

ANS: C Pincer grasp develops at 9 months

According to Piaget, the child who is beginning to imitate behavior is in which of the following stages? a. Intuitive b. Preconceptual c. Sensorimotor d. Reflexive

ANS: C The child progresses from reflexive behavior to imitate behavior during the sensorimotor stage. The Preoperational stage begins at the age of 2 and occurs after imitative behavior has begun. The preconceptual stage is the first phase of the preoperational stage and begins at the age of 2. The intuitive stage is the second phase of the preoperational stage and begins at the age of 4 and represents a higher level of cognitive development.

Which of the following is cause for concern in a 6-month-old child? a. The infant does not sit without support b. The infant does not clap his hands c. The infant does not grasp and hold objects d. The infant does not have a pincer grasp

ANS: C The infant should grasp and hold objects by 3 months. The infant should sit without support at 8 months, demonstrate pincer grasp at 9 months, and clap his hands between 10 and 12 months.

The nurse is caring for a 3-year-old child who is restricted to bed rest due to a fractured femur. Which of the following toys should the nurse select for this child?a. A stuffed bear b. A large ball c. Dress up clothes d. A play hammer and pounding board

ANS: D A hammer and pounding board will help develop gross motor skills and release frustration due to immobilization. A stuffed toy may be ok for rest but is not the ideal toy for play. A large ball is a good toy for a 3-year-old who can move about but would pose frustration for a child on bed rest. Dress-up clothes would be difficult to maneuver and may lead to frustration.

The mother of 3-month-old Bryan tells the nurse that she is concerned that he doesn't turn his head toward her when she talks to him. Which of the following is the nurse's best response? a. "The hearing doesn't mature for almost a year, keep an eye on him and we will talk about it more at his next visit." b. "Bryan can most likely hear but lacks muscular maturity to turn his head. His muscles will continue to develop over the next few months." c. "It is not uncommon for an infant's hearing to lack maturity at this age, continue to work with him and we will see how he is doing in a month." d. "This can be a concern, tell me more about things you have noticed regarding Bryan's hearing."

ANS: D A three-month-old infant should turn his head in response to sound. It is appropriate for the nurse to gather more information since further evaluation is required.

Which of the following would be most helpful when assessing a child's bone age? a. Birth date b. Body mass index c. Blood test d. X-rays

ANS: D Bone age is determined by taking x-rays of the child's hands and wrists for comparison against an atlas of standard x-rays categorized by age. This test is used to predict the remaining height growth prediction given a certain bone age. Typically, a child's bone age should match their chronological age. A delayed bone age as compared to chronological age is consistent with an increased height growth prediction, while an advanced bone age as compared to chronological age is consistent with a decreased height growth prediction.

The nurse is caring for two-year-old Mikey hospitalized with cellulitis. When selecting a toy for him which of the following is the best choice? a. A simple board game such as Chutes and Ladders b. A stuffed animal c. Crayons and coloring book d. Large dump trucks and cars

ANS: D Dump trucks and garbage trucks will likely encourage physical activity and are an appropriate choice for a toddler. A 2 ½-year-old is not developmentally ready for even a simple board game. Although a stuffed animal may provide comfort, it will not likely encourage physical activity. Most toddlers do not have the attention span to enjoy playing with crayons and coloring books.

The father of a 9-month-old brings his daughter Julie to the clinic for a well-baby assessment. The father asks why it is important to record Julie's length and weight on a growth chart. What is the nurse's best response? a. "The growth charts are used to plot Julie's growth and we can see how she is growing compared to other 9-month-old girls throughout the world." b. "It is important to measure her to see if she is too heavy or too small." c. "We measure all babies." d. "The growth charts show how Julie's length and weight compare to other infants her age as well as show us a pattern over time."

ANS: D Growth charts offer the ability to observe a pattern over time, as well as a comparison among other children of the gender in the U.S. Growth charts, compare the growth rates of children in the U.S., not the world. Although growth charts do allow the practitioner to assess the infant's size, they are also used to observe the pattern of growth over time.

You note that Joshua's head circumference is now smaller than his chest circumference. His age is most likely? a. 3 months b. 9 months c. 15 months d. 30 months

ANS: D The chest circumference is greater than the head circumference after the age of 24 months. The head circumference is greater than the chest circumference from birth to 6 months. The head circumference is equal to the chest circumference between the ages of 6 and 24 months.

When assessing the development of a 6-month-old, which of the following would be most concerning? a. The child weighs twice as much as his birth weight b. The child does not look for hidden objects c. The child does not understand the word "no" d. The child does not transfer objects from one hand to the other

ANS: D The infant can transfer objects from one hand to the other at 5 months. Failure to achieve this fine motor developmental task is considered a developmental delay in a 6-month-old. The 6-month-old should weigh at least twice as much as her birth weight. Looking for hidden objects is an example of the understanding of object permanence, which occurs at 8-12 months. Infants understand the word "no" by approximately 9 months.

Which of the following would most likely pose the greatest fear for 7-year-old Dana who was recently admitted to your unit for treatment of osteomyelitis? a. Oral medications b. A visit from the doctor c. Having her mother leave for a few minutes d. An IM injection

ANS: D Young school-age children are particularly fearful of disruption of their body integrity. Stranger anxiety subsides at the end of infancy and separation anxiety typically resolves at the end of toddlerhood.

Which is an example of cephalocaudal development? a. A child crawls before he walks; walks before he runs; runs before he jumps b. A child lifts his head before lifting his shoulders; sits with support before sitting without support c. A child rakes toys before developing a pincher grasp; develops a pincer grasp before feeding himself with a spoon d. A child first develops reflexive behaviors; then develops imitative behaviors

NS: B The principles of cephalocaudal development state that a child develops from head to toe.