NUR Peds Ch. 1-18

1) The newest nurse on the pediatric unit is concerned about maintaining a professional distance in her relationship with a patient and the patient's family. Which comment indicates that she needs more mentoring regarding her patient-nurse relationship? a. "I realize that caring for the child means I can visit them on my days off if they ask me." b. "When the mother asks if I will care for her daughter every day, I explain that the assignments change based on the needs of the unit." c. "When the mother asks me questions about my family, I answer politely, but I offer only pertinent information." d. "I engage in multidisciplinary rounds and listen to the family's concerns."

a

10) The type of play in which infants engage is called: a. Solitary b. Parallel c. Associative d. Cooperative

a

1) What is the overriding goal of atraumatic care? a. Prevent or minimize the child's separation from the family. b. Do no harm. c. Promote a sense of control. d. Prevent or minimize bodily injury and pain.

b

4) A nurse looks over her assignment for the day that includes an infant, a preschool-age child, a third-grader, and a sophomore in high school. Which techniques take into consideration developmental stages when working with pediatric patients? a. Being aware that infants will become agitated due to stranger anxiety around age 4 months. b. When a preschooler is getting blood drawn, giving a detailed explanation will be helpful. c. Explaining and demonstrating what the blood pressure machine does to the third-grader before taking her blood pressure. d. Using a single consistent approach with the adolescent will help allay anger and hostility.

c

10E) The nurse is assessing a 6-month-old infant who is noted to have head lag. What is the appropriate response documentation in the chart related to this finding? a. Normal development b. Cognitive impairment noted, follow-up in 1 month c. Developmental, neurologic evaluation referral d. Teach parents to practice exercises with infant

c Most infants have only slight head lag when pulled from a lying to a sitting position at 4 months of age. By 6 months, head control should be well established. Developmental neurologic evaluation is indicated to determine why the child is not achieving an expected milestone. The head lag is suggestive of a developmental delay. It does not provide information about cognitive status. As part of normal development, interventions cannot be done until a cause is identified.

1E) What is the leading cause of death from unintentional injuries in children? a. Poisoning b. Drowning c. Motor vehicles d. Fires and burns

c Motor vehicle-related injuries are responsible for more than half of the injury-related deaths in children. Half of all poisonings occur in children younger than the age of 4 years, and it is the third leading cause of injury in those 15 to 24 years of age. Drowning and burns are among the top three causes of death for boys and girls throughout childhood.

13E) In terms of fine motor development, what would a 3-year-old child be expected to do? a. Tie shoelaces. b. Use scissors or a pencil very well. c. Draw a person with seven to nine parts. d. Draw single-line shapes such as circles.

d Three-year-old children are able to draw single-line shapes such as circles. A 5-year-old child's fine motor skills include the ability to tie shoelaces, use scissors or a pencil, and draw a person with seven to nine parts.

6) Which childhood vaccine provides some protection against bacterial meningitis, epiglottis, and bacterial pneumonia? a. Hib vaccine b. Hepatitis B vaccine c. Varicella vaccine d. Influenza vaccine

a (hint- it's the only bacterial vaccine)

12) One of the primary reasons for monitoring the toddler's activities and intervening to prevent accidental injury is that: a. Toddlers have oppositional defiant behavior and negativism. b. Toddlers do not understand the concept of "cause and effect" so explaining that certain actions will result in serious injury is useless. c. Toddlers will often listen to reasoning about why an activity should be avoided. d. Toddlers enjoy making their parents worry about their safety and like to see the parents' reactions to the behavior.

b

12) The typical play activity in which toddlers engage is called: a. Solitary b. Parallel c. Associative d. Cooperative

b

6) One of the most common intestinal parasitic pathogens in the US acquired from a contaminated water sources such as a lake or swimming pool is: a. Tinea capitis b. Giardia intestinalis c. Pediculosis capitis d. Enterobiasis

b

6E) What disease would require strict isolation of the patient? a. Mumps b. Chickenpox c. Exanthema subitum (roseola) d. Erythema infectiosum (fifth disease)

b Chickenpox is communicable through direct contact, droplet spread, and contaminated objects. Mumps is transmitted from direct contact with the saliva of the infected person and is most communicable before the onset of swelling. The transmission and source of the viral infection exanthema subitum (roseola) is unknown. Erythema infectiosum is communicable before the onset of symptoms.

10) An important nutritional supplement recommended to prevent rickets in infants who are exclusively breastfeeding is: a. Vitamin A b. Fluoride c. Vitamin D d. Folic Acid

c

5E) What is a common significant side effect from opioid administration? a. Euphoria b. Diuresis c. Constipation d. Allergic reactions

c Constipation is one of the most common side effects of opioid administration. Preventive strategies should be implemented to minimize this problem. Sedation is a more common result than euphoria. Urinary retention, not diuresis, may occur with opiates. Rarely, some individuals may have pruritus.

11E) What are the most common food allergens that need to be considered when educating parents of an infant? a. Fruit, eggs, and rice b. Fruit, vegetables, and wheat c. Eggs, cow's milk, and peanuts d. Cow's milk and green vegetables

c Milk products, eggs, and peanuts are three of the most common food allergens. Ingestion of these products can cause sensitization and, with subsequent exposure, an allergic reaction. Eggs are a common allergen but not fruit or rice. Wheat is a common allergen but not fruit and vegetables. Cow's milk is a common allergen but not green vegetables.

6E) What illnesses does respiratory hygiene and cough etiquette by the Centers for Disease Control and Prevention (CDC) prevent? a. HBV, Hib, and pertussis b. HSV, influenza, and HBV c. RSV, influenza, and adenovirus d. RSV, pertussis, and varicella

c The CDC (2007) recommends respiratory hygiene and etiquette to prevent the transmission of RSV, influenza, adenovirus, and other droplet-transmitted unknown viruses. HBV, HSV, and varicella are not transmitted via droplets.

2) Family systems theory includes: a. Direct causality, meaning each change affects the whole family. b. Family systems react to changes as they take place, not initiate it. c. A balance between morphogenesis and morphostasis is necessary. d. Theory is used primarily for family dysfunction and pathology.

c page 16 Both too little change and too much change are dysfunctional for the family system; therefore a balance between morphogenesis (change) and morphostasis (no change) is necessary.

11) Which factors are considered protective factors for SIDS? a. Side sleeping position, breastfeeding, updated childhood immunization status b. Supine sleeping position, breastfeeding, soft bedding c. Prone sleeping position, exposure to maternal tobacco use, updated childhood immunization status d. Supine sleeping position, breastfeeding, updated childhood immunization status

d

6E) The hepatitis A vaccine is now recommended for the first dose started at what age? a. 1 year b. 1 month c. 12 years d. It is not recommended at any age

a Hepatitis A has been recognized as a significant child health problem, particularly in communities with unusually high infection rates. Hepatitis A virus is spread by the fecal-oral route and from person-to-person contact, by ingestion of contaminated food or water, and rarely by blood transfusion. HepA vaccine is now recommended for all children beginning at age 1 year (i.e., 12 to 23 months). The second dose in the 2-dose series may be administered no sooner than 6 months after the first dose.

The nurse has a 2-year-old boy sit in "tailor" position while palpating for the presence of the testes. What is the rationale for this position? a. It prevents the cremasteric reflex. b. Undescended testes can be palpated. Incorrect c. The child has an inguinal hernia. d. The child does not yet have a need for privacy.

a The tailor position stretches the muscle responsible for the cremasteric reflex. This prevents its contraction, which pulls the testes into the pelvic cavity. Undescended testes cannot be predictably palpated. Inguinal hernias are not detected by this method. Privacy should always be provided for children.

2E) What is one of the top factors affecting children and directly related to health disparities? a. Poverty b. Divorce c. Genetic conditions d. Alternative families

a page 22-23 A major factor that affects child and family health in the United States is poverty. Nearly 1/5 of all American children live in families with annual incomes below 100% of the federal poverty level (approximately $22, 000) and almost ½ of children live 200% below the federal poverty limit ($44,000 for a family of four). Poverty affects children and their families across all geographic areas, including urban, suburban, and rural. There is a direct correlation between lower socioeconomic status (poverty) and increase health disparities in children and families.

4) These general approaches can be helpful when performing a physical exam. Select all that apply. a. With toddlers, restraint may be necessary, and requesting a parent's assistance is appropriate. b. When examining a preschooler, giving a choice of which parts to examine may be helpful in gaining the child's cooperation. c. With a school-age child, it is always best to have the parents present when examining. d. Giving explanations about body systems can make adolescents nervous due to their egocentricities. e. An infant physical exam is done head to toe, similarly to the adult.

a, b

6E) The Hib conjugate vaccine protects an infant against what diseases? (Select all that apply.) a. Bacterial meningitis b. Epiglottitis c. Bacterial pneumonia d. Septic arthritis e. Sepsis

a, b, c, d, e Hib conjugate vaccines protect against a number of serious infections caused by Haemophilus influenza type b, especially bacterial meningitis, epiglottitis, bacterial pneumonia, septic arthritis, and sepsis.

5) As the nurse is getting Nathan ready for surgery, his doctor asked you to explain preemptive analgesic to Nathan's mother. Which response leads you to believe his mother needs more teaching? a. "I understand that preemptive analgesia is giving Nathan pain medication before he has pain and could be given before surgery." b. "This medication will control Nathan's pain so he doesn't feel anything." c. "Giving this medicine early may help prevent complications after surgery." d. "By controlling Nathan's pain, he will be more comfortable and may be able to go home sooner."

b

12E) What is not an appropriate recommendations for parents of toddlers to meet fluoride requirements? a. Supervise the use of toothpaste. b. Supervise the use of fluoride rinses. c. Store fluoride products out of reach. d. Administer fluoride supplements if water fluoride content is low.

b Fluoride rinses are only suggested for children at high risk for cavities or over the age of 6 years. Toothpaste supervision, storage of fluoride products out of reach, and administration of fluoride supplements if water fluoride content is low are all recommended for toddlers.

13E) What is descriptive of a preschooler's concept of time? a. Has no understanding of time. b. Associates time with events. c. Can tell time on a clock. d. Uses terms such as "yesterday" appropriately.

b In a preschooler's understanding, time has a relation with events such as: "We'll go outside after lunch." Preschoolers develop an abstract sense of time at age 3 years. Children can tell time on a clock at age 7 years. Children do not fully understand use of time-oriented words until age 6 years.

10E) What reflexes appear at about 7 to 9 months of age? a. Moro b. Parachute c. Neck righting d. Labyrinth righting

b The parachute reflex appears at 7 to 9 months of age and persists indefinitely. The Moro reflex is one of the primitive reflexes present at birth. Neck righting appears at 3 months of age and persists until 24 to 36 months. Labyrinth righting appears at 2 months and is strongest at 10 months.

10E) The clinic is loaning a federally approved car seat to a 4.5-kg (10-pounds) infant's family. Where does the nurse teach the family is the most appropriate location to place the infant car seat? a. Back seat facing forward. Incorrect b. Middle of the back seat facing rearward. c. Front seat with air bags on passenger side. d. Front seat if there is no air bag on the passenger side.

b The rear-facing car seat provides the best protection for an infant's disproportionately heavy head and weak neck in the event of an accident. The middle of the back seat is the safest position for the child. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat.

11E) What intervention lowers the risk of sudden infant death syndrome (SIDS)? a. Smoking near the infant b. Having the infant sleep in the supine position c. Having the infant sleep with the parents instead of alone in a crib d. Making certain the infant is kept very warm while sleeping

b The supine position is recommended for all infants while sleeping. Smoking in the infant's environment increases the infant's risk for SIDS by 1.9%. There is a positive association between bed sharing with parents and SIDS. Thermal stress or overheating is associated with an increased risk of SIDS.

11E) What vitamin increases the absorption of iron? a.B12 b. C c. D d. Biotin

b Vitamin C increases the absorption of iron for hemoglobin formation. No correlation exists between vitamins B12, D, and biotin and iron absorption.

11) A 3-month-old is being seen in the well-child clinic for positional plagiocephaly. The nurse knows that the initial interventions for this condition involve which of the following? Select all that apply. a. Place the infant to sleep in the prone position. b. Place the infant in a prone position when awake (approx. 15 min.) c. Alternate the infant's head position (side of head) when asleep. d. Have the infant wear a soft helmet for 23-24 hours a day. e. Place the infant to sleep in an infant seat twice a day.

b, c

4) While interviewing parents who have just arrived in the health care clinic, the nurse begins the interview. Which of the following statements involve therapeutic communication techniques? Select all that apply. a. Allow the parents to direct the conversation so that they feel comfortable and in control. b. Use broad, open-ended questions so that the parents can feel open to discuss issues. c. Redirect by asking guided questions to keep the parents on task. d. Use careful listening, which relies on the use of clues and verbal leads to help move the conversation along. e. Ask carefully worded, detailed questions to get accurate information.

b, c, d

10) An important milestone in the infant's life is the development of object permanence. This milestone is represented by which of these statements? a. The infant smiles at the mother when she talks to him. b. The infant repeatedly flexes and extends his arms and legs when the mother picks him up. c. The infant turns and looks for the mother when she walks out of his view. d. The infant cries when the mother hands him to a babysitter.

c

13E) What is one of the benefits of imaginary playmates to the preschool child? a. Take the place of social interactions. b. Take the place of pets and other toys. c. Become friends in times of loneliness. d. Accomplish what the child has already successfully accomplished.

c One purpose of an imaginary friend is to be a friend in times of loneliness. Imaginary friends do not take the place of social interaction but may encourage conversation. Imaginary friends do not take the place of pets or toys. Imaginary friends accomplish what the child is still attempting.

5) When caring for their infant, a parent asks you, "Is Emily in a lot of pain? How would you know since she can't really tell you?" The best answer to this question is: a. "Infants don't feel pain as we do because their pain receptors are not fully developed yet." b. "The nurses give pain medication before she really feels the pain." c. "We assess her pain using an infant pain assessment tool and give the medication as needed." d. "Although we try to give her medicine before she feels pain, we watch her very closely and use different techniques to help relieve the pain."

d

11E) What dietary concerns place infants at risk for developing vitamin D-deficiency rickets? a. Exclusively formula fed b. Exposure to daily sunlight Incorrect c. Mothers who are lacto-ovovegetarians d. Families using yogurt as primary source of milk

d Yogurt does not contain adequate amounts of vitamins A and D. Commercial formulas have recommended amounts of vitamin D. Lack of sunlight is a causative factor. Individuals who follow a lacto-ovovegetarian diet use dairy products and can obtain sufficient vitamin D.

11) Vitamin A may be administered in significant amounts to children with this childhood communicable illness to decrease morbidity and mortality: a. Pertussis b. Varicella c. Rubella d. Measles

d

1E) What do morbidity rates measure? a. Life span statistics b. Acute illness, chronic disease, or disability c. Cost-effective treatment for the general population d. Prevalence of a specific illness in a population

d

10E) A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. What does the nurse recommend based on the American Academy of Pediatrics? a. Skim milk b. Whole cow's milk c. Commercial formula without iron d. Commercial iron-fortified formula

d For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, then iron-fortified commercial formula should be used. Cow's milk should not be used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron-deficiency anemia.

11) The recommended treatment for cow's milk protein allergy is the substitution of cow's milk-based formula for: a. Goat's milk b. Soy milk or a hydrolyzed formula c. Whole milk d. Evaporated milk

b, c

6) Which vaccine do the CDC and American College of OB's and Gynecologists recommend that pregnant adolescents and women who are not protected against pertussis receive optimally between 27 and 36 weeks of gestation or postpartum before discharge from the hospital? a. DTaP b. Td c. IPV d. Tdap

d

6) Which of the following should be used in the care of all pediatric patients to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection? a. Transmission-Based Precautions b. Airborne Precautions c. Standard Precautions d. Droplet Precautions

c

5E) The nurse is educating a new nurse on identification of pain in children. What does the nurse teach about physiologic measurements in children's pain assessment? a. Not useful as the only indicator for pain b. Best indicator of pain in children of all ages c. Most value when children also report having pain d. Essential to determine whether a child is telling the truth about pain

Physiologic manifestations of pain may vary considerably, so they do not provide a consistent measure of pain. Heart rate may increase or decrease. The same signs that may suggest fear, anxiety, or anger also indicate pain. In chronic pain, the body adapts, and these signs decrease or stabilize. Physiologic measurements are of limited value and must be viewed in the context of a pain rating scale, behavioral assessment, and parental report. When the child reports pain on an appropriate pain scale, the appropriate interventions should be used.

12) A common cause of accidental death in children ages 1 to 19 years involves MV crashes. Evidence from test crashes indicates that the safest action to prevent accidental deaths in toddlers includes: a. Placing the child in a rear-facing weight-appropriate car restraint seat until the child has outgrown the car seat manufacturer's height and weight recommendations. b. Allowing the child to ride in the front seat with a lap-shoulder seat restraint to avoid emotional outbursts. c. Allowing the child to ride in a forward-facing booster restraint seat after 12 months of age. d. Placing the child in the regular seat using the lap-shoulder belt as long as the child weighs as least 45 pounds.

a

11E) Deficiency of what vitamin correlates with increased morbidity and mortality in children with measles and increased complications from diarrhea and infections? a. A b. C c. Niacin d. Folic acid

a Vitamin A deficiency contributes to increased morbidity in measles, diarrhea, and infections. The American Academy of Pediatrics recommends that supplementation be considered in children with measles and related disorders. No correlation exists between vitamin C, niacin, and folic acid and increased morbidity and mortality with measles.

13) At an appointment at the pediatrician's office, a patient's mother states, "My son gets rough with some of the neighborhood kids. I am worried that he is becoming a bully." Which statement by the mother needs more teaching? Select all that apply. a. When my son becomes aggressive, I feel he needs to be punished. b. I think it is good for him to bond with his dad, so they often watch TV together. c. I am trying to get him to learn to say what he is upset about in words. d. Boys will be boys, so I think this can be considered a normal stage in development. e. I am thinking that a time-out would be a better strategy than spanking when my son shows this behavior.

a, b, d

11) A 10-year-old child with a peanut allergy would be expected to have which of these as an early manifestation of his allergy? Select all that apply. a. Wheezing b. Nausea c. Headache d. Trouble breathing e. Urticaria

a, d, e

1) Because injuries are the most common cause of death and disability in children in the United States, which stage of development correctly determines the type of injury that may occur? Select all that apply. a. A newborn may roll over and fall off an elevated surface. b. The need to conform and gain acceptance from his peers may make a child accept a dare. c. Toddlers who can run and climb may be susceptible to burns, falls, and collisions with objects. d. A preschooler may ride her two-wheel bike in a reckless manner. e. A crawling infant may aspirate due to the tendency to place objects in his mouth.

b, c, e

2) Duvall's Developmental Stages of the Family include which of the following? Select all that apply. a. Stages an individual progresses through in his or her moral and spiritual development. b. Stages families progress through in adulthood. c. Stages that designate how parenting progresses as a child develops. d. Stages that designate appropriate discipline related to developmental stages. e. Stages that describe the journey a couple will take as their children mature.

b, c, e page 17 Stage I: Marriage and an Independent Home: The Joining of Families Stage II: Families with Infants Stage III: Families with Preschoolers Stage IV: Families with Schoolchildren Stage V: Families with Teenagers Stage VI: Families as Launching Centers Stage VII: Middle-Aged Families Stage VIII: Aging Families

5E) A school-age child with cancer is being prepared for a procedure. The child says, "I have had one of these before. They hurt." The nurse bases her response on what knowledge related to pain in this patient? a. Often lie about experiencing pain b. Tolerate pain better than adults c. Become accustomed to painful procedures d. Commonly experience treatment-related moderate to severe pain when they have cancer

d Pain is reported by approximately 84% of children with cancer. Of these, most report it as moderate to severe, and half report the pain as highly distressing. There are no data to support that children misrepresent pain experiences. Pain tolerance is a complex phenomenon that is not based on age. Children do not become accustomed to painful procedures.

12E) A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. What is the most appropriate recommendation? a. Punish the child. b. Explain to the child why the tantrum is wrong. c. Leave the child alone until the tantrum is over. d. Remain close by the child but ignore the behaviors.

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.

2) Ways to integrate spiritual practices into nursing care include: a. Explaining the religious practices you personally take part in. b. Realizing that young children have little understanding regarding their spirituality. c. Agreeing with children and their families when they explain their religious beliefs so they are not offended. d. Becoming knowledgeable about the religious worldview of cultural groups found in the patients you care for.

d page 35, Box 2.7

Family Systems Theory Family Stress Theory Developmental Theory

page 16 table 2.1

12E) What is descriptive of toddlers' cognitive development at age 20 months? a. Realize that "out of sight" is not out of reach. b. Search for an object only if they see it hidden. c. Put objects into a container but cannot take them out. d. Understand the passage of time, such as "just a minute" and "in an hour."

A At this age, children are in the final sensorimotor stage. They will now search for an object in several potential places even though they saw only the original hiding place. Children have a more developed sense of objective permanence. They will search for objects even if they have not seen them hidden. When a child is able to put objects into a container but cannot take them out, this is indicative of tertiary circular reactions, which appear between the ages of 13 and 18 months. An embryonic sense of time exists; although children may behave appropriately to time-oriented phrases, their sense of timing is exaggerated.

12) One indication that the toddler is ready to begin toilet training is: a. Child recognizes urge to void and is able to communicate this sensation to the parent b. Child is able to stay dry all night c. Child demonstrates mastery of dressing and undressing self d. Child asks parent to have wet or soiled diaper changed

a

4) When assessing blood pressure in a child: a. Knowledge of normal mean is important: newborn, 65/41 mmHg; 1 month to 2 years, 95/58 mmHg; and 2 to 5 years, 101/57 mmHg. b. Cuff size is the most important variable and should be measured using limb length. c. The child is considered normotensive if the BP is below the 95th percentile. d. Check upper- and lower-extremity BP to look for abnormalities such as aortic stenosis, which causes lower-extremity BP to be higher than upper-extremity BP.

a

13E) Preschoolers' fears can best be dealt with by what interventions? a. Actively involving them in finding practical methods to deal with the frightening experience b. Forcing them to confront the frightening object or experience in the presence of their parents c. Using logical persuasion to explain away their fears and help them recognize how unrealistic the fears are d. Ridiculing their fears so that they understand that there is no need to be afraid

a Actively involving preschoolers in finding methods to deal with frightening experiences is the best way to deal with fears. Forcing a child to confront fears may make the child more afraid. Preconceptual thought prevents logical understanding. Ridiculing fears does not make them go away.

11E) What is an important nursing consideration when caring for an infant with failure to thrive? a. Establish a structured routine, which is followed consistently. b. Limit sensory stimulation and play activities to alleviate fatigue. c. Place the child in an infant's seat during feedings to prevent overstimulation. d. Maintain a non-distracting environment by not speaking to the child during feeding

a An infant with failure to thrive should have a structured routine that is followed consistently. Disruptions in other activities of daily living can have a great impact on feeding behaviors. Bathing, sleeping, dressing, playing, and feeding are structured. The child can engage in sensory and play activities at times other than mealtimes. Young children should be held while being fed, and older children can sit at a feeding table. The child should be fed in the same manner at each meal. The nurse should talk to the child by giving directions about eating. This will help the child maintain focus.

12E) What statement characterizes toddlers' eating behavior? a. Food fads are common. b. They have increased appetite. c. They have few food preferences. d. Their table manners are predictable.

a Appetite and food preferences are sporadic during the toddler years. The child may enjoy the same food several days in a row and then refuse to eat it. It is difficult to change the food fad. At approximately 18 months of age, toddlers have decreased nutritional needs. This is labeled physiologic anorexia. Toddlers have distinct food preferences that may not be consistent or predictable. At the toddler age, sitting at a table for a meal may be more disruptive than functional.

1E) What nursing intervention is most descriptive of atraumatic care of children? a. Preparing a child before any unfamiliar treatment or procedure b. Preparing a child for separation from parents during hospitalization c. Helping a child accept pain that is associated with a treatment or procedure d. Helping a child accept the loss of control associated with hospitalization

a Atraumatic care is the provision of therapeutic care in settings, by personnel, and through the use of interventions that eliminate or minimize the psychologic and physical distress experienced by children and their families in the health care system. Interventions are used to reduce and eliminate bodily injury and pain whenever possible. Children should be allowed choices and control whenever possible.

11E) What is most descriptive of kwashiorkor? a. Has a multifactorial etiology. Correct b. Occurs primarily in breastfed infants. c. Results from excessive amounts of vitamin K. d. Is related to inadequate calories but adequate protein

a Current evidence suggests a multifactorial causation, including cultural, psychologic, and infective factors that interact to place the child at risk. Kwashiorkor appears in infants after being weaned from the breast after the birth of another child. No correlation exists between vitamin K and kwashiorkor. Protein deficiency exists in children with kwashiorkor.

10E) What is the primary task of development in infancy, according to Erikson's stages? a. Trust b. Industry c. Initiative d. Autonomy

a During the first year of life, the infant focuses on the task of developing a sense of trust of self, of others, and of the world. This presents challenges for infants who are separated from parents or consistent caregivers. Industry is the focus of school-age children. Preschoolers are engaged in acquiring initiative. Autonomy is a developmental task during the toddler years.

11E) What food combinations will generally provide the appropriate amounts of essential amino acids for someone who is a vegetarian? a. Grains and legumes b. Grains and vegetables c. Legumes and vegetables d. Milk products and fruit

a Eating grains (cereal, rice, and pasta) and legumes (beans, peas, lentils, and peanuts) at the same meal provides the appropriate amount of essential amino acids. Grains and vegetables, legumes and vegetables, and milk products and fruit are combinations that do not provide the appropriate amounts of essential amino acids.

10E) The nurse is providing information to parents asking about selecting a daycare facility for their child. What does the nurse instruct the parents as important to consider when making the selection? a. Health practices of the facility b. Structured learning environment Incorrect c. Socioeconomic status of the children d. Cultural similarities of the children

a Health practices should be most important. With the need for diaper changes and assistance with feeding, young children are at increased risk when hand washing and other hygienic measures are not consistently used. A structured learning environment is not the highest priority for a child this age. The socioeconomic status of the children should have little effect on the choice of facility. Cultural similarities may be important to some families, but the facility's health care practices are more important.

2E) The father of a hospitalized child tells the nurse, "He can't have meat. We are Buddhist and vegetarians." What is the nurse's best intervention? a. Order the child a meatless tray as requested. b. Ask a Buddhist priest to visit the family. c. Explain that hospital patients are exempt from dietary rules. d. Help the parent understand that meat provides protein needed for healing.

a It is essential for the nurse to respect the religious practices of the child and family. The nurse should arrange a dietary consult to ensure that nutritionally complete vegetarian meals are prepared by the hospital kitchen. It is not necessary to ask a Buddhist priest to visit. The nurse should be able to arrange for a vegetarian tray. The nurse should not encourage the child and parent to go against their religious beliefs. Nutritionally complete, acceptable vegetarian meals should be provided.

5E) What information does the nurse include when teaching parents about nonpharmacologic strategies for pain management in children? a. May reduce pain perception. Correct b. Make pharmacologic strategies unnecessary. c. Usually take too long to implement. d. Trick children into believing they do not have pain.

a Nonpharmacologic techniques provide coping strategies that may help reduce pain perception, make the pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics. Nonpharmacologic techniques should be learned before the pain occurs. It is best to use both pharmacologic and nonpharmacologic measures for pain control. The nonpharmacologic strategy should be matched with the child's pain severity and taught to the child before the onset of the painful experience. Some of the nonpharmacologic techniques may mitigate the child's experience with mild pain, but the child will still know the discomfort was present.

13E) What would the nurse emphasize when preparing parents to teach their children about human sexuality? a. Parents should determine exactly what the child knows and wants to know before answering a question about sex. b. A parent's words may have a greater influence on the child's understanding than the parent's actions. c Parents should avoid using correct anatomic terms because they are confusing to preschoolers. d. Parents should allow children to satisfy their sexual curiosity by "playing doctor."

a Parents should be told that there are two rules that should be followed: find out what the child knows and be honest. Parents should model sexual behavior that is consistent with what they are teaching their children. Anatomic terms, although sometimes difficult to pronounce, will lay the groundwork for honest discussions later. Parents should not condone or condemn "playing doctor," which is an extension of curiosity.

6E) What time frame has the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists recommended that pregnant adolescents and women who are not protected against pertussis receive the tetanus, diphtheria, and pertussis (Tdap) vaccine? a. Between 27 and 36 weeks of gestation or postpartum before discharge from the hospital b. During the first prenatal visit when pregnancy is confirmed c. The vaccine should be administered 24 hr prior to delivery d. This vaccine is only recommended during the first trimester

a The ACIP of the CDC and American College of Obstetricians and Gynecologists has recommended that pregnant adolescents and women who are not protected against pertussis receive the Tdap vaccine optimally between 27 and 36 weeks of gestation or postpartum before discharge from the hospital. The vaccine is not recommended during the first trimester. The vaccine is not recommended between 27 and 36 weeks to allot for antibody formation that will protect the mother and passive immunity to the infant. The vaccine is not recommended during the first trimester.

1E) What is most suggestive that a nurse has a non-therapeutic relationship with a patient or family? a. Staff members are concerned about the nurse's actions with the patient or family. b. Staff assignments allow the nurse to care for the same patient or family over an extended time. c. The nurse uses teaching skills to instruct the patient or family rather than doing everything for them. d. The nurse is able to withdraw emotionally when emotional overload occurs but still remain committed.

a The concern of other staff members may indicate that the nurse is exhibiting negative behaviors and may be involved in a non-therapeutic relationship.

1E) What is descriptive of nursing diagnoses? a. They provide the basis for the selection of nursing interventions. b. They should describe everything for which nursing is responsible. c. The cause of the problem must be identified before a nursing diagnosis can be made. e. The cause of the problem implies a cause-and-effect relationship in the nursing diagnosis.

a The nursing diagnosis is the clinical judgment about the client's response to actual or potential health problems. The outcome statement guides the necessary interventions. Nursing diagnoses do not describe all areas of nursing practice. An actual problem may not exist. There may be risk factors that predispose a child or family to dysfunctional health patterns. There may not be a direct cause-and-effect relationship expressed in the diagnostic statement.

When taking a child's blood pressure, the nurse would select a cuff with a bladder width that is large enough to cover what percentage of the upper arm? a. 20% b. 40% c. 60% d. 80%

a The width of the cuff bladder ideally covers 40% of the arm circumference at the midpoint of the upper arm. Twenty percent is too small and may give falsely elevated blood pressure values. Sixty percent and eighty percent are too large and may give falsely low blood pressure values.

4E) What approach would be best to use to ensure a receptive response from a toddler? a. Focus communication on the child and tell him or her how a procedure will feel. b. Call the toddler's name while picking up him or her. c. Call the toddler's name and say, "I am your nurse." d. Stand by the toddler, addressing him or her by name.

a Toddlers see things only in relation to themselves and from their point of view. A stranger picking up a child up in an unfamiliar environment is very frightening for the toddler. Toddlers will not know the meaning of "nurse." Unknown adults who call the toddler by name can frighten the child.

5E) The nurses caring for a child are concerned about the child's frequent requests for pain medication. During a team conference, a new nurse suggests they consider administering a placebo instead of the usual pain medication to see how the child responds. The team educates the nurse on why this is not appropriate and bases the decision on what knowledge? a. This practice is unjustified and unethical. b. This practice is effective to determine whether a child's pain is real. c. The absence of a response to a placebo means the child's pain has an organic basis. d. A positive response to a placebo will not occur if the child's pain has an organic basis.

a Use of placebos without the patient's consent is unethical. Use of placebos does not provide information about the presence or severity of the pain. Individuals may have a positive response to a placebo despite a significant organic cause for their pain.

2E) What statement is true concerning folk remedies in pediatric health care? a. They may be used to reinforce the treatment plan. b. They are incompatible with modern medical regimens. c. They are a leading cause of death in some cultural groups. d. They are not a part of the culture in large, developed countries.

a Whenever folk remedies are compatible, they should be used to reinforce the treatment plan. This will assist in establishing a caring environment. Depending on the folk remedy, it may not be incompatible with modern medical regimens. Occasionally, a folk remedy can lead to death, but this varies with the remedy and its use. The roles that folk remedies have in large, developed countries vary depending on the remedies and the country's cultures.

10E) The nurse is assessing a 7-month old infant during a well baby exam. What does the nurse anticipate for fine motor development for this infant? a. Transfer objects from one hand to the other. b. Use the thumb and index finger in crude pincer grasp. c. Hold a crayon and make a mark on paper. d. Release cubes into a cup.

a The ability to transfer objects from one hand to another occurs at about age 7 months. The infant can use one hand for grasping and hold a cube in the other at the same time. A crude pincer grasp develops by ages 8 to 9 months. The ability to hold a crayon and mark on a piece of paper develops between ages 12 and 15 months. Infants can release a cube into a cup at ages 9 to 12 months.

1) A family you are caring for on the pediatric unit asks you about nutrition for their baby. What facts will you want to include in this nutritional information? Select all that apply. a. Breastfeeding provides micronutrients and immunologic properties. b. Eating preferences and attitudes related to food are established by family influences and culture. c. Most children establish lifelong eating habits by 18 months old. d. During adolescence, parental influence diminishes and adolescents make food choices related to peer acceptability and sociability. e. Because of the stress of returning to work, most mothers use this time as a time to stop breastfeeding.

a, b, d

12) Toddlers are often known to be finicky eaters and may exhibit abnormal eating patters that may concern parents. Which of the following actions for feeding toddlers should be suggested so adequate amounts of nutrients for growth and development are consumed? Select all that apply. a. Avoid playing large food portions on the toddler's plate. b. Allow the child to graze on nutritious (not "junk" food) snacks during the day. c. Insist that the child sit at the table until all persons have completed their meals. d. Allows the child to make certain food choices (within reasonable limits) - for example, "Would you like a peanut butter or hand sandwich?" e. Provide meals at the same time of day as much as possible so the toddler has a sense of consistency. f. Make the child eat all of the food provided, and provide disciplinary actions such as a "time-out" if the plate is not cleaned.

a, b, d, e

13) The nurse caring for a preschool child understands which of the following developmental concepts? Select all that apply. a. Preschoolers have egocentric thought and believe that everyone thinks as they do. b. Play can be therapeutic and enlightening into a child's level of understanding. c. Explanations are helpful when using detail to ally the preschooler's stress. d. Preschoolers understand inferences and can relate to others' feelings with empathy. e. Preschools have magical thinking and believe their thoughts have power.

a, b, e

What vaccinations are included in health promotion during infancy? (Select all that apply.) a. Haemophilus influenzae type b (Hib) b. Hepatitis C virus (HCV) c. Diphtheria, tetanus, and pertussis (DTaP) d. Poliovirus e. Hepatitis B virus (HBV)

a, c, d, e The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the Committee on Infectious Diseases of the American Academy of Pediatrics govern the recommendations for immunization, which include diphtheria, tetanus, and pertussis (DTaP using acellular pertussis); poliovirus; measles, mumps, and rubella (MMR); Hib; HBV; hepatitis A virus (HAV); meningococcal; pneumococcal conjugate vaccine (PCV); and influenza (and H1N1) during infancy. There is no current vaccination to prevent the transmission of hepatitis C virus.

13) At the clinic appointment, a 4-year-old's mother wants to discuss several concerns. Which statements require more teaching by the nurse? Select all that apply. a. My husband feels that TV is okay as long as it is educational. b. I think it is okay for my son to play dress-up along with the girls. c. I told my son that his imaginary playmate moved away because it did not seem normal. d. My mother-in-law thinks I should be working around the house all the time, but I believe playing with my soon is very important. e. My neighbor gave me some flash cards with letters and numbers for my son to use, but I said, "What's the rush? He's only 4."

a, c, e

4) Growth measurement is a key element in children of their health status. One measurement for height is linear growth measurement. What should the nurse do to perfect this technique? Select all that apply. a. Understand the difference in measurement for children who can stand alone and for those who must lie recumbent. b. Use a length board and footboard or a stadiometer, which is the best technique, or use a tape measure. c. Two measurers are usually required for a recumbent child, although one measurer may be sufficient for a cooperative child. d. Reposition the child and repeat the procedure. Measure at least twice (ideally three times). Average the measurements for the final value. e. Demonstrate competency when measuring the growth of infants, children, and adolescents. Refresher sessions should be taken when a lack of standardization occurs.

a, d, e

13) One of the concerns of the preschool period is adequate nutrition. What can the nurse say to give anticipatory guidance to parents? a. Preschoolers are growing during this period and need to increase their caloric intake to 110 kcal/g, for an average daily intake of 2200 calories. b. There is some evidence that children self-regulate their caloric intake. If they eat less at one meal, they compensate at another meal or snack. c. To monitor fat intake, dairy and meat should be limited to twice a day. d. For children who do not like milk, consumption of fruit juices is a healthy alternative.

b

13) When her preschool son is in the hospital, the parent tells the nurse, "I think there is something wrong with him because he is so skinny." The most appropriate answer by the nurse is: a. Most preschoolers weight between 10 and 14 kilograms. b. The legs of a preschooler, rather than the trunk, increase in length, which may make him look slimmer. c. Preschoolers usually keep that pot-bellied appearance until about 4 years old. d. Most preschoolers gain 2 to 3 pounds per year.

b

5) Pain scales for infants and their uses include but are not limited to: a. CRIES: Crying, Requiring increased oxygen, Inability to console, Expression, and Sleeplessness. b. FLACC: child's face, legs, activity, cry, and consolability. c. NCCPC: parent and health caregiver questionnaire assessing acute and chronic pain d. NPASS: neonatal pain, agitation, and sedation scale for infants from 3 to 6 months.

b

6E) What is the most common piece of medical equipment that can transmit harmful microorganisms among patients? a. Thermometer b. Stethoscope c. Injection needle d. Disposable gloves

b A stethoscope is commonly used between patients, and if not correctly disinfected, it can be a dangerous source of spreading microorganisms. Thermometers of all types have barriers to prevent this. Needles are discarded immediately after injections and never reused, so they are not a common source of transmission. Disposable gloves are not reused, so they are not a common source of transmission.

What is the normal age for binocularity, the ability to fixate on one visual field with both eyes simultaneously, to be achieved? a. 1 month b. 3 to 4 months c. 6 to 8 months d. 12 months

b Binocularity is usually achieved by age 3 to 4 months. One month is too young for binocularity. If binocularity is not achieved by 6 to 12 months, the child must be observed for strabismus.

10E) The nurse is assessing a 6-month-old healthy infant who weighed 3.2 kg at birth. The nurse would expect the infant to now weigh approximately how many kilograms? a. 5.2 b. 6.3 c. 8.7 d. 9.6

b Birth weight doubles at about ages 5 to 6 months. At 6 months, a child who weighed 3.2 kg at birth would weigh approximately 6.3 kg. The infant would have gone from the 50th percentile at birth to below the 5th percentile; 5.2 kg is too little. The infant would have tripled the birth weight by 6 months; 8.7 kg to 9.6 kg is too much.

10E) Sara, age 4 months, was born at 35 weeks of gestation. She appears to be developing normally, but her parents are concerned because she is a "more difficult" baby than their other child, who was full term. What response by the nurse is appropriate? a. Infants tend to become more difficult over time. b. Infants become less difficult if they are kept on scheduled feedings and structured routines. c. Behavior is suggestive of failure to completely bond with her parents. d. Difficult temperament is the result of painful experiences in the neonatal period.

b Children perceived as difficult may respond better to scheduled feedings and structured caregiving routines than to demand feedings and frequent changes in routines. Infant temperament has a strong biologic component. Together with interactions with the environment, primarily the family, the biologic component contributes to the infant's unique temperament. Sara's temperament has been created by both biologic and environmental factors. The nurse should provide guidance in parenting techniques that are best suited to Sara's temperament.

2E) Which of the following terms best describes a group of people who share a set of values, beliefs, practices, social relationships, laws, politics, economics, and norms of behavior? a. Race b. Culture c. Ethnicity d. Social group

b Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames the outlook and decisions of a group of people. Race is defined as a division of humankind possessing traits that are genetically transmissible. Ethnicity is the affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. A social group consists of a system of roles carried out in both primary and secondary groups. Socialization is the process by which individuals learn the roles that are expected of them.

10E) What behavior indicates that an infant has developed object permanence? a. Secures objects by pulling on a string. b. Actively searches for a hidden object. c. Recognizes familiar face, such as mother. d. Recognizes familiar object, such as bottle.

b During the first 6 months of life, infants believe that objects exist only as long as they can see them. When infants search for an object that is out of sight, this signals the attainment of object permanence, whereby an infant knows an object exists even when it is not visible. The ability to understand cause and effect is part of secondary schema development, which is a later developmental task. Between ages 8 and 12 weeks, infants begin to respond differentially to their mothers. They cry, smile, vocalize, and show distinct preference for the mother. This preference is one of the stages that influences the attachment process but is too early for object permanence. Recognizing familiar objects is an important transition for the infant, but it does not signal object permanence.

6E) What is the appropriate site to administer an intramuscular (IM) vaccine to a newborn? a. The dorsal gluteal muscle b. The vastus lateralis muscle Correct c. The ventral gluteal muscle d. The biceps muscle

b If the vaccine is given intramuscularly, then it is given in the vastus lateralis in newborns or in the deltoid for older infants and children. Regardless of age, the dorsogluteal site should be avoided because it has been associated with low antibody seroconversion rates, indicating a reduced immune response, and it is no longer an acceptable evidence-based practice site for IM injections. The ventral gluteal muscle and the biceps muscle are not appropriate sites for IM injections.

6E) The mother of a child is hepatitis B surface antigen (HBsAg) negative, when would receive his or her first dose of the hepatitis B virus (HBV) vaccine? a. 2 months of age, at the first well-child visit. b. Birth before discharge from the hospital. c. 6 months of age, at the third well-child visit. d. No time (this vaccine is not currently recommended).

b It is recommended that newborns receive the hepatitis B vaccine before hospital discharge if the mother is HBsAg negative. The second dose of the vaccine is given at the first well-child visit. The third dose of the vaccine is given at the third well-child visit. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the Committee on Infectious Diseases of the American Academy of Pediatrics govern the recommendations for immunization, which include the hepatitis B virus vaccine.

10E) What information would the nurse give a mother regarding the introduction of solid foods during infancy? a. Fruits and vegetables should be introduced into the diet first. b. Foods should be introduced one at a time at intervals of 5 to 7 days. c. Solid foods can be mixed in a bottle to make the transition easier for the infant. d. Solid foods should not be introduced until 8 to 10 months when the extrusion reflex begins to disappear. Incorrect

b One food item is introduced at intervals of 5 to 7 days to allow the identification of food allergies. Iron-fortified cereal should be the first solid food introduced into the infant's diet. Mixing solid foods in a bottle has no effect on the transition to solid food. Solid foods can be introduced earlier than 8 to 10 months. The extrusion reflex usually disappears by age 6 months.

5E) A child who has been receiving morphine intravenously will now start receiving it orally. The nurse would anticipate that to achieve equianalgesia (equal analgesic effect), the oral dose will be what compared to the intravenous dose? a. Same as the intravenous dose b. Greater than the intravenous dose c. One half of the intravenous dose d. One fourth of the intravenous dose

b Oral morphine undergoes significant metabolism from the first-pass effect. For this reason, a higher oral dose is necessary to achieve the same effect as parenteral morphine. The same dose given orally will provide less pain relief. A dose larger than the intravenous dose must be given to achieve an equianalgesic effect.

12E) Two toddlers are playing in a sandbox when one child suddenly grabs a toy from the other child. What is the best interpretation of this behavior? a. This is typical behavior because toddlers are aggressive. b. This is typical behavior because toddlers are egocentric. c. Toddlers should know that sharing toys is expected of them. d. Toddlers should have the cognitive ability to know right from wrong.

b Play develops from the solitary play of infancy to the parallel play of toddlers. A toddler plays alongside other children, not with them. When a child grabs a toy from another child, it is typical behavior of the toddler and is not intentionally aggressive. Shared play is not within their cognitive development. Toddlers do not conceptualize shared play. Because a toddler cannot view the situation from the perspective of the other child, it is okay to take the toy. Therefore, no right or wrong is associated with taking a toy.

The nurse is assessing a 3-year-old African American child who is being seen in the clinic for the first time. The child's height and weight are at the 20th percentile on the commonly used growth chart from the National Center for Health Statistics (NCHS). When interpreting these data, the nurse would recognize what? a. The data suggest the child requires nutritional intervention. b. The NCHS charts are accurate for U.S. African American children. c. A correction factor is used when the NCHS chart is used for nonwhite ethnic groups. d. No assessment can be made until several measurements are plotted over time.

b The NCHS growth charts can serve as reference guides for all racial or ethnic groups. U.S. African American children were included in the sample population. The 20th percentile for height and weight are not indicative of nutritional failure. No correction factor exists. The growth chart can be used with the perspective that different groups of children have varying normal distributions on the growth curves. Serial measurements are useful for longitudinal assessment of the child; single data points provide information about the child's current status.

Kimberly is having a checkup before starting kindergarten. The nurse asks her to do the "finger-to-nose test." What is the purpose of this test? a. Deep tendon reflexes b. Cerebellar function c. Sensory discrimination d. Ability to follow directions

b The finger-to-nose test is an indication of cerebellar function. This test checks balance and coordination. Each deep tendon reflex is tested separately. Each sense is tested separately. Although performing this test can demonstrate the child's ability to follow directions, it is used primarily for cerebellar function.

4E) The nurse is taking a health history on a child. At the beginning of the interview, a parent says, "I brought him here because he always has diarrhea." Under what heading is this information recorded? History Chief complaint Review of systems Nutritional assessment

b The mother has verbalized the specific reason for the child's visit to the health care provider. The chief complaint is the reason for which the child has been brought to the clinic, office, or hospital. History refers to information that relates to previous aspects of the child's health, not the current health. The review of systems is a specific review of each body system. It usually begins with a statement similar to asking the parent to describe how the child's general health has been. A nutritional assessment combines a nutrition history with a physical examination.

4E) When the nurse interviews an adolescent, what is important to help establish a relationship? a. Focus the discussion on the peer group. b. Display a genuine interest in the adolescent. c. Emphasize that confidentiality will always be maintained. d. Use the same type of language as the adolescent.

b Adolescents accept anyone who shows a genuine interest in them. Although peers are important to this age-group, the focus of the interview should be on the adolescent. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. The nurse should maintain a professional relationship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently.

5) When teaching a 6 y/o child with sickle cell disease and his family about pain management, which of the following should the nurse discuss? Select all that apply. a. When pain medications are used, all pain will be eliminated. b. Non-pharmacologic methods of pain relief, including heat, massage, physical therapy, humor, and distraction. c. It is helpful to use a "passport card" that includes information about the diagnosis, any previous complications, and the pain regimen. d. Only the physician can decide the best course of treatment, and the other health care providers follow that plan. e. Long-term medication use considerers many factors.

b, c, d

2) Culture includes which of the following? Select all that apply. a. Cultural competence, which includes building skills in the health care provider, such as offering lists of common foods, health care beliefs, and important rituals. b. Cultural humility, which requires that health care providers participate in a continual process of self-reflection and self-critique. c. Recognizing the power of the health care provider role that views the patient and the family as full members of the health care team. d. A particular group with its values, beliefs, norms, patterns, and practices that are learned, shared, and transmitted from one generation to another. e. A complex whole in which each part is interrelated, including beliefs, tradition, life ways, and heritage.

b, c, d, e

1) The National Children's Study is the largest prospective, long-term study of children's health and development in the United States. Which of these options are the goals of this study? Select all that apply. a. Ensure that every child is immunized at the appropriate age. b. Provide information for families to eradicate unhealthy diets, dental caries, and childhood obesity. c. Enlist the help of school lunch programs to reach the goal of vegetables and fruits as 30% of each lunch. d. Significantly reduce violence, substance abuse, and mental health disorders among the nations children. e. Decrease tardiness and truancy and increase the high school graduation rate in each state over the next 5 years.

b, d

10) A 4-month-old infant is brought to the well-child clinic for immunizations. The mother indicates that the infant often strains to have a bowel movement, so she has been giving him honey and has stopped feeding him iron-fortified formula, based on her sister's recommendations. The nurse recognizes that the infant is at risk for the development of which of the following? Select all that apply. a. Obesity b. Iron-deficiency anemia c. Rickets d. Infant botulism e. Cow's milk allergy

b, d

5) How can the nurse prepare a child for a painful procedure? Select all that apply. a. Be honest and use correct terms so that the child trusts the nurse. b. Involve the child in the use of distraction, such as using bubbles, music, or playing a game. c. Kindly as parents to leave the room so they don't have to watch the painful procedure. d. Use positive self-talk such as "When I go home, I will feel better and be able to see my friends." e. Use guided imagery that involves recalling a previous pleasurable event.

b, d, e

10) In relation to developmental milestones, the infant can be expected to role over from back to abdomen at approximately: a. 2 months b. 4 months c. 6 months d. 8 months

c

6) Which childhood vaccine provides protection against streptococcal infections such as otitis media, sinusitis, and pneumonia? a. Rotavirus b. Hib c. Pneumococcal d. MMR

c

11E) What information on relieving colic would a nurse include in teaching a parents of an infant with the diagnosis? a. Avoid using a pacifier. b. Avoid touching the abdomen. c. Change the infant's position frequently. d. Place the infant where the family cannot hear the crying.

c Changing the infant's position frequently may be beneficial. The parent can walk holding the child face down and with the child's abdomen across the parent's arm. The parent's hand can support the child's abdomen, applying gentle pressure. Pacifiers can be used for meeting additional sucking needs. Gently massaging the abdomen is effective in some children. The child should not be placed where he or she cannot be monitored. The child can be placed in the crib and allowed to cry. Periodically, the child should be picked up and comforted.

6E) A 12-month-old child presents to the clinic for a well visit after missing several appointments. The child began her immunization schedule but has missed several follow-up appointments and doses of immunizations. What is the most appropriate nursing intervention? a. Administer initial immunizations from the beginning of schedule. b. The child cannot receive missed immunizations if the schedule is not followed and will not be vaccination. c. The child should only receive the missed doses of immunizations based on catch-up schedule. d. The child should receive double-strength immunizations at this well visit.

c Children who began primary immunization at the recommended age but fail to receive all the doses do not need to begin the series again but instead should receive only the missed doses. The child may receive missed vaccinations on a catch-up schedule per CDC guidelines.

2E) Maria is a Spanish-speaking 5-year-old girl who has started kindergarten in an English-speaking school. Crying most of the time, she appears helpless and unable to function in this new situation. What is the best explanation for this behavior? a. She lacks adequate maturity for attending school. b. She lacks the knowledge needed in school. c. She is experiencing cultural shock. d. She is experiencing minority group discrimination.

c Cultural shock is the helpless feeling and state of disorientation felt by an outsider attempting to adapt to a different culture group. Maria's inability to speak English inhibits her ability to interact. This would explain Maria's inability to function in this new situation. There is no evidence that the child lacks the maturity or knowledge needed in school or is experiencing minority group discrimination.

10E) The parents of a 3-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hr during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. What would the nurse suggest to help them deal with this problem? a. Let her cry herself back to sleep. b. Put her in parents' bed to cuddle. c. Start putting her to bed while still awake and while the parent is present. d. Give her a bottle of formula instead of breastfeeding her so often at night.

c Current research suggests that parents be present at bedtime until the child is drowsy. The child should then be allowed to fall asleep alone. This encourages self-soothing behaviors. Children who learn to fall asleep on their own have longer sustained sleep periods than those who fall asleep with parents present. Letting the child cry herself back to sleep is difficult to implement for many parents. Co-bedding could be unsafe at this age. The type of feeding will not affect the child's sleep pattern.

5E) The nurse is caring postoperatively for an 8-year-old child with multiple fractures and other traumatic injuries from a motor vehicle crash. The child is experiencing severe pain. What is an important consideration in managing the child's pain? a. Give only an opioid analgesic at this time. b. Increase the dosage of analgesic until the child is adequately sedated. c. Plan a preventive schedule of pain medication around the clock. d. Give the child a clock and explain when she or he can have pain medications.

c For severe postoperative pain, a preventive around-the-clock schedule is necessary to prevent decreased plasma levels of medications. The opioid analgesic will help for the present but is not an effective strategy. Increasing the dosage requires an order. The nurse should give the drug on a regular schedule and evaluate the effectiveness. Giving the child a clock and explaining when she or he can have pain medications is counterproductive. It focuses the child's attention on how long he or she will need to wait for pain relief.

4E) What are some legal and ethical issues that arise for the nurse when using an interpreter? a. Direct the questions to the interpreter. Incorrect b. Ask several questions at a time. c. The family should be fully informed of all aspects of procedures before consenting. d. Discourage the interpreter and client from discussing topics not included in the interview.

c In obtaining informed consent through an interpreter, the nurse should fully inform the family of all aspects of the particular procedure to which they are consenting. The communication is with the family members. The nurse directs the questions toward the family while observing nonverbal cues. Questions are asked one at a time to allow the interpreter and family to translate, process, and answer the question. The interpreter and client should build a rapport. Discussion of topics outside of the interview allows the two parties to become acquainted.

4E) What is most likely to encourage parents to talk about their feelings related to their child's illness? a. Be sympathetic. b. Ask direct questions. c. Use open-ended questions. d. Avoid periods of silence.

c Open-ended questions require the parent to answer with more than a brief answer. Closed-ended questions should be avoided when attempting to elicit parents' feelings. Sympathy is having feelings or emotions in common with another person rather than understanding those feelings (empathy). Sympathy is not therapeutic in the helping relationship. Direct questions may obtain limited information. In addition, they may be considered threatening by the parent. Silence can be an effective interviewing tool. It allows a sharing of feelings in which two or more people absorb the emotion in depth. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions

What approach is the most appropriate when performing a physical assessment on a toddler? a. Demonstrate use of equipment. b. Perform traumatic procedures first. c. Use minimum physical contact initially. d. Always proceed in a head-to-toe direction.

c Parents can remove clothing, and the child can remain on the parent's lap. The nurse should use minimum physical contact initially to gain the cooperation of the child. The nurse should introduce the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex for this age-group. Traumatic procedures should always be performed last. These will most likely upset the child and inhibit cooperation. The head-to-toe assessment can be done in older children but usually must be adapted in younger children.

5E) A 5 year old has patient-controlled analgesia (PCA) for pain management after abdominal surgery. What information does the nurse include in teaching the parents about the PCA? a. The child will be pain free. b. Only the child is allowed to push the button for a bolus. c. The pump allows for a continuous basal rate and delivers a constant amount of medication to control pain. d. There is a high risk of overdose, so monitoring is done every 15 minutes.

c The PCA prescription can be set for a basal rate for a continued infusion of pain medication to prevent pain from returning during sleep and when the patient cannot control the infusion. Although the goal of PCA is to have effective pain relief, a pain-free state may not be possible. With a child who is 5 years old, the parents and nurse must assess the child to ensure that adequate medication is being given. A child who is 5 years old may not be able to understand the concept of pushing a button. Evidence suggests that effective analgesia can be obtained with the parents and nurse giving boluses as necessary. The prescription for the PCA includes how much medication can be given in a defined period. Monitoring every 1 to 2 hr for patient response is sufficient.

5E) What self-report pain rating scales can be used in children as young as 3 years of age? a. Poker Chip Tool b. Visual Analog Scale c. FACES Pain Rating Scale d. Word-Graphic Rating Scale

c The Poker Chip Tool has been validated for children 4 years of age who have been determined to have the cognitive ability to identify the larger of two numbers. The Visual Analog Scale can be used for children older than 4 years of age but is most appropriate for ages 7 and older. The FACES Pain Rating Scale is for children as young as 3 years of age. The Word-Graphic Rating Scale uses descriptive words and is recommended for children 4 to 17 years of age.

11E) What consideration is important in educating parents of an infant with atopic dermatitis (eczema)? a. Keeping the baby content b. Maintaining adequate nutrition c. Preventing infection of lesions d. Applying antibiotics to lesions

c The lesions of atopic dermatitis are itchy. New lesions develop when the skin is scratched. This cycle leads to the possibility of infection. Although keeping the baby content and maintaining adequate nutrition are important, decreasing the amount of scratching is a primary aim. Antibiotics are not the primary treatment of atopic dermatitis.

6E) An important role of the nurse in ambulatory settings and schools is the identification of communicable diseases for treatment and the prevention of spread. What is an important component related to the first period of the contagiousness of disease? a. Source b. Causative agent c. Prodromal stage d. Constitutional symptoms

c The prodromal period is the interval between the early manifestations of the disease and the time when the overt clinical syndrome is evident. Most communicable diseases are contagious during this time. Although the source and causative agent of the disease are important, recognizing the early signs can help the nurse prevent spread and refer the child for medical therapy when indicated. Constitutional symptoms occur during the active disease phase. The child has been contagious, and the time for early intervention may have passed.

1E) In 1935, Title V of the Social Security Act was passed. This was significant in the evolution of child health care in the United States because it established what? a. Medicaid b. Children's Bureau c. Child Welfare Services d. White House Conferences on Children

c This legislation provided for federal grants to be given to states for three major programs, Maternal Child Health, Crippled Children's Services, and Child Welfare Services. Medicaid was created in 1965 to reduce financial barriers to health care for poor individuals. The Children's Bureau was established in 1912 and was placed under the Department of Health, Education, and Welfare. The White House Conferences on Children was first convened in 1909.

4E) What statement is true concerning the increased use of telephone triage by nurses? a. Health care costs have increased as a result. b. Emergency department visits are not recommended. c. Access to high-quality health care services has increased. d. Home care is recommended when it is not appropriate.

c With well-designed telephone triage programs, access to high-quality health care services and patient satisfaction have increased. With the reduction in unnecessary emergency department and clinic visits, health care costs have decreased. Emergency department visits are recommended based on the response to screening questions and when the child's condition is in doubt. Guidelines are given for home management if the triage assessment indicates that level of care. Parents are given instructions about changes in the child's condition to report.

2) The nurse is explaining the strategy of consequences to a parent he is working with. Which response by the parent indicates that more teaching is needed when he describes the types of consequences? a. Natural: those that occur without any intervention. b. Logical: those that are directly related to the rule. c. Transforming: allowing the child to come to the conclusion on his or her own. d. Unrelated: those that are imposed diliberately

c page 22 "Transforming" is not listed as a type of consequence. The other three are defined in the answer choices.

10E) The parent of a 10-week-old infant tells the nurse, "She cries sometimes when nothing is wrong—for example, when she is dry and has recently been fed." What is the appropriate response by the nurse? a. Reassure the parent that nothing is wrong. b. Explain how to better interpret infant cues. c. Evaluate for failure of the parent to bond with the infant. d. Reassure the parent that periods of "unexplained fussiness" can be normal.

d A crying infant can be a source of great distress for parents. There is great variability in the amount of crying that can be expected from an infant. Parents should be reassured that some crying without apparent cause is normal. Persistent and inconsolable crying may need further attention. Reassuring the parent that nothing is wrong negates the parent's concern about the child. The parent is responding to cues from the infant by feeding and changing diapers. There is no evidence that an attachment issue exists. The parent is seeking information about how to care for the infant.

4E) What statement explains why it can be difficult to assess a child's dietary intake? a. No systematic assessment tool has been developed. b. Biochemical analysis for assessing nutrition is expensive. c. Families usually do not understand much about nutrition. d. Recall of food consumption is frequently unreliable.

d An individual's recall of food intake, especially amounts eaten, is frequently unreliable. Systematic tools such as the 24-hr recall and detailed dietary history questionnaires are available. Biochemical analysis is not necessary for assessing dietary intake. Family knowledge of nutrition is not required. Detailed questions can elicit the child's patterns of eating and food intake.

12E) A parent has a 2-year-old child in the clinic for a well-child checkup. What statement by the parent would indicate to the nurse that the parent needs more instruction regarding accident prevention? a. "We locked all the medicines in the bathroom cabinet." b. "We turned the thermostat down on our hot water heater." c. "We placed gates at the top and bottom of the basement steps." d. "We stopped using the car seat now that our child is older."

d Convertible car seats are necessary until the child is at least 18 kg (40 pounds). Booster seats are required until the child is 36.2 kg (80 pounds). Locking medicines in the bathroom cabinet will help prevent the child from accidentally ingesting medicines. Decreasing the temperature on the water heater can help prevent burns. Gates are appropriate to keep the toddler from falling down the stairs.

5E) What is the most consistent and commonly used indicator of pain in infants? a. Increased respirations b. Increased heart rate c. Thrashing of arms and legs d. Facial expression of discomfort

d Facial expression has consistently been validated as an indicator of pain in infants. Behavioral pain measures are most reliable for sharp procedural pain in infants. Increased heart rate and respirations are indicative of a generalized and complex response to stress. They are not specific for pain in infants. Thrashing of arms and legs is a reliable indicator in young children, not infants.

5E) An intravenous line is needed in a school-age child. What medication is appropriate analgesic for use with this patient? a. TAC (tetracaine, epinephrine [Adrenalin], cocaine) 15 minutes before the procedure. b. A transdermal fentanyl (Duragesic) patch at the site of venipuncture. c. EMLA (eutectic mixture of local anesthetics) immediately before the procedure. d. LMX (4% liposomal lidocaine cream) 30 minutes before the procedure.

d LMX is an effective analgesic agent when applied to the skin 30 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. TAC provides skin anesthesia about 15 minutes after application to nonintact skin. The gel can be placed on the wound for suturing. It is not useful for intact skin. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control. For maximum effectiveness, EMLA must be applied approximately 60 minutes in advance.

1E) What health promotion interventions have the greatest impact on injury prevention? a. Utilizing auditory learning strategies for all families b. Including the nutritional counseling for the food pyramid c. Integrating Maslow's hierarchy of needs in the lesson d. Using a developmental approach to safety counseling

d Utilizing a developmental approach to safety counseling will ensure that the parents are taught risks associated with developmental age and increased risk factors for that population. Maslow's hierarchy of needs is a theoretical model to assist in assuring all the needs of an individual are met, but it is not the theoretical model of choice in this scenario.

12E) Myelination of the spinal cord is almost complete by 2 years of age. As a result of this, what can gradually be achieved? a. Visual acuity of 20/20 b. Throwing a ball without falling Incorrect c. Respirations becoming diaphragmatic d. Control of anal and urethral sphincters

d With complete myelination of the spinal column, voluntary control of elimination occurs. Control of anal and urethral sphincters is gradually achieved. Visual acuity is acceptable at 20/40. Throwing a ball without falling is achieved by 18 months of age. Respirations remain abdominal in this age-group.