Pediatric growth

A 2-year-old girl has just become a big sister. Her mother has been a stay-at-home mother. Based on the developmental level of a 2-year-old, which comment should the child's mother expect from her toddler about her new baby brother? 1. "Mommy, when my baby brother takes a nap, will you play with me?" 2. "Mommy, can I play with my baby brother?" 3. "Mommy, he is so cute. I love him." 4. "Mommy, it is time to put him away so we can play."

. 1. Toddlers are egocentric and are not yet capable of delayed gratification. It is un- likely that the child will wait to play with her mother until the baby sleeps. 2. Toddlers do not usually engage in play with others. They are generally involved in parallel play. 3. Toddlers usually initially resent the pres- ence of new siblings because they take away some of the parents' time and attention. 4. This is a typical statement that would be made by a toddler. Toddlers are very egocentric and do not consider the needs of the other child. TEST-TAKING HINT: The age of the child is essential to answering this question. The test taker must understand the psychoso- cial development of the toddler in order to choose the appropriate statement.

The mother has brought her 16-year-old daughter to the ER because she is concerned her daughter is anorexic. During the child's initial physical assessment, the nurse notes the daughter has signs and symptoms of nutritional deficit. Which assessment item led the nurse to this initial conclusion? 1. The child has a protein level within normal limits. 2. The child's blood pressure is 110/66. 3. The child's hair and nails are brittle and dry. 4. The child's teeth appear to be eroded.

1. A low protein level could indicate a nutri- tional deficit. However, this would not be an indication that the nurse sees on an initial assessment. Lab work would be required to have this information. 2. This is a normal blood pressure for a teen. 3. Dry and brittle hair and nails are common among people who have a nutritional deficit. 4. Eroded teeth are more common of people who have frequent vomiting. The acidic nature of the vomitus causes the enamel of the teeth to deteriorate causing erosion. This practice is most common among teens with bulimia. TEST-TAKING HINT: The test taker must have knowledge of the nutritional needs of an adolescent. Answer 1 can be elimi- nated because it states that the value is normal. Answer 2 can be eliminated because it is a normal blood pressure. Answer 4 can be eliminated because it relates more to bulimia than anorexia.

A 3-year-old was admitted to the hospital with croup. His nurse just obtained vital signs. The child's heart rate is 90, his respiratory rate is 44, his blood pressure is 100/52, and his temperature is 98.8°F (37.1° C). The parents ask the nurse if his vital signs are appropriate for a child his age. The nurse's best response to the parents is: 1. "Your son's blood pressure is elevated, but the other vital signs are within normal limits." 2. "Your son's temperature is elevated, but the other vital signs are within normal limits." 3. "Your son's respiratory rate is elevated, but the other vital signs are within normal limits." 4. "Your son's heart rate is elevated, but the ogther vital signs are within normal limits."

1. A normal systolic blood pressure for a child from 3 to 6 years is 78 to 111. A normal diastolic blood pressure for a child from 3 to 6 years is 42 to 70. 2. A normal temperature is 96.6°F to 100°F (35.8° C to 37.7° C). 3. A normal respiratory rate for a child from 3 to 6 years is 20 to 30 breaths per minute. 4. A normal heart rate for a child from 3 to 6 years is 75 to 120. TEST-TAKING HINT: Normal vital signs for each age group should be memorized in order to understand abnormalities that occur with different disease processes.

An 8-day old female was admitted to the hospital with vomiting and dehydration. The nurse has just obtained vital signs. The child's heart rate is 185, her respiratory rate is 44, her blood pressure is 85/52, and her temperature is 99°F (37.2° C). The child's parents ask the nurse if her vital signs are within normal limits. What is the nurse's best response to the parents? 1. "Your daughter's blood pressure is elevated, but the other vital signs are within normal limits." 2. "Your daughter's temperature is elevated, but the other vital signs are within normal limits." 3. "Your daughter's respiratory rate is elevated, but the other vital signs are within normal limits." 4. "Your daughter's heart rate is elevated, but the other vital signs are within normal limits."

1. A normal systolic blood pressure for a child from birth to 1 month is 50 to 101. A normal diastolic blood pressure for a child from birth to 1 month is 42 to 64. 2. A normal temperature is 96.6°F to 100°F (35.8° C to 37.7° C). 3. A normal respiratory rate for a child from birth to 1 month is 30 to 60. 4. A normal heart rate for a child from birth to 1 month is 90 to 160. TEST-TAKING HINT: Normal vital signs for each age group should be memorized in order to understand abnormalities that occur with different disease processes.

A 16-year-old girl is having a discussion with her nurse about her recent diagnosis of lupus. The nurse understands how to best answer the young woman's questions about her prognosis because she understands that cognitively: 1. Adolescents are preoccupied with thoughts of the here and now. 2. Adolescents are able to understand and imagine possibilities for the future. 3. Adolescents are capable of thinking only in concrete terms. 4. Adolescents are overly concerned with past events and relationships.

1. Adolescents are becoming abstract thinkers and are able to imagine possibili- ties for the future. 2. Adolescents are becoming abstract thinkers and are able to imagine possi- bilities for the future. 3. Preschool and school-age children think in concrete terms. Adolescents are begin- ning to think in abstract terms. 4. Adolescents are becoming abstract thinkers and are able to imagine possibilities for the future. They are not preoccupied with past events. TEST-TAKING HINT: The test taker must understand the cognitive level of an adolescent in order to choose the appropriate answer.

The school nurse is planning an educational program centered on abstinence for adolescents. Which of the following methods does the nurse recognize as the most effective way to present this program? 1. Use peer-led programs that emphasize the consequences of unprotected sexual contact. 2. Teach students methods to resist peer pressure. 3. Offer students the opportunity to care for a simulator infant for 1 week. 4. Offer statistics, pamphlets, and films discussing the consequences of unprotected sexual contact.

1. Adolescents are most concerned with what their peers think and feel. They are most receptive to information that comes from another adolescent. 2. It is very difficult for teens to resist peer pressure even with the appropriate tools of resistance. 3. Infant simulators are useful, but they are very expensive and often difficult to obtain. 4. Pamphlets are helpful aids in relaying information to teens, but hearing the information firsthand from a peer is the most effective method of education. TEST-TAKING HINT: The test taker must understand the psychosocial development of an adolescent in order to choose the appropriate intervention. Adolescents focus on their relationships with peers and are much more influ- enced by peers than by multimedia in- formation or by information provided by an adult.

An 18-year-old boy comes to the ER complaining of a rash and itching in the groin area. He is concerned that he has contracted a sexually transmitted disease and worries that his parents will find out. The nurse's best response is: 1. "We will need to contact your parents to let them know you are in the ER." 2. "We will not contact your parents regarding this visit." 3. "Who would you like us to contact about your visit here today?" 4. "We cannot promise that the hospital will not contact your parents."

1. An 18-year-old has a right to privacy; if he does not want his parents contacted, as long as no harm has come to him they do not need to be contacted. 2. An adolescent has every right to pri- vacy as long as the situation is not life-threatening. 3. The nurse can ask if the patient would like the nurse to contact someone; again, if the teen says no, that is his or her right. 4. An adolescent has every right to privacy as long as the situation is not life-threatening. Therefore, the hospital can promise not to contact the parents. TEST-TAKING HINT: The test taker must have knowledge of the psychosocial devel- opment of an adolescent and what the state law says about privacy.

A 6-month-old male is at his well-child checkup. The nurse weighs him, and his mother asks if his weight is normal for his age. The nurse's best response is: 1. "At 6 months his weight should be approximately three times his birth weight." 2. "Each child gains weight at his or her own pace." 3. "At 6 months his weight should be approximately twice his birth weight." 4. "At 6 months a child should weigh about 10 lb more than his or her birth weight."

1. At 6 months his weight should be approximately two times his birth weight. 2. Children gain weight at their own pace but should double the birth weight by 4 to 6 months. 3. Children should double their birth weight by 4 to 6 months of age. 4. By 6 months an infant should have doubled the birth weight; 10 lb is a lot of weight to gain in 4 to 6 months. TEST-TAKING HINT: This is a specific physical developmental milestone that should be memorized.

A 2-day-old girl is being discharged from the hospital. Her mother asks the nurse when she will receive her first hepatitis B immunization. Which is the nurse's best response? 1. "Babies receive the hepatitis B vaccine only if their mother is hepatitis B-positive." 2. "She will receive her first dose of the hepatitis B vaccine prior to discharge today." 3. "She will receive her first hepatitis B vaccine when she is 1 year of age." 4. "She will receive her first hepatitis B vaccine at 6 months of age."

1. Babies born to mothers positive for hepa- titis B receive the first dose of hepatitis B vaccine within 12 hours of delivery. 2. The first dose of hepatitis B vaccine is recommended between birth and 2 months. Most hospitals give the vac- cine prior to discharge home. 3. The first dose of hepatitis B vaccine is rec- ommended between birth and 2 months. Most hospitals give the vaccine prior to discharge home. 4. The first dose of hepatitis B vaccine is rec- ommended between birth and 2 months. Most hospitals give the vaccine prior to discharge home. TEST-TAKING HINT: The test taker must have knowledge of vaccination schedules for children of varying ages.

The nurse is instructing a new breastfeeding mother in the need to provide her pre- mature infant with an adequate source of iron in her diet. Which one of the following statements reflects a need for further education of the new mother? 1. "I will use only breast milk or an iron-fortified formula as a source of milk for my baby until she is at least 12 months old." 2. "My baby will need to have iron supplements introduced when she is 4 months old." 3. "I will need to add iron supplements to my baby's diet when she is 9 months old." 4. "When my baby begins to eat solid foods, I should introduce iron-fortified cereals to her diet."

1. Breast milk or an iron-fortified formula is recommended as the primary source of nutrition for the first year of life. 2. Premature infants have iron stores from the mother that last approximately 2 months, so it is important to introduce an iron supplement by 2 months. 3. Premature infants have iron stores from the mother that last approxi- mately 2 months, so it is important to introduce an iron supplement by 2 months. Full-term infants have iron stores that last approximately 4 to 6 months. 4. Iron-fortified cereals are a good source of iron once a child is old enough to consume solid foods. TEST-TAKING HINT: The test taker must have knowledge of the recommended nu- trition for an infant.

A male infant is visiting the pediatrician for his 6-month well-child checkup. His mother tells the nurse she wants to advance the infant's diet. Which statement by the infant's mother leads the nurse to believe that she needs further education about the nutritional needs of a 6-month-old? 1. "I will continue to breastfeed my son and will give him rice cereal three times a day." 2. "I will start my son on fruits and gradually introduce vegetables." 3. "I will start my son on carrots and will introduce one new vegetable every few days." 4. "I will not give my son any more than 8 ounces of baby juice per day."

1. Breastfeeding is the ideal nutrition for the first year of life. Cereal can be introduced between 4 and 6 months of age. 2. Infants should be started on vegetables prior to fruits. The sweetness of the fruits may inhibit them from taking vegetables. 3. It is essential to introduce new foods one at a time to determine if a child has any allergies. 4. Infants can be given fruit juice by 6 months of age, but it is recommended not to ex- ceed 4 to 6 ounces per day. TEST-TAKING HINT: The test taker must have knowledge of the recommended nu- trition for an infant.

An ER nurse is assessing a 12-month-old female. Which statement accurately describes the best method for assessing this child? 1. The nurse should assess the child on the examining table. 2. The nurse should assess the child in a head-to-toe sequence. 3. The nurse should have the child's mother assist in holding her down. 4. The nurse should assess the child while she is in her mother's lap.

1. Children 12 months old are best assessed in proximity to their parents. 2. The appropriate sequence for assessment with an infant is to auscultate first, palpate next, and assess ears, eyes, and mouth last. Least invasive procedures are recom- mended first. 3. Infants do not like to be held down. This will likely cause the child distress. If the child neceds to be held down, it is best to enlist the aid of another staff member. 4. Infants are most secure when in prox- imity to the parent. The parent's lap is an excellent place to assess the child. TEST-TAKING HINT: Health-care profes- sionals must use developmentally appro- priate methods to approach children. The test taker must have knowledge of a child's psychosocial development. Answers 1 and 2 can be eliminated because these meth- ods of assessment would be used on an older child

A 3-year-old girl is attending her grandfather's funeral. Her parents have told her that her grandfather is in heaven with God. The child is taken up to the open casket with her parents. Which statement by the child describes a 3-year-old child's understanding of spirituality? 1. "Grandpa's body is here with us on Earth, and his spirit is in heaven." 2. "Grandpa is in heaven. Is this heaven?" 3. "Grandpa's spirit is no longer in his body." 4. "Grandpa won't need his body in heaven."

1. Children 3 years old do not understand the difference between body and spirit. Their understanding of spirituality is literal in nature. 2. Children 3 years old are literal thinkers. The child's parents told her that Grandpa was in heaven. She sees his body, so she thinks they are all in heaven. 3. Children 3 years old do not understand the difference between body and spirit. Their understanding of spirituality is literal in nature. 4. Children 3 years old think of spirituality in literal terms and do not understand the concept of heaven. TEST-TAKING HINT: The age of the child is essential to answering this question. The test taker must understand the cog- nitive development of the child in order to choose the appropriate response. Answers 1, 3, and 4 can be eliminated because they demonstrate the under- standing of an older school-age child.

A 12-month-old boy weighed 8 lb 2 oz at birth. Understanding developmental mile- stones, what should the nurse caring for the child calculate his current weight as? 1. Approximately 16 lb 4 oz. 2. Approximately 20 lb 5 oz. 3. Approximately 24 lb 6 oz. 4. Approximately 32 lb 8 oz.

1. Children should double their birth weight by 6 months of age. 2. Children should triple their birth weight by 12 months of age. 3. Children should triple their birth weight by 12 months of age. 4. Children should triple their birth weight by 12 months of age. TEST-TAKING HINT: This is a specific physi- cal developmental milestone that should be memorized.

The parents of a 2-year-old boy are concerned about his behavior. Since the child's admission to the hospital 2 days ago he has been crying much more than usual and is inconsolable much of the time. The nurse's best response to the child's parents is: 1. The child is in the detachment phase of separation anxiety, which is normal for children during hospitalization. 2. The child is in the despair stage of separation anxiety, which is normal for children during hospitalization. 3. The child is in the bargaining stage of separation anxiety, which is normal for children during hospitalization. 4. The child is in the protest stage of separation anxiety, which is normal for children during hospitalization.

1. During the detachment phase of separa- tion anxiety, children are usually fairly cheerful, and they often lack a preference for their parents. 2. During the despair stage of separation anxiety, children usually have a loss of ap- petite, altered sleep patterns, and a lack of much interest in play. 3. The bargaining stage is not a stage of sep- aration anxiety; it is one of the stages of grief. 4. During the protest stage of separation anxiety, children are often inconsolable, and they often cry more than they do when they are at home. These children also frequently ask to go home. TEST-TAKING HINT: The test taker must have knowledge of the stages of separa- tion anxiety.

A 5-year-old boy has always been one of the shortest children in class since pre- school. His mother tells the school nurse that her husband is 6' and she is 5'7". She is concerned about her son's height. Based on her knowledge of a child's physical growth during the school-age years, what should the nurse tell the child's mother? 1. She should expect him to grow about 3 inches every year from ages 6 to 9 years. 2. She should expect him to grow about 2 inches every year from ages 6 to 9 years. 3. She should have him seen by an endocrinologist for growth hormone injections. 4. Be sure to have her son's growth reevaluated when he is 7 years old

1. During the school-age years, a child grows approximately 2 inches per year. 2. During the school-age years, a child grows approximately 2 inches per year. 3. This is not the appropriate time to have the child evaluated. His mother needs to reserve her concerns until he is older. He will likely begin to catch up with his peers within the next year. 4. The child should continue to see his pedi- atrician for annual visits, but there is no need for a special visit to reevaluate his growth at this time. TEST-TAKING HINT: This is a specific physi- cal developmental milestone that should be memorized.

The nurse caring for an 8-year-old boy is trying to encourage developmental growth. What activity can the nurse provide for the child to encourage his sense of industry? 1. Allow the child to choose what time to take his medication. 2. Provide the child with the homework his teacher has sent in. 3. Allow the child to assist with his bath. 4. Allow the child to help with his dressing change.

1. Giving the child choices while in the hos- pital is important. However, medications should be kept on schedule. It is essential to give them at the prescribed time. 2. The school-age child is focused on aca- demic performance; therefore the child can achieve a sense of industry by com- pleting his homework and staying on track with his classmates. 3. The child should have already mastered bathing. It is not likely to give him a sense of accomplishment. 4. The child may enjoy assisting with his dressing change, but it is not the best ex- ample of industry. TEST-TAKING HINT: The test taker must have knowledge of Erickson's stages of development. Answer 1 can be eliminated because it could be detrimental to chil- dren to allow them to choose medication times. Answers 3 and 4 can be eliminated because they are not activities that help the child achieve a sense of industry.

An 8-year-old girl is at the pediatrician's office for a well-child checkup. Her mother tells the nurse that she has been having some difficulty getting her daughter to com- plete her chores. The child's mother asks the nurse for techniques for gaining the child's cooperation with chores. Which of the following should the nurse suggest the mother do? 1. Use "grounding" as a technique. 2. Use "time-out" as a technique. 3. Use a reward system as a technique. 4. Use spanking as a technique.

1. Grounding is a technique that generally works well with adolescents. 2. Time-out is a technique that is primarily used for toddler and preschool children. 3. School-age children usually respond very well to a reward system and often enjoy the rewards so much that they will continue chores without continual reminders. 4. Spanking is never a suggestion that should be given to families. TEST-TAKING HINT: The age of the child is essential to answering this question. The test taker must understand the psychoso- cial development of the child in order to choose the appropriate intervention. Answer 4 can be eliminated because physi- cal punishment should never be suggested. Answer 1 can be eliminated because it is a technique that works best with adolescents. Answer 2 can be eliminated because it is a technique that works best with toddlers and preschool children.

A 13-year-old boy is visiting the pediatrician's office for his well-child checkup. The child tells the nurse that he is worried because his breasts are growing and they hurt. He tells the nurse he is afraid to take his shirt off in front of the other boys during gym class. What should the nurse tell him? 1. "The pediatrician will draw some blood to find out why your breasts are growing." 2. "It is just a slight hormonal imbalance that can be easily corrected with medication." 3." This is a normal condition of puberty that will resolve within a year or two." 4. "This is a rare finding that occurs in about 5% of boys during puberty."

1. Gynecomastia and breast tenderness are common for about a third of boys during middle puberty. Gynecomastia usually re- solves in 2 years. 2. Gynecomastia and breast tenderness are common for about a third of boys during middle puberty. Gynecomastia usually re- solves in 2 years. 3. Gynecomastia and breast tenderness are common for about a third of boys during middle puberty. Gynecomastia usually resolves in 2 years. 4. Gynecomastia and breast tenderness are common for about a third of boys during middle puberty. Gynecomastia usually resolves in 2 years. TEST-TAKING HINT: The test taker must have knowledge about the physical development of adolescent boys.

How can the nurse best facilitate the trust relationship between infant and parent while the infant is hospitalized? 1. The nurse should encourage the parents to remain at their child's bedside as much as possible. 2. The nurse should keep parents informed about all aspects of their child's condition. 3. The nurse should encourage the parents to hold their child as much as possible. 4. The nurse should encourage the parents to participate actively in their child's care.

1. Having parents close to the child is impor- tant, but infants are most secure when they are being held, patted, and talked to. 2. It is important that the nurse keep the par- ents informed about their child's condition, but it does not have any impact on the child's trust versus mistrust relationship with the parents. 3. Having parents hold their child while in the hospital is an excellent means of building the trust relationship. Infants are most secure when they are being held, patted, and spoken to. 4. Parents should be encouraged to learn their child's care, but it is not the best means of enhancing the trust relationship. TEST-TAKING HINT: The test taker must un- derstand Erickson's stages, including the individual tasks that are met during each stage.

A 17-year-old male has had some recent behavioral changes. His mother calls the nurse at the pediatrician's office and tells her that her son has been coming home from school every day, closing his door, and refraining from interaction with his parents. The child's mother does not know what she should do about her son's unsociable behavior. The nurse's best response to the child's mother is: 1. "You should go speak with your son and ask him directly what is wrong with him." 2. "You should set limits with your son and tell him that this is unacceptable behavior." 3. "Your son's behavior is abnormal, and he is going to need a psychiatric referral." 4. "Your son's behavior is normal. You should listen to him without being judgmental."

1. If the child's parents confront him, he may feel like they are being judgmental, and he will likely not want to communicate with them. When parents begin a dialogue with their child early on in life, they are more capable of approaching the child when they do notice behavioral changes. 2. Setting limits is always a good thing to do with children. However, the child's par- ents are not addressing the reason for his behavioral changes. 3. The child's behavior is typical of a teen's response to developmental and psychosocial changes of adolescence. He does not need a psychological referral at this time. 4. The child's behavior is typical of a teen's response to developmental and psychosocial changes of adolescence. TEST-TAKING HINT: The age of the child is essential to answering this question. The test taker must understand the psychoso- cial development of an adolescent in order to choose the appropriate answer. Adoles- cents focus on their relationships with peers and are much more influenced by peers than parents. Adolescents also want privacy, so the best thing parents can do is listen to their teens.

An 11-month-old girl has a diagnosis of iron-deficiency anemia. The child's mother tells the nurse that her daughter is currently taking iron and a multivitamin. Which statement made by the mother should be of concern to the nurse? 1. "I give my daughter her iron and multivitamin at the same time each morning." 2. "I give my daughter her iron and her multivitamin in her morning 6-oz bottle." 3. "I give my daughter her iron and multivitamin in a nipple before I feed her the morning bottle." 4. "I give my daughter her iron and multivitamin in oral syringes toward the back of her cheek."

1. It is always a good idea for parents to administer medications at the same time each day. 2. Medications should never be mixed in a large amount of food or formula be- cause the parent cannot be sure that the child will take the entire feeding. Formula decreases the absorption of iron. 3. Giving medications in a nipple is an ac- ceptable method of administering liquid oral medications to infants. 4. An oral syringe is a good method of ad- ministering oral medications. The syringe should be placed in the back side of the cheek. Small amounts of the medication should be given at a time. TEST-TAKING HINT: The test taker must have knowledge of medication administra- tion. Answers 1, 3, and 4 can be eliminated as they are all appropriate methods for ad- ministering medications to infants.

A mother requests that her child receive the varicella vaccine at her 9-month well-child checkup. The nurse tells the mother that: 1. Children who are vaccinated will likely develop a mild case of the disease from the vaccine. 2. The nurse cannot give the vaccine. 3. The nurse will administer the vaccine after the physician examines the child. 4. The child will need a booster vaccination at 18 months of age.

1. It is possible for children to develop a mild rash after receiving the varicella vaccine. However, the varicella vaccine is not usually administered prior to 1 year of age. 2. The nurse should not give the vaccine. The varicella vaccine is not usually ad- ministered prior to 1 year of age. 3. The varicella vaccine is not usually admin- istered prior to 1 year of age. 4. The recommendation is that a second dose be administered at 4 to 6 years of age. TEST-TAKING HINT: The test taker must understand basic immunization schedules to answer the question.

A 2-year-old boy has been admitted to the hospital for anemia. His mother asks the nurse what foods to include in his diet to improve his nutritional status. Which of the following should the nurse recommend? 1. Increase the child's intake of whole cow's milk to 32 ounces a day. 2. Increase the child's intake of meats, eggs, and green vegetables. 3. Increase the child's intake of fruits, whole grains, and rice. 4. Increase the number of snacks the child eats during the day.

1. One of the primary reasons toddlers de- velop anemia is because they are consum- ing too much milk, which is limiting their intake of iron-rich foods. Milk is a poor source of iron and should be limited to 24 ounces per day for a child with anemia. 2. Meat, eggs, and green vegetables are excellent sources of iron. 3. Iron-enriched cereals are a good choice for children, but this list of foods is not the choice of the most iron-rich foods. 4. Increasing the number of snacks the child consumes is not the focus. Instead, the fo- cus is on providing the child with the most iron-rich foods. TEST-TAKING HINT: The test taker must have knowledge of the recommended nu- trition for children. The test taker must also have knowledge of foods that are high in iron.

A 2-day-old girl is being discharged home. The nurse is working on discharge teach- ing with her parents. They are asking the nurse about how to use the infant car seat and where it should be placed in their vehicle. Which of the following should the nurse do? 1. Give the parents a pamphlet explaining how to install the car seat. 2. Accompany the parents to the car, and show them how to install the car seat. 3. Contact the hospital's car-seat safety officer, and ask the officer to accompany the parents to the car for car-seat installation. 4. Show the parents a video on car-seat installation and safety, and ask if they are comfortable with the information.

1. Pamphlets may be a useful tool to reinforce teaching. However, a hands-on approach is best in this situation. 2. The nurse could accompany the parents if she is proficient in car-seat safety and installation. 3. The car-seat safety officer is the best choice, as that individual would have the needed information and certification to help the family. 4. A video may be a useful tool to reinforce teaching. However, a hands-on approach is best in this situation. TEST-TAKING HINT: The question requires knowledge of the safety concerns involv- ing improper car-seat installation. The question also requires the test taker to implement teaching and learning strate- gies for educating parents. Most people learn best with demonstration and return demonstration. Therefore the test taker can eliminate answers 1 and 4.

The parents of a 7-month-old girl are attending a class on child safety. Following the class, what should the child's parents understand as one of the most common causes of injury and death for a 7-month-old child? 1. Poisoning. 2. Child abuse. 3. Aspiration. 4. Dog bites.

1. Poisoning is more common among tod- dlers and preschoolers who are ambulating. 2. Child abuse is not one of the leading causes of injury and death in children. Accidents are the most common cause of injury and death. 3. Aspiration is a common cause of injury and death among children of this age. These children often find small objects lying on the floor and place them in their mouths. Older siblings are often responsible for leaving small objects around. 4. Dog bites are not a leading cause of injury or death in children. TEST-TAKING HINT: The test taker must have knowledge of the primary safety concerns of infants. Answer 1 can be eliminated as poisoning is more common among preschoolers. Child abuse and dog bites, answers 2 and 4, are not common causes of injury and death in infants.

A 3-year-old female is hospitalized for an ASD repair. Her parents have decided to go home for a few hours to spend time with her siblings. The child asks when her mommy and daddy will be back. The nurse's best response is: 1. "Your mommy and daddy will be back after your nap." 2. "Your mommy and daddy will be back at 6 p.m." 3. "Your mommy and daddy will be back later this evening." 4. "Your mommy and daddy will be back in 3 hours."

1. Preschoolers understand time in rela- tion to events. 2. Preschoolers cannot tell time. 3. Preschoolers want concrete information, and the words "this evening" are not meaningful to them. 4. Preschoolers have no concept how long an hour is. TEST-TAKING HINT: The age of the child is essential to answering this question. The test taker must have knowledge of a child's understanding of the concept of time. Answers 2, 3, and 4 can be elimi- nated because they provide choices for time measurement that would only be un- derstandable to children school-age or older.

A 17-year-old male is being seen in the ER. In order to obtain the adolescent's health information, his nurse should: 1. Interview the adolescent using direct questions. 2. Gather information during a casual conversation. 3. Interview the adolescent only in the presence of his parents. 4. Gather information only from the parents.

1. Teens may not speak as freely when asked direct questions. 2. Frequently adolescents will share more information when it is gathered during a casual conversation. 3. Teens may share more information when they are not in the presence of their par- ents. It is important to interview the child first. Parent information can be obtained following the interview with the child. 4. It is important to gather information from both the teen and the parent. TEST-TAKING HINT: The age of the child is essential to answering this question. An- swers 3 and 4 contain the word "only." There are rare instances in nursing when the word "only" would apply. These an- swers can usually be eliminated.

An 11-year-old male is being evaluated in the ER for an inguinal hernia. Which statement accurately describes how the nurse should approach him for his physical assessment? 1. The nurse should ask the child's parents to remain in the room during the physical exam. 2. The nurse should auscultate the child's heart, lungs, and abdomen first. 3. The nurse should explain to the child that the physical exam will not hurt. 4. The nurse should explain to the child what the nurse will be doing in basic understandable terms.

1. Privacy is very important to school-age children. The child should be given the choice whether his parents are present for the exam. 2. School-age children can be assessed in a head-to-toe sequence. 3. The nurse should not promise that the exam will not hurt. Palpation of the area of the hernia may hurt the child, and that may jeopardize the trust relationship between the nurse and the child. 4. School-age children are capable of understanding basic functions of the body and should be taught about their diagnosis in simple, basic terms. TEST-TAKING HINT: Health-care profes- sionals must approach children using de- velopmentally appropriate methods. The test taker must have knowledge of a child's psychosocial development. Answers 1 and 2 can be eliminated because they are methods of assessment used for younger children.

A 9-year-old boy has been hospitalized following a bicycle injury. What should the nurse recommend to the child's parents to prevent future injury? 1. Their son should wear safety equipment while riding bicycles. 2. Their son should read educational material on bicycle safety. 3. Their son should watch a video on bicycle safety. 4. Their son should ride his bike in the presence of adults.

1. Safety equipment is essential for bicy- cling, skateboarding, and participating in contact sports. Most injuries occur during the school-age years, when children are more active and partici- pate in contact sports. 2. Educational material is a good way to re- inforce the use of safety equipment, but the parents must insist that the child use his safety equipment. 3. Video material is a good way to reinforce the use of safety equipment, but the parents must insist that the child use his safety equipment. 4. The child's parents may not always be pres- ent when he rides his bike, so the use of safety equipment is the primary concern. TEST-TAKING HINT: This is a question focusing on safety. The test taker must understand that educational material may reinforce a child's knowledge of safety. However, in order to avoid injury, the best thing a parent can do is insist on the use of safety equipment.

The school nurse is preparing a discussion on nutrition with the fourth-grade class. Based on the childrens' developmental level, what information should she include in her presentation? 1. A review of the number of calories that a fourth-grade child should consume in a day. 2. A review of a list of high-calorie foods that all fourth-graders should avoid. 3. A review of how to read food labels so children know which foods are good for them. 4. A review of nutritious foods with basic scientific information about how they affect the body organs and systems.

1. School-age children do not engage in calorie counting. This is an adult activity. 2. Children may not want to hear this infor- mation, as most of them enjoy consuming high-calorie foods that taste good. 3. School-age children do not engage in calorie counting. This is an adult activity. 4. Reviewing nutritious choices keeps the lesson on a positive note, and school- age children are very interested in how food affects their bodies. They are ca- pable of understanding basic medical terminology. TEST-TAKING HINT: The test taker must have knowledge of the school-age chil- dren's cognitive level and their ability to process and understand information.

The nurse is caring for a 7-year-old female on the school-age unit. Her mother is con- cerned that she may have some developmental delays. Which of the following statements would indicate to the nurse that the child is not developmentally on track for her age: 1. The child is able to follow a four-to-five-step command. 2. The child started wetting the bed on this admission to the hospital. 3. The child has an imaginary friend named Kelly. 4. The child enjoys playing board games with her sister.

1. School-age children should be able to fol- low a four- to five-step command, so this does not indicate that the child has a devel- opmental delay. 2. The child was potty-trained before entering the hospital, and it is important to inform her mother that bedwetting is a common form of regression seen in hospitalized chil- dren. The child will likely return to her nor- mal toileting habits when she returns home. 3. Most school-age children do not have imaginary friends. This is much more common for children of 3 and 4 years of age. 4. Most school-age children do enjoy playing board games. TEST-TAKING HINT: The test taker must also understand the stressors that affect chil- dren who are hospitalized and how they will react to those stressors based on their developmental level.

An 8-year-old is NPO while he awaits surgery for central line placement later in the afternoon. The nurse is trying to engage the child in some form of activity to distract him from thinking about his upcoming surgery. Which is the best method of distraction for a child of this age in this situation? 1. Encourage the child to use the telephone to call friends. 2. Encourage the child to watch television. 3. Encourage the child to play a board game. 4. Encourage the child to read the central line pamphlet he was given.

1. Talking to friends may distract the child for some time. However, the conversation could revert to a discussion about the up- coming surgery. 2. Watching television may distract the child for some time, but he may still be thinking about his surgery. 3. A board game is the optimal choice be- cause school-age children enjoy being engaged in an activity with others that will require some skill and challenge. 4. Reading material about the surgery will only increase his thoughts about the surgery.

A 5-year-old is at the pediatrician's office for his well-child checkup. The nurse will be administering three immunizations to the child. The nurse should expect which reaction from the child when she gives his immunizations? 1. The child will likely remain silent and still. 2. The child will likely cry and tell the nurse that it hurts. 3. The child will likely try to stall the nurse. 4. The child will likely remain still while telling the nurse that she is hurting him.

1. Teens are more likely to be stoic and re- main still and silent during injections. 2. The common response of a 5-year-old is to cry and protest during an immunization. 3. School-age children are most likely to try to stall the nurse. 4. Teens usually remain still, and they may calmly tell the nurse that they are feeling pain during the injection. TEST-TAKING HINT: The age of the child is essential to answering this question. The test taker must understand the child's psychosocial development in order to choose the appropriate response.

The mother of a 15-year-old boy is frustrated because he spends much of his weekend time sleeping. She informs the nurse, "My son sleeps longer now than he did when he was in kindergarten." What is the nurse's best response to the child's mother's frustration? 1. "Your son may be trying to catch up on the sleep he misses during the week while he is studying." 2. "Developmental theorists believe that teens require more sleep as they begin to integrate new roles into their lives." 3. "Teens require more sleep due to the rapid physical growth that is occurring during adolescence." 4. "Teens require more sleep due to the increase in their social obligations."

1. Teens require more sleep due to the rapid physical growth that occurs during adolescence. 2. Teens are trying to integrate new roles into their lives. However, that has no impact on their need for increased sleep. 3. Teens require more sleep due to the rapid physical growth that occurs during adolescence. 4. Teens are generally more social and may be staying out late. However, their in- creased requirement for sleep is related to their rapid growth during adolescence. TEST-TAKING HINT: The test taker must have knowledge of the physical growth and development of adolescents.

A 5-year-old boy is being screened for developmental delays using the Denver Developmental Screening Test. The child's mother is explaining to the nurse her understanding of the screening test. The nurse realizes that the child's mother needs further education about the test when she states which of the following? 1. "It screens my son's gross motor skills." 2. "It screens my son's fine motor skills." 3. "It screens my son's intelligence level." 4. "It screens my son's language development."

1. The Denver Developmental Test, which evaluates children from 1 month to 6 years, is used to screen gross motor skills, fine motor skills, language development, and personal/social development. 2. The Denver Developmental Test, which evaluates children from 1 month to 6 years, is used to screen gross motor skills, fine motor skills, language development, and personal/social development 3. The Denver Developmental Test does not test a child's level of intelligence. 4. The Denver Developmental Test, which evaluates children from 1 month to 6 years, is used to screen gross motor skills, fine motor skills, language development, and personal/social development. TEST-TAKING HINT: The test taker must have knowledge of the Denver Develop- mental Test and what it screens for.

A 13-year-old boy is hospitalized for a femur fracture. He was hit by a car while he and his friends were racing bikes near a major intersection. The child's parents are concerned about his judgment. What should the nurse understand? 1. The child's behavior is typical of young teens. 2. The child's behavior is related to hormonal surges during adolescence. 3. This was an isolated incident and will not likely happen again. 4. The child's behavior is related to teen rebellion.

1. The brains of young teens are not completely developed, which often leads to poor judgment and low impulse control. 2. Hormonal changes in teens play a primary role in the development of secondary sex characteristics. 3. The child may be prone to other lapses in judgment. The brains of young teens are not completely developed, which often leads to poor judgment and low impulse control. 4. The child's behavior had nothing to do with rebellion. TEST-TAKING HINT: The age of the child is essential to answering this question. The test taker must understand the psychosocial and cognitive development of the adolescent in order to choose the appropriate intervention.

The nurse is caring for a 12-month-old girl. The child's mother asks if the unit has any toys that her daughter can play with. The nurse goes to the toy area in search of a toy for the child. Which toy is the best choice for this child? 1. A doll. 2. A musical rattle. 3. A board book. 4. Colorful beads.

1. The child can play with a small doll, but she will likely just put the doll in her mouth. She is not old enough to play ap- propriately with this toy. 2. A musical rattle is the perfect toy for this child. Infants have short attention spans and enjoy auditory and visual stimulation. 3. Reading to children is essential through- out childhood. However, the child will likely just chew on the book, so it is not the ideal choice. 4. Beads are not appropriate for infants due to the risk of choking. TEST-TAKING HINT: The test taker must understand the developmental level of the child in order to choose the appropriate toy. The test taker must also understand safety issues for a child this age.

A 4-year-old is visiting the pediatrician's office for his well-child checkup. The nurse needs to take his blood pressure. Which action by the nurse is a developmentally appropriate method for eliciting the child's cooperation? 1. Have the child's parents help put on the blood pressure cuff. 2. Tell the child that if he sits still, the blood pressure machine will go quickly. 3. Ask the child if he feels a squeezing of his arm. 4. Tell the child that blood pressures do not hurt.

1. The child is preschool age. Preschool chil- dren like to do things for themselves and will not likely behave any better for the parents than the nurse. 2. The nurse should not promise the child that the procedure will go quickly. The nurse needs to develop a trusting relation- ship with the child so only promises than can be kept should be made. 3. Preschool children enjoy games, and it is a good way to elicit their assistance and cooperation during a procedure. 4. The nurse should not promise the child that the procedure will not hurt. Each child's perception of pain is individual in nature. The nurse needs to develop a trusting relationship with the child so only promises that can be kept should be made. TEST-TAKING HINT: The age of the child is essential to answering this question. The test taker must understand the psychoso- cial and cognitive development of a pre- schooler in order to choose the appropri- ate intervention. Answers 2 and 4 can be eliminated because nurses should never make promises to children that they may not be able to keep. It is difficult to build a trusting relationship with children un- less the nurse is completely honest.

A female nurse caring for a 5-year-old boy is trying to encourage developmental growth. What can the nurse do to reinforce the child's intellectual initiative when he asks the nurse about his upcoming surgery? 1. Answer the child's questions about his upcoming surgery in simple terms. 2. Provide the child with a book that has vivid illustrations about his surgery. 3. Tell the child he should wait and ask the doctor his questions. 4. Tell the child that she will answer his questions at a later time.

1. The child is taking the initiative to ask questions, as all toddlers do, and the nurse should always answer those questions as appropriately and accu- rately as possible. 2. A book illustrating what will happen to the child may help him, but it will not en- courage his intellectual initiative. 3. By not answering the child's questions, the nurse may actually be stifling his sense of initiative. 4. By not answering the child's questions, the nurse may actually be stifling his sense of initiative. TEST-TAKING HINT: The age of the child is essential to answering this question. The test taker must understand the cognitive level of the child in order to choose the appropriate intervention. Answers 3 and 4 can be eliminated because the nurse is avoiding the child's questions.

The nurse caring for a 4-year-old female in the ER is about to start a peripheral IV. The nurse's best method for explaining the procedure to the child is to: 1. Show the child a pamphlet with pictures showing the IV placement procedure. 2. Have the 5-year-old patient next door tell the 4-year-old about her experience with her IV placement. 3. Show the child the IV placement equipment, and demonstrate the procedure on a doll. 4. Tell the child that if she remains still, the procedure will be over quickly.

1. The child is too young to understand the procedure using pamphlets. 2. Children 4 years old are egocentric and will not relate the other child's experience to their own. 3. A 4-year-old child understands things in very concrete and simple terms. Therefore, medical play is an excellent method for helping her understand the procedure. 4. The nurse has no idea how long the procedure will take and should not give the child information that may not be reliable. TEST-TAKING HINT: The age of the child is essential to answering this question. The test taker must understand the developmental level of the child in order to choose the appropriate intervention. Most 4-year-old patients are unable to read, so choice 1 can be eliminated.

Which statement by the mother of an 18-month-old would lead the nurse to believe that the child should be referred for further evaluation for developmental delay? 1. "My child is able to stand but is not yet taking steps independently." 2. "My child has a vocabulary of approximately 15 words." 3. "My child is still thumb sucking." 4. "My child seems to be quite wary of strangers."

1. The child should be walking indepen- dently by 15 to 18 months. Because this toddler is 18 months and not walk- ing, a referral should be made for a developmental consult. 2. The vocabulary of an 18-month-old should be 10 words or more. 3. Thumb sucking is still common for 18-month-olds and may actually be at its peak at that age. 4. It is very common for a child of 18 months to exhibit stranger anxiety. TEST-TAKING HINT: The age of the child is essential to answering this question. The test taker must understand basic develop- mental milestones in order to choose the appropriate intervention.

A 4-year-old has been hospitalized with FTT. The child has orders for daily weights, strict input and output, and calorie counts as a means of measuring her nutritional status. Which action by the nurse would be a concern? 1. The nurse weighs the child every morning before the child eats breakfast. 2. The nurse weighs the child with no clothing except for undergarments. 3. The nurse sits with the child when the child eats her meals. 4. The nurse weighs the child using the same scale every morning.

1. The child should be weighed every day before she eats. Her weight will not be an accurate reflection if she is fed prior to being weighed. 2. The child should be weighed only in un- dergarments. The weight of clothing must not be included. 3. The nurse should remain in the room while the child eats in order to accurately record a calorie count. 4. The child should be weighed on the same scale every time. All scales are not equally accurate, so it is important to use the same scale in order to obtain an accurate trend. TEST-TAKING HINT: The test taker must have knowledge of a child's nutrition and how to obtain an accurate weight.

A 9-year-old girl builds a clubhouse in her backyard. She hangs a sign outside her clubhouse that says "No boys allowed." The child's parents are concerned that she is excluding their neighbor's son, and they are upset. What should the school nurse tell the child's parents? 1. Her behavior is cause for concern and should be addressed. 2. Her behavior is common among school-age children. 3. Her feelings about boys will subside within the next year. 4. They should have their daughter speak with the school counselor.

1. The child's behavior is normal. Girls of 9 and 10 generally prefer to have friends who are of the same gender. 2. This is common behavior. Girls of 9 and 10 generally prefer to have friends who are of the same gender. 3. Girls of 9 and 10 generally prefer to have friends who are of the same gender. The child will likely have the same feelings next year. 4. There is no need for the child to see the counselor. Girls of 9 and 10 generally pre- fer to have friends who are of the same gender. TEST-TAKING HINT: The age of the child is essential to answering this question. The test taker must understand the psychoso- cial development of the child in order to choose the appropriate behavior. Answer 3 can be eliminated because it is too absolute. There is no way to determine

A 16-year-old boy has a diagnosis of new onset diabetes. The child is meeting with the nurse educator regarding changes that will need to be made in his diet. What would most influence a teenager's food choices? 1. Parents and their dietary choices. 2. Cultural background. 3. Peers and their dietary choices. 4. Television and other forms of media influence.

1. The child's family does have some influence on his dietary choices, but teens are more focused on being like their peers. 2. The child's culture does affect his food choices. However, teens are more likely to choose "junk foods" and foods that their peers are eating. 3. As a teen, the child is most influenced by his peers. Teens long to be like oth- ers around them. 4. Television does affect personal food choices, but the peer group still has the most prevalent impact in a teen's life. TEST-TAKING HINT: The age of the child is essential to answering this question. The test taker must understand that peers are central to an adolescent's life.

The mother of a 13-year-old girl tells the nurse that she is concerned because her daughter has gained 10 lb since she began puberty. The child's mother asks the nurse for advice about what to do about her daughter's weight gain. Which of the following should the nurse do? 1. Provide the child's mother with some pamphlets on nutrition and healthy eating. 2. Provide the child's mother with information about a new exercise program for teens. 3. Inform the child's mother that it is common for teen girls to gain weight during puberty. 4. Inform the child's mother that her daughter will likely gain another 5 to 10 lb in the next year.

1. The child's mother may be interested in information relating to proper nutrition and exercise. However, the most impor- tant thing is for the nurse to let the child's mother know that this is a normal finding in teenage girls as they enter puberty. 2. The child's mother may be interested in information relating to proper nutrition and exercise. However, the most important thing is for the nurse to let the mother know that this is a normal finding in teenage girls as they enter puberty. 3. The nurse should tell the child's mother that this is a normal finding in teenage girls as they enter puberty. 4. The nurse knows that it is normal for girls to gain weight during puberty but has no idea how much weight the child will gain or if she will gain any more. TEST-TAKING HINT: The test taker must have knowledge of the physical develop- ment of adolescent girls.

The nurse is caring for a 6-month-old in the ER. The physician orders the nurse to give the child a dose of Rocephin IM. The 1.5-mL dose arrives from the pharmacy. The nurse must do which of the following? 1. Administer the injection in the deltoid muscle. 2. Split the dose into two injections. 3. Administer the injection in the dorsogluteal muscle. 4. Administer the dose as a single injection to the vastus lateralis muscle.

1. The deltoid of a 6-month-old is not developed enough and should not be used for IM injections 2. A nurse should not deliver more than 1 mL per IM injection to a child of 6 months. 3. The dorsogluteal muscle should not be used in children until they have been walking for at least 2 years. 4. The vastus lateralis is the site of choice for an IM injection for a child 6 months old. However, the injection should not be more than 1 mL for a single injection. TEST-TAKING HINT: The test taker must have knowledge of IM injections sites and acceptable volumes for children of varying ages.

A first-time mother brings in her 5-day-old baby for a well-child visit. The nurse weighs the infant and reports a weight of 7 lb 5 oz to the mother. The mother looks concerned and tells the nurse that her baby weighed 7 lb 10 oz when she was dis- charged 4 days ago. The nurse's best response to the mother is: 1. "I will let the doctor know, and he will talk with you about possible causes of your infant's weight loss." 2. "An initial weight loss of a few ounces is common among newborns, especially for breastfeeding mothers." 3. "I can tell you are a first-time mother. Don't worry; we will find out why she is losing weight." 4. "Maybe she isn't getting enough milk. How often are you breastfeeding her?"

1. The nurse should inform the physician how many ounces the infant lost. How- ever, a loss of a few ounces during the first few days of life is normal. There will be reason for concern if the infant does not gain weight within the next week. 2. Newborns can lose up to 10% of their birth weight without concern but should regain their birth weight by 2 weeks of age. 3. The nurse should not make this comment. The mother will likely feel belittled, and she may be afraid to ask questions in the future. 4. A loss of a few ounces during the first few days of life is normal. Many times infants of breastfeeding mothers lose weight ini- tially because the mother's milk has not come in yet. TEST-TAKING HINT: The test taker can eliminate 3. This is a non-therapeutic response. Remembering that newborns can lose up to 10% of their birth weight will help you choose the right response.

A 7-year-old female is being admitted to the hospital for a diagnosis of acute lymphocytic leukemia. The nurse wants to gather information from the child regarding her eelings about her diagnosis. Which nursing action is most appropriate to gain infor- mation about how the child is feeling? 1. The nurse should actively attempt to make friends with the child before asking her about her feelings. 2. The nurse should ask the child's parents what feelings she has expressed in regard to her diagnosis. 3. The nurse should provide the child with some paper to draw a picture of how she is feeling. 4. The nurse should ask the child direct questions about how she is feeling.

1. The nurse should not attempt to make friends with the child too quickly. The child should be given the opportunity to observe the nurse working in order to increase her comfort level with the nurse. 2. The child's parents are a good source of in- formation, but the child may not have ex- pressed all of her feelings to her parents. 3. Often children will include much more detail of their feelings in drawings. They will often express things in pictures they are unable to verbalize. 4. School-age children do not often share all of their feelings verbally, especially to peo- ple with whom they are not familiar.

A 5-year-old girl has been brought to the ER for suspected child abuse. What approach should the nurse use to gather information from the child? 1. The nurse should promise the child that her parents will not know what she tells the nurse. 2. The nurse should promise the child that she will not have to see the suspected abuser again. 3. The nurse should use correct anatomical terms to discuss body parts. 4. The nurse should tell the child that the abuse is not her fault and that she is a good person.

1. The nurse should not promise not to tell. The nurse should always be honest with the child in order to develop a level of trust. 2. The nurse should not make a promise that cannot be kept. Once again, the trust rela- tionship could be jeopardized if the child feels the nurse lied to her. 3. The nurse should discuss body parts in re- lation to the child's vocabulary. 4. Many young children believe abuse or illness is their fault, and they should be reminded they are not to blame. Many children of this age believe they have acquired a disease or have been abused because they are bad people. TEST-TAKING HINT: Children of this age of- ten believe an injury or abuse is their fault. They sometimes feel they are being punished for being bad. The safety and security of the child is paramount in this situation. The child needs to know she is now safe and she did not cause the abuse. Answers 1 and 2 can be eliminated be- cause of the word "promise." The nurse needs to build a trusting relationship with the child and should never make a prom- ise that cannot be kept.

In order to prevent separation anxiety in a hospitalized toddler, which of the following should the nurse do? 1. Assume the parental role when parents are not able to be at the bedside. 2. Encourage the parents to remain at the bedside always. 3. Establish a routine that is similar to that of the child's home. 4. Rotate nursing staff so the child becomes comfortable with a variety of nurses.

1. The nurse should try to comfort the child and be friendly, but she should not try to replace the parent. 2. Parents should be encouraged to be with their child as much as possible. However, parents may feel guilty if they leave knowing the staff believes the parents should always be at the bedside. 3. It is very important to try to maintain a child's home routine both when par- ents are present and when they have to leave the hospital. This will increase the child's sense of security and de- crease anxiety. 4. Providing consistent nursing care is important, not rotating staff. The child needs consistent care to decrease anxiety. TEST-TAKING HINT: The test taker must have knowledge of the stages of separa- tion anxiety. Answer 1 can be ruled out because the nurse should never assume a parental role with a child. Answer 4 can be eliminated because it is essential that children be provided with continuity of care.

The nurse is performing a physical assessment on a 6-month-old baby. Which finding should the nurse understand as abnormal for this child? 1. The child's posterior fontanel is open. 2. The child's anterior fontanel is open. 3. The child has the beginning signs of tooth eruption. 4. The child is able to track and follow objects.

1. The posterior fontanel should close between 6 and 8 weeks of age. 2. The anterior fontanel usually closes between 12 and 18 months. 3. The infant usually has a first tooth by 6 months. 4. The infant should be able to track objects. TEST-TAKING HINT: This is a specific physi- cal developmental milestone that should be memorized.

A 16-year-old male is hospitalized for cystic fibrosis. He will be an inpatient for 2 weeks while he receives IV antibiotics. As the nurse caring for this patient, what action can you take that will most enhance his psychosocial development? 1. Fax the teen's teacher, and have her send in his homework. 2. Encourage the teen's friends to visit him in the hospital. 3. Encourage the teen's grandparents to visit frequently. 4. Tell the teen he is free to use his phone to call friends.

1. The teen may want to continue his school-work while in the hospital, but it is not the best means of enhancing his psychosocial development. 2. Teens are most concerned about being like their peers. Having the teen's friends visit will help him feel he is still part of the school and social environment. 3. The teen may want to see his grandparents, but they are not the primary focus in his life. 4. Calling friends is a good means of remaining in contact with peers. However, having direct contact with friends is a better means of maintaining social contact. TEST-TAKING HINT: The age of the child is essential to answering this question. The test taker must understand that peers are central to an adolescent's life.

A 3-year-old boy has been hospitalized because he fell down the stairs. His mother is crying and states, "This is all my fault." Which is the nurse's best response to the child's mother? 1. "Accidents happen. You shouldn't blame yourself." 2. "Falls are one of the most common injuries for toddlers." 3. "It may be a good idea to put a baby gate on the stairs." 4. "Your son should be proficient at walking down the stairs by now."

1. This comment will not make the mother feel any better. The mother is going to blame herself regardless of where the blame lies. The nurse would do better to just listen than to make this sort of comment. 2. Falls are one of the most common in- juries, and it may make the parent feel better to know that this is common among all toddlers. 3. It may be a good idea to put up a baby gate, but in this situation the nurse's comment may be interpreted as judgmental. 4. Toddlers are still working on maintaining stability while walking, climbing stairs, and running. The toddler should not be expected to be proficient at this time. TEST-TAKING HINT: The test taker must understand the psychological state of the parent. Most parents blame themselves whenever their children are injured, so answer 1 can be eliminated. Answer 3 im- plies that the injury is the parent's fault, so it too can be eliminated.

The mother of 11-year-old fraternal twins tells the nurse at their well-child checkup that she is concerned because her daughter has gained more weight and height than her twin brother. The mother is concerned that there is something wrong with her son. The nurse's best response is: 1. "I understand your concern. I will talk with the physician, and we can draw some lab work." 2. "I understand your concern. Has your son been ill lately?" 3. "It is normal for girls to grow a little taller and gain more weight than boys at this age." 4. "It is normal for you to be concerned, but I am sure your son will catch up with your daughter eventually."

1. This is not an appropriate response. The nurse should be aware that it is normal for girls to grow taller and gain more weight than boys near the end of middle childhood. 2. This is not an appropriate response. The nurse should be aware that it is normal for girls to grow taller and gain more weight than boys near the end of middle childhood. 3. This is the appropriate response. The nurse understands that it is normal for girls to grow taller and gain more weight than boys near the end of mid- dle childhood. 4. This is not the best response. The boy will likely surpass his sister when he reaches adolescence. TEST-TAKING HINT: This is a specific physi- cal developmental milestone that should be memorized.

According to developmental theories, which important event does the nurse understand is essential to the development of the toddler? 1. The child learns to feed self. 2. The child develops friendships. 3. The child learns to walk. 4. The child participates in being potty-trained.

1. Toddlers are in a stage of life where they like to do for themselves. However, devel- opmental theorists like Erickson and Freud believe that toilet training is the es- sential event that must be mastered by the toddler. 2. Toddlers engage in more parallel play. Building friendships is not common until school age and adolescence. 3. Walking should be mastered by 18 months of age. 4. Developmental theorists like Erickson and Freud believe that toilet training is the essential event that must be mas- tered by the toddler. TEST-TAKING HINT: The test taker must have knowledge of Freud and Erickson's developmental theories.

The mother of a child 2 years 6 months has arranged a play date with the neighbor and her 3-year-old daughter. During the play date the two mothers should expect that the children will do which of the following? 1. The children will share and trade their toys while playing. 2. The children will play with one another with little or no conflict. 3. The children will play alongside one another but not actively with one another. 4. The children will play with one or two items, ignoring most of the other toys.

1. Toddlers do not share their possessions well. One of their favorite words is "mine." 2. Because toddlers do not share well, they are often in conflict with one another dur- ing play. 3. Toddlers engage in parallel play. They often play alongside another child but they rarely engage in activities with the other child. 4. Toddlers have very short attention spans and commonly play with various items for short periods. TEST-TAKING HINT: The age of the child is essential to answering this question. The test taker must understand the develop- mental level of the child in order to choose the appropriate form of play.

The nurse caring for a 9-month-old is using the FLACC scale to rate her pain level. The child's parents ask the nurse what the FLACC scale is. Which is the nurse's best response? 1. "It estimates a child's level of pain utilizing vital sign information." 2. "It estimates a child's level of pain based on parents' perception." 3. "It estimates a child's level of pain utilizing behavioral and physical responses." 4. "It estimates a child's level of pain utilizing a numeric scale from 0 to 5."

1. Vital signs are not considered when mea- suring pain using the FLACC scale. 2. The parents' perception of their child's pain level is not considered when using the FLACC scale. 3. The FLACC scale utilizes behavioral and physical responses of the child to measure the child's level of pain. The scale utilizes facial expression, leg position, activity, intensity of cry, and level of consolability. 4. The FLACC scale assigns a numeric value to a child's pain level, which is from 0 to 10. TEST-TAKING HINT: The test taker must have knowledge of pain rating scales used to measure the pain of nonverbal children.

An 8-week-old male has just had surgery for pyloric stenosis. His nurse is assessing his level of pain. The child's mother asks the nurse what vital sign changes she should expect to see in a child who is experiencing pain. The nurse's best response is: 1. "We expect to see a child's heart rate decrease and respiratory rate increase." 2. "We expect to see a child's heart rate and blood pressure decrease." 3. "We expect to see a child's heart rate and blood pressure increase." 4. "We expect to see a child's heart rate increase and blood pressure decrease."

1. When a child is experiencing pain, the normal physiological response is for the heart rate and respiratory rate to increase. 2. When a child is experiencing pain, the normal physiological response is for the heart rate and blood pressure to increase. 3. When a child is experiencing pain, the normal physiological response is for the heart rate, respiratory rate, and blood pressure to increase. 4. When a child is experiencing pain, the normal physiological response is for the heart rate, respiratory rate, and blood pressure to increase. TEST-TAKING HINT: The test taker must have knowledge of vital sign changes that occur when a child is in pain.

Which of the following are stressors common to hospitalized toddlers? Select all that apply. 1. Social isolation. 2. Interrupted routine. 3. Sleep disturbances. 4. Self-concept disturbances. 5. Fear of being hurt.

2, 3, 5. 1. Social isolation is a stressor of the hospitalized teen. 2. Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. 3. Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. 4. Self-concept disturbance is a stressor of the hospitalized teen. 5. Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. The stressors of social iso- lation and self-concept disturbances are stressors of the hospitalized teen. TEST-TAKING HINT: The age of the child is essential to answering this question. The test taker must understand the develop- mental level of the child in order to choose the appropriate intervention. The test taker must also have knowledge of com- mon stressors that affect children during hospitalization.

A 3-year-old female is hospitalized for a femur fracture. As her nurse, what nursing action would help foster the child's sense of autonomy? 1. Allow the child to choose what time to take her oral antibiotics. 2. Allow the child to have a doll for medical play. 3. Allow the child to administer her own dose of Keflex (cephalexin) via oral syringe. 4. Allow the child to watch age appropriate videos.

Medication administration times must be adhered to. A 3-year-old should not be allowed to choose administration times. 2. A doll for medical play is an excellent method for teaching children about medical procedures, but it will not enhance her sense of autonomy. 3. Allowing toddlers to participate in actions of which they are capable is an excellent way to enhance their autonomy. 4. Age-appropriate videos are a good way to occupy the child while she is hospitalized, but they will not enhance her autonomy.