Pediatric Growth & Development EAQ

Which statement by the parents of an infant with Erb palsy indicates to the nurse that they have an accurate understanding of their infant's prognosis? 1 "Complete recovery takes a few months." 2 "This is a progressive paralysis with no cure." 3 "Physical therapy will be necessary for a year." 4 "Surgery will be needed to correct the problem."

1 "Complete recovery takes a few months." The nerves that have been stretched take about 3 months to recover from the trauma sustained during the birth process. The paralysis is not progressive, and the prognosis is usually excellent. Passive range of motion and intermittent splinting performed by a family member are generally all the interventions that are necessary; only in rare instances, when avulsion of the nerves results in permanent damage, is orthopedic or surgical intervention necessary.

Which statement by the mother of a 5-month-old infant indicates effective learning about proper nutrition for the infant's growth and development? 1 "I will breastfeed my child." 2 "I will give my child whole cow's milk." 3 "I will give my child adequate fruit juice." 4 "I will give my child iron-fortified cereals."

1 "I will breastfeed my child." Breastfeeding is recommended for infant nutrition because breast milk contains essential nutrients of proteins, fats, carbohydrates, and immunoglobulins. Giving cow's milk to an infant may lead to internal bleeding, anemia, and an increased incidence of allergies. Fruit juices should be avoided because they do not provide sufficient calories during this period. Iron-fortified cereals should be given to infants after 6 months of age because infants younger than 6 months of age are not sufficiently mature to digest solid foods.

Which statement by the parent of a 9-month-old supports the nurse's conclusion that the infant displays developmental accomplishments appropriate for this age? 1 "My child can throw a ball." 2 "My child can crawl backwards." 3 "My child can locate small objects." 4 "My child shows jerky movements upon hearing loud sounds."

1 "My child can throw a ball." A child who is 8 to 12 months old is capable of throwing objects. Therefore, this statement made by the parent indicates that the 9-month-old infant has achieved the developmental milestone appropriate for the age. An infant who is 4 to 7 months old is capable of crawling backwards and can locate small objects. These actions can be observed in an infant who is 9 months old, but it does not indicate major developmental accomplishments as per its age. Showing jerky movements upon hearing loud noise indicates that the child is showing startle reflex, which is an involuntary reflex seen from the birth to 4 months of age.

Which reading of a newborn's pulse may indicate an abnormality in the function of the cardiovascular system? 1 100 beats/min 2 120 beats/min 3 130 beats/min 4 140 beats/min

1 100 beats/min The normal pulse rate of a newborn ranges from 120 to 160 beats/min. Therefore, a pulse rate of 100 beats/min may indicate an abnormality. Pulse rates of 120 beats/min, 130 beats/min, and 140 beats/min are within normal range.

Which behavior is observed in a newborn in deep sleep? 1 Closed eyes 2 Irregular breathing 3 Occasional smiling 4 Rapid eye movements

1 Closed eyes A newborn in deep sleep will have closed eyes, regular breathing, and no eye movements. A newborn in light sleep would have irregular breathing, rapid eye movements, and may smile.

Which condition results from an abnormal organization of cells into a particular tissue type? 1 Dysplasia 2 Disruption 3 Deformation 4 Malformation

1 Dysplasia Dysplasias result from abnormal organizations of cells into a particular tissue. Disruptions result from the breakdown of normal tissue. Extrinsic mechanical forces on previously normal tissue cause deformations. A malformation results when developmental processes lead to an abnormally formed body part or organ.

An infant with a myelomeningocele is scheduled for surgery to close the defect. Which nursing action best facilitates the parent-child relationship in the preoperative period? 1 Encouraging the parents to stroke their infant 2 Allowing the parents to hold their infant in their arms 3 Referring the parents to the Spina Bifida Association of America 4 Teaching the parents to use special techniques when feeding the infant

1 Encouraging the parents to stroke their infant Because the infant cannot be held, tactile stimulation helps meet the infant's needs and fosters bonding with the parents. An infant with an unrepaired myelomeningocele cannot be held in the arms. Referrals will be more appropriate at a later time. Although special feeding techniques are important in the postoperative period, they may not improve the parent-infant relationship.

The parents of a toddler who has been admitted to the pediatric unit for surgery to correct hypospadias ask the nurse when this defect happened. The nurse responds that it usually occurs during fetal development, in the: 1 First 12 weeks 2 Third trimester 3 Second 16 weeks 4 Implantation phase

1 First 12 weeks The critical period of organogenesis occurs during the first trimester, when fetal development is most likely to be adversely affected. The fetus is less vulnerable after the first trimester because organ development is complete. The fetus is less vulnerable to major anomalies during the second 16 weeks because all major organ systems already are formed. At the time of implantation cellular differentiation has not occurred; the genital bud appears in the seventh week.

Which immunoglobulins (Ig) are transferred from a mother to a fetus? 1 IgG 2 IgA 3 IgD 4 IgM

1 IgG Significant amounts of maternal IgG antibodies are passed on to a newborn and confer immunity against antigens. IgA is not present at birth but is found in saliva and tears by 2 to 5 weeks of age. The production of IgD is gradual, and increases progressively during childhood. Significant amounts of IgM are produced at birth, and adult levels are reached by 9 months of age.

Which stage of psychosocial development is observed in a 5-year-old child according to Erikson's theory? 1 Initiative vs. guilt 2 Trust vs. mistrust 3 Industry vs. inferiority 4 Autonomy vs. shame and doubt

1 Initiative vs. guilt Children between 3 and 6 years of age like to pretend and try out new things. Conflicts may often occur between the child's desire to explore and the limits placed on his or her behavior, which may lead to frustration and guilt. Therefore, the initiative vs. guilt stage is seen in 3- to 5-year-old children. The trust vs. mistrust stage is observed in infancy (birth to 18 months). The industry vs. inferiority stage is seen in children between 6 and 12 years of age. The autonomy vs. shame and doubt stage is seen in children between 18 months and 3 years of age.

n which phase does a child develop the sense of object permanence according to Jean Piaget? 1 Sensorimotor 2 Preoperational 3 Formal operations 4 Concrete operations

1 Sensorimotor During the sensorimotor period, the child understands that objects continue to exist even when they cannot be seen, heard, or touched. This is called object permanence. During the preoperational phase, children learn to think with the use of symbols and mental images. Egocentricity is observed in the formal operations period. Children are able to perform mental operations during the concrete operations period.

Which gross motor skill can be observed in a 7-month-old infant? 1 Sits alone without support 2 Creeps on hands and knees 3 Walks holding onto furniture 4 Sits down from a standing position

1 Sits alone without support Infants between 6 and 8 months of age can sit alone without support. Infants can creep on their hands and knees at the age of 8 to 10 months. Infants who are 10 to 12 months of age can walk while holding onto furniture and can sit down from a standing position due to their well-developed motor skills.

After interacting with a preschooler, the nurse concludes that the child has normal development according to Fowler's spiritual development. Which behavior of the child supports the nurse's conclusion? 1 The child imitates the adults as they pray. 2 The child does not exhibit any spiritual behavior. 3 The child accepts the existence of a supreme power. 4 The child questions the religious practice and its benefits.

1 The child imitates the adults as they pray. A preschooler is in the intuitive-projective stage of Fowler's spiritual development, and would imitate the others as they pray and perform other religious activities. An infant is in the undifferential stage of Fowler's development and will not have any spiritual behavior. The school-age child is in mythical-literal stage of Fowler's spiritual development, and may accept the existence of a supreme power. An adolescent is in the synthetic-convention stage of Fowler's spiritual development, and may question religious practice and its benefits.

The nurse is evaluating the dietary plan of a 6-month-old infant. Which action by the infant's mother needs correction? 1 The mother gives low-fat milk to the infant in a bottle. 2 The mother gives teething crackers to the infant for pain relief. 3 The mother refrains from giving iron supplements to the infant. 4 The mother refrains from giving chopped table food to the infant.

1 The mother gives low-fat milk to the infant in a bottle. Cholesterol is required for proper neurological development in infants. Therefore, low-fat milk should not be given to infants and toddlers. Finger foods, such as teething crackers, should be introduced at the age of 6 months, as it helps provide complete nutrition to the infant. The nurse should encourage the mother to give whole cereals instead of iron supplements to the child. Chopped table food can be given to the child at the age of 9 months.

Which intervention, if followed by the parent, may help manage encopresis in a 9-year-old child? 1 Limiting fluids in the child's diet 2 Including cereals in the child's diet 3 Giving milk and milk-based products 4 Encouraging the child to delay defecation when the urge is felt

2 Including cereals in the child's diet A child with encopresis may pass feces voluntarily or involuntarily at inappropriate settings. Encopresis is usually associated with constipation. Therefore, cereals should be included in the diet to prevent constipation. Limiting fluids may increase the risk of dehydration and constipation. Increasing the fluid intake may help prevent constipation and encopresis. Milk and milk-based products may increase the risk of encopresis and should be avoided. Delaying defecation may result in constipation, and should not be encouraged.

The school health nurse is teaching a group of teachers about promoting the mental health of school-age children. Which action made by the teachers promotes a sense of industry among the children? 1 Separating children during tasks 2 Basing a reward structure on evidence of mastery 3 Giving grades and gifts for satisfactory performances 4 Comparing the performances of children with one another

3 Giving grades and gifts for satisfactory performances During the psychosocial development of school-age children, reinforcement in the form of grades, material rewards, additional privileges, and recognition provides encouragement and stimulation. A sense of accomplishment also involves the ability to cooperate, to compete with others, and to cope effectively with people, so separating children will not promote their mental health. When the reward structure is based on evidence of mastery, children who are incapable of developing these skills are also at risk for feelings of inadequacy and inferiority. Comparison with one another can also cause some children to develop negative feelings towards themselves, and result in a sense of inferiority.

After collecting data on a 2-month-old infant, the nurse reinforces proper safety measures to the infant's mother to reduce the risk of injury in the infant. Which statements made by the infant's mother need correction? Select all that apply. 1 "I should use cool mist vaporizers if my baby has a cold." 2 "I should provide a one-piece pacifier to soothe my baby." 3 "I should protect my child's crib mattress with a plastic covering." 4 "I should place a firm mattress and loose blankets in my baby's bed." 5 "I should ensure that my child's car seat is rear-facing in a seat with an airbag."

3 "I should protect my child's crib mattress with a plastic covering." 5 "I should ensure that my child's car seat is rear-facing in a seat with an airbag." Covering a crib mattress with plastic should be avoided, as it can expose the child to toxins. The nurse should instruct the mother to refrain from placing the infant in a seat with an air bag, as it can cause suffocation and trauma. The nurse should inform the mother to use cool mist vaporizers, as they prevent burns. The mother should provide a one-piece pacifier to the infant, as it prevents accidental swallowing of any small objects and aspiration. Placing the infant in a crib with a firm mattress and loose blankets helps to prevent suffocation.

A father expresses concern that his 2-year-old daughter has become a "finicky eater" and is eating less. How should the nurse respond? 1 "Your daughter has become manipulative." 2 "She's probably experiencing the stress of a typical 2-year-old." 3 "She may have an eating problem that requires a referral to a specialist." 4 "Your daughter's behavior is expected in response to her slower growth."

4 "Your daughter's behavior is expected in response to her slower growth." Growth slows during the toddler years and these children generally do not eat as much as they do during infancy; this is called physiologic anorexia, which is typical of this age group. Toddlers may try to manipulate as they assert their autonomy, but usually not through eating behaviors unless the parents express anxiety and concern over their food intake. Although toddlers have difficulty withstanding frustration and are prone to temper tantrums, these eating behaviors are within the norm for toddlers. Eating disorders usually do not occur in children this young; these behaviors are typical of healthy toddlers.

While playing, a child takes a few pebbles and places them in order from smallest to largest. Which stage of cognitive development does the child's behavior demonstrate? 1 Sensorimotor 2 Preoperational 3 Formal operations 4 Concrete operations

4 Concrete operations During the stage of concrete operations, the child's thought becomes more logical and coherent. The child in this stage is able to classify, sort, order, and organize facts about the world to use in problem-solving. Therefore, the child placing the pebbles in order of smallest to largest indicates that the child is in the stage of concrete operations. In the sensorimotor stage, the child develops a sense of cause and effect as they direct behavior towards objects. In the preoperational stage, thinking is concrete and tangible. The child lacks the ability to make deductions or generalizations. In formal operations, thought is characterized by adaptability and flexibility. Abstract thinking and problem-solving skills are observed in this stage.

A middle-aged adult contributes to future generations through parenthood, teaching, and community involvement. To which stage of Erikson's theory does this relate? 1 Ego integrity versus despair 2 Intimacy versus isolation 3 Identity versus role confusion 4 Generativity versus stagnation

4 Generativity versus stagnation In the generativity versus stagnation stage, the adult focuses on supporting future generations. Middle-aged adults achieve success in this stage by contributing to future generations through parenthood, teaching, and community involvement. The ego integrity versus despair stage is seen in older adults. During this stage, some older adults live their lives with a sense of satisfaction and others see themselves as failures marked by despair and regret. The intimacy versus isolation stage is seen in young adults, in which they develop a sense of identity and a capacity to love and care for others. In the identity versus role confusion stage, an individual will have a marked preoccupation with his or her appearance and body image.

According to Piaget, which developmental stage is characterized by logical thinking? 1 Preschool 2 Adolescence 3 Early childhood 4 Middle childhood

4 Middle childhood Logical thinking is a characteristic of middle childhood, which is 6 to 12 years of age. The use of symbols and egocentric behavior is seen in preschoolers. Adolescence is characterized by abstract thinking. Early childhood is characterized by a preoperational period during which thinking using symbols and egocentric behavior are observed.

Which content type of play allows a child to experience pleasure by swinging? 1 Skill play 2 Pretend play 3 Social-affective play 4 Sense-pleasure play

4 Sense-pleasure play Sense-pleasure play is a nonsocial stimulating experience in which the pleasurable experiences are derived from the environment, handling of raw materials, and body motion such as swinging, bouncing, and rocking. In skill play, infants persistently demonstrate and exercise their newly acquired abilities. The simple, imitative, dramatic play of toddlers, such as using a telephone, driving a car, or rocking a doll is called pretend play or dramatic play. In social-affective play, the infant takes pleasure in relationships with people. As adults talk, touch, nuzzle, and in various ways elicit responses from an infant, the infant soon learns to provoke parental emotions and responses.

Which behaviors are observed in individuals at a conventional level of moral development? Select all that apply. A Obeying the rules B Respecting authority C Maintaining social order D Changing law in terms of societal needs E Orienting culturally to the labels of good or bad

A Obeying the rules B Respecting authority C Maintaining social order At the conventional stage, individuals are concerned with conformity and loyalty. Obeying the rules, doing one's duty, showing respect for authority, and maintaining the social order are the behaviors demonstrated during the conventional stage. Changing law in terms of societal needs is observed at the postconventional level. In the preconventional level, individuals are culturally oriented to the labels of good or bad and right or wrong. These labels of good and bad are then integrated into their concept of physical or pleasurable consequences of their actions.

The nurse who is caring for a child with botulism anticipates that the child's growth and development may be hampered due to cranial nerve deficits. Which signs presented by the child support the nurse's conclusion? Select all that apply. A Reduced gag reflex B Loss of head control C Accumulated secretions D Breathlessness in vocalizations E Paroxysmal muscle contractions

A Reduced gag reflex B Loss of head control Cranial nerve deficits are evidenced by diminished or reduced gag reflex or loss of head control. Accumulated secretions are seen due to laryngospasm and tetany of the respiratory muscles. Breathlessness in vocalizations is observed in Guillain-Barré syndrome due to intercostal and phrenic nerve involvement. Paroxysmal muscle contractions are observed in patients with tetanus due to extreme sensitivity to external stimuli.

The nurse is explaining which developmental milestones a child's parents should expect to see at the age of 18 months. Which statements made by the parents indicate the need for further instruction? Select all that apply. 1 "My child will be able to take a few steps on tiptoe." 2 "My child will be able to pull and push toys." 3 "My child will be able to climb stairs with assistance." 4 "My child will be able to pick up objects without falling." 5 "My child will be able to kick a ball without losing balance."

Correct 1 "My child will be able to take a few steps on tiptoe." Correct 4 "My child will be able to pick up objects without falling." Correct 5 "My child will be able to kick a ball without losing balance." The child starts taking a few steps on tiptoe at the age of 30 months, not 18 months. The child will be able to pick up objects without falling and kick a ball forward at the age of 24 months, not 18 months. The gross motor skills of an 18-month-old child are well developed, so the child can pull or push toys. The child should also be able to climb stairs with one hand held.

A registered nurse advises parents to assist their child with stretching exercises. The child has impaired physical mobility due to neuromuscular impairment. What is the rationale for performing stretching exercises? 1 To minimize pain 2 To prevent contractures 3 To promote the achievement of developmental milestones 4 To facilitate the mobilization of foods and fluids through the esophagus

Correct2 To prevent contractures A contracture deformity is the result of stiffness or constriction in the muscles. A contracture would adversely affect a child's development, depending upon location and severity. For example, if an infant developed a contracted Achilles tendon, the infant would not be able to physically develop the ability to walk. Administering pain medications helps decrease the pain. To promote the achievement of developmental milestones, the nurse encourages play exercises that involve joint movement and enhance fine and gross motor skill acquisition. The nurse places the child in the semi-upright position during feedings to facilitate the mobilization of food and fluids through the esophagus.

When does the Babinski reflex disappear? 1 By 6 months 2 By 4 months 3 By 3 months 4 After 12 months

4 After 12 months The Babinski reflex disappears after 1 year or 12 months. The Perez reflex disappears by 6 months. The extrusion reflex and the Moro reflex may disappear by 4 months. The rooting reflex may disappear by 3 months.

How many deciduous teeth would be present in a 10-month-old infant? Record your answer as a whole number. ________

Age of child in months minus 6 = Number of deciduous teeth. Therefore, the number of deciduous teeth is 10 - 6 = 4.

A new mother who is unable to breastfeed her newborn expresses breast milk to feed the baby. Which actions of the mother should be corrected by the nurse? Select all that apply. A Adding water to dilute the expressed milk B Storing expressed milk at room temperature C Expressing milk by hand or with breast pump D Storing expressed milk in the refrigerator for 5 days E Adding honey to expressed milk to improve taste

Correct A Adding water to dilute the expressed milk Correct B Storing expressed milk at room temperature Correct E Adding honey to expressed milk to improve taste

Which physiologic changes are observed in pregnant women during the third trimester? Select all that apply. A Fatigue B Morning sickness C Urinary frequency D Breast enlargement E Braxton Hicks contractions

Correct A Fatigue Correct C Urinary frequency Correct E Braxton Hicks contractions Due to the enhanced growth of the fetus and uterus in the third trimester, physiologic changes including fatigue, urinary frequency, and Braxton Hicks contractions are observed in pregnant women. Women in the first trimester may experience morning sickness, breast enlargement and tenderness, and fatigue.

What could be a cause of a stiff, tense appearance of the sutures in a newborn? 1 The neonate is crying. 2 The neonate is sneezing. 3 The skull bones of the neonate are fused. 4 The neonate has irregular breathing pattern.

1 The neonate is crying. Sutures are the layers of connective tissue formed between the bones of the cranium. They facilitate the molding of the cranium during vaginal delivery. Conditions like crying and coughing may cause a temporary bulging in the sutures, which may cause stiffness and tension on palpation. Sneezing and an irregular breathing pattern may not directly influence the stiffness of the sutures. The fusion of skull bones is not generally observed in newborns except in some rare conditions.

During a routine checkup, the nurse learns that an adolescent patient is planning to get a navel piercing. What should the nurse assess in the adolescent to ensure safety? 1 Thyroxin levels 2 Hemoglobin levels 3 Blood glucose levels 4 Serum potassium levels

3 Blood glucose levels Skin piercing can cause bleeding, dermatitis, and metal allergy. A patient with diabetes mellitus has an increased risk of skin infection due to high blood glucose levels. Therefore, the nurse should monitor the adolescent's blood glucose levels to ensure safety. A change in thyroxin levels does not indicate that the client has a risk of bleeding, so the nurse does not assess thyroid levels. The nurse assesses hemoglobin levels when the patient has risk of anemia. The nurse will assess serum potassium levels if the adolescent has risk of dehydration, but not before skin piercing.

A newborn who was delivered with the assistance of forceps sustains an injury that results in facial paralysis. What would the nurse state to the mother? 1 The baby will have this condition for life. 2 The newborn may need intensive physiotherapy. 3 The condition usually subsides on its own in a few days. 4 The newborn should not be allowed to cry because it can cause pain.

3 The condition usually subsides on its own in a few days. A difficult delivery performed with forceps may result in facial paralysis, which may manifest as asymmetrical movements of the face, an inability to close the eyelid, and drooping of the corner of the mouth. This condition is self-limiting and may subside in few days. Physiotherapy is not indicated for the treatment of this condition. The parents should be informed that this condition is not painful.

In which type of play do children play together, share toys, and communicate with each other? 1 Parallel play 2 Solitary play 3 Onlooker play 4 Associative play

4 Associative play Children from 2 years of age are mostly involved in associative play, in which they play together, share toys, and communicate with other children. In parallel play, children play next to each other but have little interaction. In solitary play, the child plays alone, which is usually seen in infants. In onlooker play, a child watches others playing, but does not interact.

Which physical findings can be observed in a 2-month-old infant? Select all that apply. A The doll's eye reflex is fading. B The rooting reflex disappears. C The crawling reflex disappears. D The posterior fontanel is closed. E The primitive reflexes are fading.

C The crawling reflex disappears. D The posterior fontanel is closed. The crawling reflex disappears and the posterior fontanel is closed by 2 months of age. The doll's eye reflex disappears at 1 month of age. The primitive reflexes fade during the third month. The rooting reflex disappears at 4 months of age.

At which age does an infant have a strong grasp reflex? 1 1 month 2 2 months 3 3 months 4 4 months

1 1 month The grasp reflex is strong in 1-month-old infants. Fading of the grasp reflex is observed at 2 months of age. The absence of a grasp reflex is observed in a 3-month-old infant. A 4-month-old infant grasps objects with both hands. However, a grasp reflex is absent in this infant.

Which type of cerebral palsy may cause a wide-based gait in children? 1 Ataxic 2 Spastic 3 Dyskinetic 4 Mixed type

1 Ataxic Ataxic cerebral palsy is caused by damage to the cerebellum, which is essential for the coordination of muscle movements and balance. Therefore, a wide-based gait is observed in patients with ataxic cerebral palsy. Spastic cerebral palsy causes hypertonicity with poor control of posture, balance, and coordinated motion. Dyskinetic cerebral palsy is characterized by athetoid and dystonic movements. Mixed cerebral palsy is a combination of spastic and dyskinetic cerebral palsy, and symptoms of both conditions are present.

While caring for a newborn in a neonatal intensive care unit, the nurse notices that the neonate is not moving his legs simultaneously. Which condition might the nurse suspect to be the reason for this? 1 Rickets 2 Spinal cord injury 3 Caput succedaneum 4 Neonatal abstinence syndrome

2 Spinal cord injury The spinal cord controls the movements of the legs. Therefore, failure to move the legs indicates a spinal cord lesion or injury. Rickets is suspected if physiologic craniotabes is present in an infant. Caput succedaneum refers to swelling of the infant's head that is sustained during its passage through the birth canal. Neonatal abstinence syndrome is suspected if the infant has sustained rhythmic tremors, twitches, and myoclonic jerks.

Which statement by a mother indicates the need for additional teaching about safety guidelines for infants and toddlers? 1 "I will use plastic eating and drinking utensils." 2 "I will give my child hard candies for chewing." 3 "I will not allow my child to chew on old furniture." 4 "I will turn pot handles toward the back of the stove."

2 "I will give my child hard candies for chewing." Hard candies should not be given to infants and toddlers because they can be easily aspirated, which will result in choking. Therefore, the nurse should suggest that the mother avoid giving hard candies to young children. The nurse should suggest that the mother use plastic eating and drinking utensils for young children because glass and ceramic utensils may break and lead to injury. Old furniture may contain lead paints, which are toxic. Therefore, children should not be allowed to chew on them. Some children, out of curiosity, may grab pot handles, which can cause burns. Therefore, the nurse should advise the mother to turn pot handles toward the back of the stove for the safety of young children.

During the assessment of a newborn, the nurse pulls the infant from a lying to a sitting position and observes that the infant is unable to control the head in an upright position. Which problem does the nurse suspect? 1 Hydrocephalus 2 Down syndrome 3 Congenital syphilis 4 Thromboembolic condition

2 Down syndrome An infant's inability to control the head in an upright position when pulled to a sitting position indicates head lag. The nurse suspects Down syndrome in this neonate because infants with Down syndrome typically experience delays in certain areas of development, including head lag. Hydrocephalus is suspected if the infant has a head circumference more than 4 cm larger than the chest circumference, or if physiologic craniotabes is found in the infant. The presence of physiologic craniotabes in an infant may indicate congenital syphilis. An underlying thromboembolic condition may be suspected if the infant has hypertension.

What common finding can the nurse identify in most children with symptomatic cardiac malformations? 1 Mental retardation 2 Inherited genetic factors 3 Delayed physical growth 4 Clubbing of the fingertips

3 Delayed physical growth Children with cardiac malformations often require more energy to fulfill the activities of daily living; decreased oxygen utilization and increased energy output in the developing child result in a slow growth rate. Mental retardation is not a common finding in children with congenital heart disease. Cardiac anomalies are more often a result of prenatal, rather than genetic, factors. Clubbing is not characteristic of most children with cardiac anomalies, only of those with more severe hypoxia.

Upon interacting with the parent of an infant, the nurse observes that the parent is using an incorrect formula preparation method. Which risk does this pose to the infant? 1 Colic 2 Plagiocephaly 3 Failure to thrive 4 Sudden infant death syndrome

3 Failure to thrive Incorrect formula preparation can lead to inadequate calorie intake and malnutrition, which causes failure to thrive in the infants. Colic in infants may be due to overfeeding, improper feeding techniques, and swallowing excessive air, but not incorrect formula preparation. Positional plagiocephaly and sudden infant death syndrome (SIDS) are avoided by repositioning the infant's sleeping positions, not through formula preparations.

An infant is being admitted with bacterial meningitis. The nurse knows the priority nursing action is: 1 Assessing the infant's neurological status 2 Beginning intravenous fluids and antibiotics 3 Implementing respiratory isolation precautions 4 Teaching the parents the importance of maintaining a quiet environment

3 Implementing respiratory isolation precautions The infant's illness is contagious, and the nurse, as well as other clients, must first be protected with the implementation of respiratory isolation precautions. Assessment of neurological status, implementation of prescribed fluids and antibiotics, and parental teaching may be done after assessment. Also, antibiotics are usually not administered until after all cultures have been obtained.

Which attribute of temperament is related to the energy level of the child's reaction? 1 Attention span 2 Sensory threshold 3 Intensity of reaction 4 Approach-withdrawal

3 Intensity of reaction The energy level of the child's reaction is called intensity of reaction. Sensory threshold is the amount of stimulation, such as sounds or light, required to evoke a response in the child. Approach-withdrawal is the nature of initial responses to a new stimulus. Approach responses are positive expressions, and withdrawal responses are negative expressions. The length of time a child pursues a given activity is called attention span.

What does a nurse recognize as the most serious complication of meningitis in young children? 1 Epilepsy 2 Blindness 3 Peripheral circulatory collapse 4 Communicating hydrocephalus

3 Peripheral circulatory collapse Peripheral circulatory collapse (Waterhouse-Friderichsen syndrome) is a serious complication of meningococcal meningitis caused by bilateral adrenal hemorrhage. The resultant acute adrenocortical insufficiency causes profound shock, petechiae, ecchymotic lesions, vomiting, prostration, and hypotension. Although epilepsy or blindness may occur, neither condition is as serious a complication as peripheral circulatory collapse. Similarly, although hydrocephalus may occur, it is rare and not as serious as peripheral circulatory collapse.

After teaching from the nurse about common infant injuries, the parent says, "I will not allow my child to go near the plants in our house." Which risk to the infant can be prevented by this action? 1 Falls 2 Asphyxia 3 Poisonings 4 Allergic reactions

3 Poisonings Household plants may be a source of accidental poisonings because a curious infant may put the leaves in the mouth. Therefore, plants should be kept out of the child's reach to avoid poisonings and ingestions. Stairs, diaper changing table, and infant walkers are the risk factors for falls in the infant. Asphyxia can be prevented by keeping the small objects out of reach of an infant and avoid giving hard candies to the infants and toddlers. Allergic reactions can be prevented by preventing exposure to the allergens.

Which internal asset helps young people make positive choices and build relationships? 1 Positive values 2 Positive identity 3 Social competencies 4 Commitment to learning

3 Social competencies Social competencies help young people make positive choices and build relationships. Positive values are a strong sense of values that are needed to direct the choices of young people. Positive identity provides a sense of own power, purpose, worth, and promise in young people. Young people need to develop a commitment to education and lifelong learning.

The nurse is reinforcing best parenting practices to the parents of a 13-year-old child. Which statements made by the parent need correction? Select all that apply. 1 "I should apologize to my child when I am wrong." 2 "I should assist my child in selecting appropriate career goals." 3 "I should motivate my child to perform well in exams by comparing her to her siblings." 4 "I should strictly instruct my child to adhere to the house rules even though it hurts her." 5 "I should teach my child to make decisions and understand consequences as an adult would."

3 "I should motivate my child to perform well in exams by comparing her to her siblings." 5 "I should teach my child to make decisions and understand consequences as an adult would." The nurse should suggest that the parents avoid comparing the adolescent to his or her siblings in order to prevent the development of an inferiority complex. The nurse should encourage parents to allow adolescent children to make their own choices and learn from them, even when those choices are not the choices an adult would make. The nurse should suggest that the parents respect their child and apologize to their child if they make a mistake. The nurse should suggest that the parents assist their child in selecting appropriate career goals and preparing for adult roles. The nurse should suggest that the parents make clear house rules and instruct the child to adhere to them, as it helps prevent the development of high-risk behaviors, like alcohol addiction.

An 8-year-old child is being prepared for surgery the next day. How should the nurse present preoperative instructions to this child? 1 By repeating instructions often 2 By providing time for needle play 3 By using several abstract examples 4 By focusing on simple anatomical diagrams

4 By focusing on simple anatomical diagrams According to Piaget, an 8-year-old child's level of development is in the stage of concrete operations; the child will benefit from simple, concrete examples. The preschooler and younger child, not the school-age child, require repetition. Therapeutic needle play is more appropriate if and when the child is to receive an injection. The child who is in the period of concrete operations cannot think in the abstract; the ability to do this develops during adolescence.

What behavior does the nurse expect a healthy 5-month-old infant to exhibit? 1 Using the pincer grasp 2 Sitting without support 3 Crawling across the floor 4 Grasping objects voluntarily

4 Grasping objects voluntarily The 5-month-old infant's neurological development has reached the stage at which objects can be grasped voluntarily; this is considered a developmental milestone. The pincer grasp appears between 9 and 12 months of age. Sitting alone without support is usually accomplished at 6 to 8 months of age. The infant begins to crawl at 8 to 10 months of age.

A nurse is caring for a 3-month-old infant with congenital hypothyroidism. What should the parents be taught about the probable effect of the condition on the infant's future if treatment is not begun immediately? 1 Myxedema 2 Thyrotoxicosis 3 Spastic paralysis 4 Cognitive impairment

4 Cognitive impairment Congenital hypothyroidism is the result of insufficient secretion by the thyroid gland because of an embryonic defect. A decreased level of thyroid hormone affects the fetus before birth during cerebral development, so it is likely that there will be some cognitive impairments at birth. Treatment before 3 months will prevent further damage. Congenital hypothyroidism does not become myxedema. Thyrotoxicosis is another term for hyperthyroidism. Although it is not expected, it may occur with an overdose of exogenous thyroid hormone, but it is too soon to discuss this possibility with the parents. Spastic paralysis occurs only if the infant has cerebral palsy.

A nurse is caring for an infant with phenylketonuria. What diet should the nurse anticipate will be prescribed by the health care provider? 1 Fat free 2 Protein-enriched 3 Phenylalanine-free 4 Low-phenylalanine

4 Low-phenylalanine Because phenylalanine is an essential amino acid it must be provided in quantities sufficient for the promotion growth but low enough to maintain a safe blood level. Phenylalanine is derived from protein, not fat. An enriched-protein diet contains increased amount of proteins, including phenylalanine, which should be ingested in limited amounts. Because phenylalanine is an essential amino acid, it cannot be totally removed from the diet.

While assessing a newborn, the nurse strokes the newborn's cheek and observes for a response. What reflex does the newborn produce in response to the nurse's stimulation? 1 Red reflex 2 Startle reflex 3 Sucking reflex 4 Rooting reflex

4 Rooting reflex When the infant's cheek is stroked, the infant will respond by turning toward the stimulated side, which is called the rooting reflex. The red reflex is elicited by placing the infant in a dark room. In an alert state, many infants open their eyes in a supported sitting position. The sucking reflex is elicited by placing a nipple or gloved finger in the infant's mouth. The startle reflex can be elicited by making a loud noise near the infant.

The nurse finds that an adolescent male's trunk is short when compared to the legs. What should the nurse infer from these findings? 1 The adolescent needs further evaluation. 2 The adolescent needs a lot of physical activity. 3 The adolescent may need hormone pills for growth. 4 The adolescent has normal growth and development.

4 The adolescent has normal growth and development. Adolescents have a characteristic growth pattern. In male adolescents, the extremities grow first, followed by the trunk, which can make them appear awkward, with a short trunk and long limbs. Physical activity will not be beneficial because the long extremities reflect normal growth and development. The adolescent does not need hormone pills or further evaluation because these findings are normal for his age.

The nurse teaches a parent about managing nocturnal enuresis for a 7-year-old child. Which action by the parent would be helpful in managing the child? 1 Making the child wear a diaper 2 Limiting fiber in the child's diet 3 Giving the child cranberry juice in the evening 4 Waking up the child at night to use the bathroom

4 Waking up the child at night to use the bathroom Wetting the bed at night, called nocturnal enuresis, may be managed by waking up the child at night to use the bathroom, relieving the bladder. The child should wear regular sleepwear, and parents should avoid use of diapers or pull-ups. Constipation may contribute to enuresis, so dietary fiber should be increased. Fruit juices and beverages are high in water content, and therefore result in an urge to urinate.

A 13-year-old child states, "I don't know if I want to go to college or start working after high school." Which stage of psychosocial development is indicated by this child's uncertainty? 1 Intimacy vs. isolation 2 Ego integrity vs. despair 3 Identity vs. role confusion 4 Generativity vs. stagnation

Correct3 Identity vs. role confusion This child's statement indicates a struggle to establish a sense of identity, which is characteristic of the identity vs. role confusion stage. The intimacy vs. isolation stage is characterized by establishing intimate bonds of love and friendship. Looking back over one's life and accepting its meaning are observed in the ego integrity vs. despair stage of psychosocial development. The generativity vs. stagnation stage is seen in middle adulthood, where fulfilling life goals that involve family, career, and society plays an important role.

Which theory explains psychosexual development through infancy to adolescence? 1 Freud's theory 2 Piaget's theory 3 Erikson's theory 4 Kohlberg's theory

1 Freud's theory Psychosexual development through the five developmental stages is explained by Freud's theory. Piaget's theory explains cognitive and moral development from infancy to adolescence. Erikson's theory explains psychosocial development. Kohlberg's theory demonstrates the development of moral reasoning.

The registered nurse is teaching the mother of an infant about the prevention of sudden infant death syndrome (SIDS). Which statement by the mother indicates effective learning? 1 "I will sleep in the bed with my baby." 2 "I will position my baby on the back while sleeping." 3 "I will use warm blankets and sheets to cover my baby." 4 "I will put my baby to sleep on soft bedding with pillows."

2 "I will position my baby on the back while sleeping." Sleeping on the stomach may cause upper airway obstruction and increase the risk of SIDS. Therefore, infants should be placed on their backs to decrease this risk. Sleeping in the same bed as the baby may increase the risk of SIDS. Covering the baby with warm blankets may cause overheating or suffocation and can increase the risk of SIDS. The use of soft bedding and pillows for an infant may lead to suffocation. Therefore, the nurse will teach the mother to use a firm mattress.

Which is observed in the preoperational stage of Piaget's cognitive development? 1 Inductive reasoning 2 Transductive reasoning 3 Sense of cause and effect 4 Deductive and abstract reasoning

2 Transductive reasoning Transductive reasoning is observed in the preoperational stage, in which the individual thinks that because two events occur together, they cause each other. Inductive reasoning occurs in the stage of concrete operations. Sense of cause and effect is observed in the sensorimotor stage of cognitive development. Deductive and abstract reasoning is the characteristic of formal operations.

A 6-week-old infant and his mother arrive in the emergency department in an ambulance. The father arrives several minutes later with two children, 7 and 9 years old. The infant is not breathing, and the eventual diagnosis is sudden infant death syndrome (SIDS). The parents take turns holding the infant in another room. The nurse remains present and provides emotional support to the parents. What is an important short-term goal for this family? 1 Identifying the problems that they will be facing as a result of the loss of the infant 2 Accepting that there was nothing that they could have done to prevent the infant's death. 3 Including the infant's siblings in the events and grieving in the wake of the infant's death 4 Seeking out other families who have lost infants to SIDS and obtaining support from them.

3 Including the infant's siblings in the events and grieving in the wake of the infant's death The other children need to be involved with the grieving process and to work through their own feelings. Identifying the problems that the family will be facing in regard to the loss of the infant is a long-term goal. It is too early to seek out other families who have lost infants to SIDS and receive support from them. It is premature to accept that there was nothing that the family could have done to prevent the infant's death; in fact, they may never achieve this goal.

The parent of a child says, "My child is repeatedly banging the table to make loud sounds." Which sensorimotor stage of cognitive development best explains this behavior of the child? 1 Reflexes 2 Primary circular reactions 3 Secondary circular reactions 4 Coordination of secondary schemas

3 Secondary circular reactions The third stage of Piaget's sensorimotor phase involves secondary circular reactions, in which the child intentionally repeats an action in order to trigger a response. The first stage of sensorimotor phase comprises of reflexes, in which the infant will exhibit involuntary responses to stimuli, such as sucking, rooting, grasping, and crying. Replacement of reflexive behavior with voluntary acts is seen in primary circular reactions, which is the second stage of sensorimotor phase. The fourth stage is coordination of secondary schemas, in which the child starts showing intentional actions and uses previous behavioral achievements, primarily as the foundation for new intellectual skills.

An anxious parent of a 6-year-old child expresses that the child looks slimmer than a year ago, although the nurse finds the child's height and weight to be age-appropriate. What is the nurse's response to the parent? 1 "The child's condition may need further investigation." 2 "It seems like the child has not been eating well lately." 3 "You need to include more carbohydrates in the child's diet." 4 "The fat has diminished, and the fat distribution pattern has changed."

4 "The fat has diminished, and the fat distribution pattern has changed." As the preschooler develops into a school-age child, the fat in the body diminishes and the distribution pattern of the fat changes, making the child appear slim. Looking slimmer during school age is a normal part of growth and development. It does not need further investigation and does not indicate that the child has not been eating well. The child may become obese if the parent includes more carbohydrates in the child's diet.

According to Kohlberg's moral judgment theory, which characteristic behavior would the nurse find in the child who is in the naive instrumental orientation stage? 1 The child tries to follow laws and respects order. 2 The child tries to develop good social relationships. 3 The child follows the rules due to fear of punishment. 4 The child is motivated by a selfish desire to obtain rewards and benefits.

4 The child is motivated by a selfish desire to obtain rewards and benefits. According to Kohlberg's moral judgment theory, every child has a gradual development of moral consciousness based on cognitive development. During the naive instrumental orientation stage, the child's behavior is motivated by a selfish desire to obtain rewards and benefits. During the law and order orientation stage, the child tries to follow rules and laws. During the social contract orientation stage, the child tries to develop good social relationships. During the punishment and obedience orientation stage, the child obeys rules without question due to fear of punishment.

When assessing the cognitive development of a 9-year-old child, which characteristic indicates inadequate cognitive development? 1 The child collects different-colored rocks. 2 The child says that fall is better than spring. 3 The child considers a boy at school to be a better friend than a neighbor. 4 The child believes there are more blocks when spread out on the floor than in the container.

Correct4 The child believes there are more blocks when spread out on the floor than in the container. At ages 5 to 7, children learn that simply altering the arrangement of objects in space does not change certain properties of the objects. A 9-year-old child should able to resist perceptual cues that there are more blocks when on the floor than when in their container. During Piaget's stage of concrete operations, children develop an understanding of relationships between things and ideas. They become occupied with collections of objects, such as rocks, and derive enjoyment from classifying and ordering their environment. They may even begin to order friends and relationships (e.g., best friend, second-best friend).